From the Guidelines
Brown semen is most commonly caused by the presence of blood in the semen, known as hematospermia, which can result from inflammation or infection in the prostate, seminal vesicles, or urethra. This condition is often self-limiting and resolves on its own within a few days or weeks [ 1 ]. The blood in the semen can come from various sources, including recent ejaculation where old blood mixes with fresh semen, prostate procedures or biopsies, trauma to the genital area, or certain medications like antibiotics or blood thinners.
Common Causes and Considerations
- Infections or inflammatory conditions of the urogenital tract are the most common causes, accounting for approximately 40% of hematospermia cases [ 1 ].
- In men under 40, hematospermia is often transient or episodic and may not require immediate imaging assessment, with watchful waiting and routine clinical evaluation being sufficient [ 1 ].
- However, if the condition persists for more than a few weeks, is accompanied by pain, fever, difficulty urinating, or if the individual is over 40, consulting a healthcare provider is recommended [ 1 ].
Diagnostic Approach and Treatment
- The approach to diagnosing hematospermia includes a detailed history, physical examination, and laboratory testing such as visual analysis of the ejaculate, microbiological testing, semen analysis, urinalysis, and assessment of serum coagulation [ 1 ].
- Treatment depends on the underlying cause and may include antibiotics for infections, anti-inflammatory medications, or monitoring if no serious cause is found [ 1 ].
- Noninvasive imaging, such as transrectal ultrasound (TRUS) and MRI, can be used in men with persistent or refractory hematospermia, or other associated symptoms or signs [ 1 ].
Outcome and Quality of Life
Given the potential causes and the importance of early detection and treatment of underlying conditions, it is crucial to prioritize morbidity, mortality, and quality of life when managing brown semen or hematospermia. This involves prompt medical evaluation for persistent or symptomatic cases, especially in older men or those with additional health concerns [ 1 ].
From the Research
Causes of Brown Semen
- The cause of brown semen is unknown, but it may relate to seminal-vesicle dysfunction 2
- Brown semen has been observed in men with spinal cord injury (SCI), with 27% of SCI subjects having brown semen on at least one ejaculation 2
- The presence of intact red blood cells (RBCs) and/or heme pigment in brown semen specimens suggests that the discoloration may be due to bleeding or inflammation in the seminal vesicles 2
Relationship to Semen Quality
- Sperm concentration and sperm motility were not significantly different in brown and not-brown semen specimens 2
- Brown semen specimens had similar pH but lower volume than not-brown specimens 2
- The presence of human papillomavirus (HPV) in semen was not associated with impairment of semen quality, including sperm concentration, motility, and morphology 3