Dear Dr. Boink,
Last night I found some bloody matter in my boyfriend's sperm. After he came during oral sex, I spit out into the sink. There was some red fluid and also some bloody clotted stuff mixed in with the ejaculate. I checked my mouth and gums for bleeding and found nothing. What's your advice?
Mary from Red Bluff
Dear Mary,
What you are describing is called hematospermia, which is Latin for "blood in your boyfriend's sperm." I'll do my best to describe some of the possible causes, but please be aware that I am a psychoanalyst and not a physician. The ejaculations I am most qualified to discuss are those that come from the head on your boyfriend's shoulders rather than the one in his pants.
In the absence of pain or other symptoms, hematospermia has been described as "benign" or "self-limiting" as long as it doesn't happen very often. Many cases seem to resolve on their own. Some people compare what you are describing with the occasional blood in your handkerchief when you blow your nose, as long as it doesn't happen very often and there are no other problems that accompany it. However, it is still important to get it checked out. The person best suited to do this is a urologist–medical guardian of the male genitals. A urologist is used to seeing this sort of thing and will usually approach it wisely.
As for causes, you would think that hematospermia would result from something violent like an elbow in the shorts during a game of basketball. But if that were the case, the guys who star in Shotgun Video's testicle-torture tapes would be ejaculating paintballs. (Yes, Mary, there are good-looking, super-buff men who enjoy punching each other in the testicles, and I'm not talking your average game of ice hockey.)
It is unlikely that the testicles are the problem. The source of the blood is more likely to be found somewhere in the prostate or on the way to it. Possibilities include a prostate infection, inflammation, cysts, tumors, tears, a misbehaving blood vessel, or even drugs or medications. Another thing to rule out is blood in the urine. Blood in the urine is nothing to spit at and needs to be checked out immediately.
A urologist has the tools to check out all of these things and more. Even then, it's unlikely that the culprit will be found, but at least you will have ruled out the causes that respond well to medical treatment.
While I realize this was not the case for the two of you, it is not uncommon for guys to think that they have blood in their ejaculate when it's really a mixture of ejaculate and menstrual blood. It is easy to check this out by masturbating into a white tissue or turning a spent condom inside out.
FOLLOW-UP FROM MARY: "My boyfriend did see a urologist and was treated for a possible prostate inflammation/infection. He was suffering from a frequent need to urinate as well, although no pain. He took some antibiotics for a while and that helped. No other abnormal symptoms were found. He had a blood test, ultrasound, urine culture and physical examination by the doctor. As for the bleeding - I haven't checked if that is still going on, so, can't answer you there."
This is one of the tricky things about prostate irritation: it could be that the antibiotics helped, or maybe it was just time that did the trick. Also, some antibiotics act as a slight anti-inflammatory, which might have provided some relief. If that's the case, there are far better anti-inflammatory drugs to use.
To add to the confusion, none of the prostate symptoms you described in your follow-up may have had a thing to do with the blood in your boyfriend's sperm.