Warning signs of hematospermia and diagnosis and treatment of vas deferens obstruction and varicocele

If semen suddenly changes from its normal milky white color to blood red, reddish-brown, or streaked with blood, it's obviously due to the presence of blood. Where does this blood come from? It's likely from a pathological change in some tissue along the sperm's pathway, such as bleeding, inflammation, or even a tumor. Don't take hematospermia lightly; it could be a sign of a serious illness, and a thorough examination by a specialist is recommended. If it's just occasional hematospermia and no specific changes are found during examination, it could be caused by the rupture of tiny blood vessels due to sudden congestion and mechanical impact during intercourse. This transient hematospermia shouldn't cause panic; it usually resolves completely after abstaining from sexual activity for 1-2 weeks. Generally, about 70% of hematospermia cases in men under 30 are caused by inflammation. Bleeding caused by inflammation is often intermittent, but short-lived. If hematospermia persists and worsens, the possibility of a tumor cannot be ruled out. In some patients, there may be a widespread bleeding tendency in other parts of the body, which could indicate a systemic hematologic disorder such as leukemia or thrombocytopenia. Other causes include tuberculosis, seminal vesicle cysts, seminal vesicle tumors, prostate cancer, portal hypertension due to cirrhosis, trauma, urinary tract obstruction, and benign prostatic hyperplasia, all of which can lead to hematospermia.

The basic principles for diagnosing and treating hemospermia, excluding conditions like tumors and tuberculosis which require special treatment, are as follows: During acute bleeding, sexual intercourse is strictly prohibited. Even after the hemospermia subsides, rest for 1-2 weeks is still necessary, and sexual intercourse should not be too frequent or too vigorous after recovery. Alcohol and spicy, irritating foods should be avoided to prevent aggravating congestion. Long-distance cycling and horseback riding should be avoided. Weekly seminal vesicle and prostate massage can help drain inflammatory secretions. Hot sitz baths should be taken daily for 15-20 minutes at a water temperature of 41-42℃ (one course of treatment is 30 days, followed by a 10-day rest period before starting the next course). Antibiotics such as penicillin, gentamicin, and kanamycin (intramuscular injection, local iontophoresis, etc.) and hemostatic agents such as vitamin K and tranexamic acid can be used for symptomatic treatment. Physiotherapy and traditional Chinese medicine can also be used. In cases of posterior urethritis, posterior urethral irrigation can be performed. With proper treatment, recovery will not affect sexual function or fertility.

Causes of vas deferens obstruction: Obstruction of the vas deferens accounts for approximately 7.4% of male infertility cases, and over 40% in cases of azoospermia. Therefore, vas deferens obstruction is a common cause of male infertility. Congenital factors mainly include: ① Congenital absence or atresia of the vas deferens. ② Congenital epididymal hypoplasia or failure of the epididymis to connect with the testis. ③ Congenital absence of the seminal vesicle or ejaculatory duct. Acquired factors most commonly include: ① Infections: Tuberculosis, gonorrhea, and filariasis. ② Trauma: Primarily iatrogenic injury caused by surgery, such as varicocele surgery, hernia repair surgery, cryptorchidism fixation, and prostate and bladder tumor surgery. ③ Tumors: Tumors within the spermatic cord, epididymal and seminal vesicle cysts and tumors.

Treatment of vas deferens obstruction: Once vas deferens obstruction is detected, the cause should be identified as soon as possible. Currently, surgical treatment remains the primary approach: ① Vas deferens-epididymis anastomosis. Primarily suitable for partial obstruction or developmental abnormalities of the vas deferens near the epididymis. ② Artificial seminal vesicle surgery. Primarily suitable for congenital absence or luminal atresia of the vas deferens or seminal vesicles. ③ Vas deferens anastomosis. Used for cases of incomplete development of a segment of the vas deferens, iatrogenic injury, or requiring recanalization after ligation. ④ Microsurgical vas deferens anastomosis. Used for cases where conventional anastomosis has failed.

Varicocele refers to the tortuous dilation of the pampiniform plexus of veins within the spermatic cord, which feels like a clump of earthworms when examined while standing. The incidence rate in young and middle-aged men is approximately 15%, with the left side being more commonly affected. Anatomically, the left spermatic vein is longer than the right and often flows into the left renal vein at a right angle, resulting in greater resistance to blood return. Varicocele accounts for 30%–40% of male infertility cases, playing a significant role. Varicocele can severely affect testicular spermatogenesis, causing testicular shrinkage and softening, reduced sperm count and motility in semen, and in severe cases, azoospermia. Causes include: congestion leading to decreased oxygen levels and carbon dioxide accumulation; increased scrotal temperature, unfavorable for spermatogenesis; and metabolic products (such as catecholamines) from renal venous reflux affecting testicular function. Treatment for varicocele is primarily surgical, with high ligation of the internal spermatic vein being the most common surgical method. For couples who have not conceived after one year of marriage and whose semen analysis is normal, surgery is not necessary; regular observation is sufficient. However, if semen analysis is abnormal and affects fertility, surgery should be performed promptly. Do not wait until the sperm count drops significantly before surgery, as the outcome will be much less effective.