Finding blood in your semen can be alarming. However, in most cases blood in the semen (also called haematospermia) is not serious. It can affect men at any age after puberty but is most common in men aged 30 to 40 years and in men over 50 years with benign prostate enlargement. In most cases, it will pass within a few days without the need for treatment.
Blood in semen is usually caused by inflammation, infection, blockage or injury anywhere in the male reproductive system. It is unlikely to be caused by sexually transmitted infections (STIs), such as gonorrhoea or chlamydia.
In rare cases, particularly for men over 40 years of age, blood in the semen can be a sign of prostate cancer.
Blood in semen facts
- Blood in the semen is known as hematospermia.
- Prostate biopsy is the most common cause of blood in the semen.
- Blood in the semen can be caused by tumors, infections, anatomical abnormalities, stones, or inflammation in many sites throughout the genitourinary system.
- Usually blood in the semen is benign and resolves on its own.
- Treatment, if indicated, depends upon the underlying cause.
- In most cases, hematospermia has no underlying cause, is benign, self-limited, and no treatment is required.
What is blood in the semen?
The presence of blood in the semen (ejaculate) is also called hematospermia. Hematospermia is not always noticed; therefore, it is difficult to make estimates of its incidence.
What are the causes of blood in the semen?
Blood in semen can be caused by many conditions affecting the male genitourinary system. Areas affected may include the bladder, urethra, the testicles, the tubes that distribute semen from the testicles (known as the seminal vesicles), the epididymis (a segment of the spermatic ducts that serves to store, mature, and transport sperm), and the prostate gland.
Blood in the semen is most commonly a result of a prostate gland biopsy. A majority of men who undergo a prostate biopsy may have some blood in their semen that persists for three to four weeks. Likewise, vasectomy can lead to bloody semen for about one week after the procedure.
In men with hematospermia who have not had a recent prostate biopsy or vasectomy, a number of benign and malignant conditions of the male genital system may be the cause. In many situations, no definitive cause is found.
The following conditions have been reported in association with hematospermia:
- Benign or malignant tumors of the prostate, bladder, testes, or seminal vesicles
- Infections including, but not limited to, chlamydia, herpes, cytomegalovirus, and trichomoniasis
- Inflammation of the prostate (prostatitis), epididymis (epididymitis), or urethra (urethritis)
- Calculi (stones similar to kidney stones) in the seminal vesicles or prostate
- Polyps in the urethra
- Ejaculation duct obstructions
- Metastatic cancers (that have spread from other sites in the body) located in the genitourinary system
- Cysts, hemorrhage, or other abnormalities in the seminal vesicles
What are the symptoms of blood in the semen?
The symptoms that can occasionally accompany blood in the semen may be any of the following, depending upon the cause (these are not all inclusive):
- Painful urination
- Pain with ejaculation
- Blood in urine
- Lower back pain
- Tenderness in the testes and/or scrotum
- Swelling in the testes and/or scrotum
- Swelling or tenderness in the groin area
How is blood in the semen evaluated?
A number of diagnostic tests may be performed after the clinical history is evaluated and a physical examination is performed. Some of the most commonly performed diagnostic tests are a urinalysis and cultures to identify any sexually transmitted or other infections.
When indicated, imaging studies such as ultrasound or MRI may reveal tumors or other abnormalities. In some situations, a semen analysis, in which the semen is analyzed under a microscope, may be recommended.
What is the treatment for blood in the semen?
Treatment of blood in the semen is directed toward the underlying cause if a cause has been found. Sometimes, treatment with antibiotics for a presumptive diagnosis of prostatitis (inflammation of the prostate gland) is given, since some studies have shown that up to about one-fourth of men with hematospermia have prostatitis. However, the benefit of such treatment has not been definitively established.
In most cases, if blood in the semen is not associated with any known abnormality of other troubling symptoms, no treatment is given, and the condition usually resolves on its own with time in these situations. Persistent hematospermia (for a month or more) even in the absence of other symptoms warrants further or follow-up evaluation.
What is the prognosis (outlook) for patients with blood in the semen?
The prognosis relates to the underlying cause of blood in the semen if a cause can be identified. However, most cases of hematospermia are benign and resolve without treatment. While cancer is a rare cause of blood in the semen, the majority of cases are not related to cancer, especially in younger men.
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