Blood in the Semen (Hematospermia)

If other underlying causes are determined, appropriate treatment should be given.

What You Need to Know About Blood in Semen

Seeing blood in your semen can be startling. It’s uncommon, and it rarely signals a serious problem, especially in men under the age of 40. Blood in the semen (hematospermia) often doesn’t last long, as it’s usually a self-resolving problem.

The amount of blood in your semen can vary from a small drop to enough to give your semen the look of blood. How much blood is in your semen will depend on the cause of your bleeding. You might also experience:

• pain when ejaculating
• pain when urinating
• tenderness or swelling in your scrotum
• tenderness in the groin area
• pain in your lower back
• blood in your urine

Semen passes along a series of tubes on the way to the urethra for ejaculation. Any number of things can cause blood vessels along this path to break and leak blood into the semen.

In many cases, the exact cause for blood in the semen is never determined. Most cases of blood in the semen are not serious, especially if you’re 40 or younger. Below are some of the possible causes of bloody semen that your doctor might investigate.

Inflammation

Inflammation of the seminal vesicles is a common cause of bloody semen. Inflammation of any gland, duct, tube, or organ involved in the male genitals can cause blood in your semen. This includes:

• Prostatitis (inflammation of the prostate gland), which can cause pain, urination problems, and sexual dysfunction.
• Epididymitis (inflammation of the epididymis, or the coiled tube in the back of the testicle where sperm is stored), most often caused by a bacterial infection, including sexually transmitted infections (STIs) such as herpes, gonorrhea, or chlamydia. Symptoms include red or swollen scrotum, testicle pain and tenderness on one side, discharge, and painful urination.
• Urethritis (inflammation of the urethra), which can cause pain while urinating, itching or burning near the opening of the penis, or penile discharge.

Inflammation can also be caused by irritation from calculi (stones) in the prostate, seminal vesicles, bladder, or urethra.

Infections

Just as with inflammation, infections in any gland, duct, tube, or organ involved in the male genitals can cause blood in the semen.

STIs (commonly referred to as sexually transmitted diseases, or STDs), such as chlamydia, gonorrhea, or herpes, can also cause blood in semen. Infections caused by viruses, bacteria, or fungi can also lead to this condition.

Obstruction

If ducts like the ejaculatory duct are blocked, surrounding blood vessels can dilate and break. If your prostate is enlarged, it can put pressure on your urethra, which can cause bloody semen.

Tumors

Benign polyps or malignant tumors in the prostate, testicles, epididymis, or seminal vesicles could lead to blood in your semen.

Vascular abnormalities

Vascular abnormalities in the male genitals, such as vascular cysts, could explain the blood you’ve seen in your semen.

Other factors

Conditions that affect your whole body can cause blood in your semen. These include hypertension (high blood pressure) and hemophilia (disorder that leads to easy and excessive bleeding). Other possibilities include leukemia and chronic liver disease.

Trauma/medical procedures

Physical trauma, such as being hit in your testicles while playing sports, can lead to blood in your semen. Trauma can cause blood vessels to leak, and that blood may leave your body in semen. A medical procedure like a prostate exam or biopsy or a vasectomy can cause blood in your semen.

Blood in the Semen (Hematospermia)

Although it’s worrisome to see blood in your semen, it’s usually not a symptom of a serious health problem. It’s rarely the first symptom of a genitourinary cancer. See your healthcare provider to get an exam, any needed tests, discuss your concerns and get reassurance.

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Overview

What is blood in semen (hematospermia)?

The presence of blood in your semen is known medically as hematospermia (also called hemospermia). Hematospermia may naturally cause concern for men who experience it. However, it is not likely to be a sign of a major health problem.

Is blood in semen a common condition in men?

It’s not clear how common the symptom of blood in semen is because men usually do not examine their semen after ejaculation.

Having blood in your semen can affect men of any age, but it is more common in men aged 30 to 40.

Is seeing blood in my semen normal?

No, seeing blood in your semen is not normal, but it could be a result of:

• Leaking of blood from a small blood vessel that bursts during ejaculation the same way that a person gets a nose bleed after blowing their nose.
• Trauma from a recently performed urologic procedure, such as a vasectomy or prostate biopsy.
• An injury to a structure of the male reproductive system (testes, epididymis, vas deferens, seminal vesicle, prostate gland).
• An infection.

Is having blood in my semen dangerous?

Although it’s frightening to see blood in your semen, it’s rarely a symptom of a major health problem. A single episode of blood in your semen is usually not a sign of cancer. However, you may still want to see your healthcare provider to be reassured, to fully discuss this symptom and get an exam and perhaps other tests if your provider thinks they’re needed.

Symptoms and Causes

What are the causes of blood in semen?

The most likely cause of blood in semen are:

• Trauma from a prostate biopsy. You may see blood for up to four weeks after the procedure.
• Trauma from a vasectomy. You may see blood for over a week.
• Treatment of prostate cancer with external beam radiation or brachytherapy.
• A seminal tract infection or inflammation.
• Leaking of blood from a small blood vessel that bursts during ejaculation — the same way that a person gets a nose bleed after blowing their nose.

Other potential causes or associated conditions may include:

• Sexually transmitted infections (STI): Including gonorrhea, chlamydia, or other viral or bacterial infection.
• Prostate conditions: Including benign prostatic hyperplasia, acute bacterial prostatitis, cysts and polyps.
• Testicular and epididymis conditions: Including orchitis, epididymitis.
• Seminal vesicle disorders: Including stones (calculi) and cysts.
• Blood disorders: Including clotting disorders or sickle cell disease.
• Chronic infections: Including tuberculosis or schistosomiasis.
• Cancers: Including testicular/epididymal cancer, prostate cancer, bladder cancer, seminal vessel cancer, urethral tumor. It’s rare for such cancers to present with their first symptom of blood in semen.
• Other medical problems: Including severe, uncontrolled high blood pressure; human immunodeficiency virus (HIV), liver diseases, and leukemia (blood cancer).

Diagnosis and Tests

How is blood in semen diagnosed?

Initial evaluation

Your healthcare provider will:

• Take a full medical history, including asking questions about your current symptoms, when you first noticed the blood, how often you’ve seen blood in your semen, and your sexual activities/practices. You will also be asked about medications you take, if you’ve had any recent medical procedures, have any bleeding disorders, or have any symptoms of a urinary tract infection.
• Conduct a physical exam to check for lumps, swelling, redness or discharge from your genitals.
• Perform a rectal exam to check the prostate for swelling, tenderness or a lump.
• Check your blood pressure.

Diagnostic tests

Your healthcare provider may order one or more of these tests:

• Urine culture to check for infections or abnormalities.
• STI test to detect any sexually transmitted infections.
• Prostate Specific Antigen (PSA) test to check for prostate cancer.

Specialized tests

The results of your exam and tests may not show the cause of blood in your semen. Your provider may refer you to a urologist (a doctor who specializes in the urinary tract and male reproductive organs) if your initial evaluation and urinalysis are not normal or if blood in your semen in present for longer than a month. Your urologist may order some or all of the following tests:

• Transrectal ultrasound to diagnosis prostate problems including cysts, calculi, varices, inflammatory changes.
• Computed tomography (CT-scan) or magnetic resonance imaging (MRI).

Management and Treatment

How is blood in semen treated?

Treatment is based on extent and duration of the presence of blood in your semen, your age and presence of other symptoms.

If you are under the age of 40, have no urinary tract symptoms, have no risk factors for other medical conditions, and there’s been only a single episode of blood in your semen, you’ll likely not need any treatment. The symptom will resolve on its own.

If a cause for blood in your semen is identified, your provider will prescribe appropriate treatments, including:

• Antibiotics if you have an infection.
• Anti-inflammatory drugs.
• Finasteride (Proscar), a medication used to shrink an enlarged prostate can often stop hematospermia if due to fragile/friable blood vessels on the prostate.
• Medicines to treat other medical conditions

If other underlying causes are determined, appropriate treatment should be given.

When should I see my doctor?

It’s always wise to be safe and see your healthcare provider any time you develop a new symptom, especially one that’s as alarming as blood in your semen. It’s usually not a serious health issue. However, do see your provider if you see blood in your semen and additional symptoms.