Healthy Male – Blood in Semen

Why is there blood in my semen?

Anyone can experience blood in their semen, also called haematospermia (hee-ma-toh-sperm-ee-ah), at any time after puberty. It’s most common between the ages of 30 to 40, or if you’re over 50 and have benign prostate enlargement.

Finding blood might seem like a worrying sign, but it’s rarely because of anything serious, and will often go away on its own. But if you’re concerned, it’s important to visit your doctor.

What does blood in semen look like?

At orgasm, sperm and fluid (semen) travel from the testicles, through the urethra (the tube that connects the bladder with the penis) and out of the tip of the penis. Bleeding can happen anywhere along the way, and the semen can have a brown or red colour. Most of the time there is no pain, and blood is noticed after ejaculation.

What causes blood in semen?

Blood in semen can just be a symptom on its own, or it can be linked to other symptoms. Sexually transmitted infections (STIs) rarely cause blood in semen. You might notice blood in your semen before or after sex, but rough sex won’t be the cause, although damage to the genital area can cause bleeding when you urinate.  

Swelling, infection, blockages or injury in the male reproductive system or prostate can also cause blood in semen.

More serious causes of blood in semen can include:

  • A side effect of a prostate biopsy to check for prostate cancer
  • benign prostate enlargement (BPH) causing the build up of calcium deposits (also called prostate stones). This generally happens to those over 50.

In rare cases, blood in semen can be a sign of:

  • Tuberculosis, an infectious disease that damages your lungs or other parts of the body
  • Parasitic infections
  • Testicular cancer   
  • Diseases that affect blood clotting, such as haemophilia and chronic liver disease
  • A side effect of some blood thinning medications.

What can I do?

If you find blood in your semen, the best thing to do is to visit your doctor.

How is blood in semen diagnosed?

When you go to the doctor, they’ll give you a physical check-up and ask you some questions about your symptoms.

Your doctor might also ask for semen and urine samples.

What treatments are there?

If blood in your semen is the only symptom that you have, and no other symptoms are found after tests and a physical examination, then usually you won’t need any sort of treatment. It should go away on its own.  

Blood in semen can go away and come back, but it generally clears up without treatment and doesn’t increase the risk of other diseases. On its own, blood in your semen doesn’t put your sexual partner at the risk of other diseases either.

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If other symptoms are found, the blood in your semen might have an underlying cause that means you need treatment.

  • Minor injuries are treated with rest and keeping track of symptoms.
  • Major injuries may need surgery
  • Infections can often be treated with antibiotics
  • Blockages (e.g. due to prostate enlargement) are usually treated with specific medicines
  • In the rare case of prostate cancer, surgery, radiation or hormonal therapy may be needed.

If you are over the age of 40 and continue to have blood in your semen, especially if you also have other symptoms, it’s a good idea to talk to your doctor.

Your doctor’s appointment

Questions to ask your doctor

  • Will I need any treatment for the blood in my semen?
  • Is the blood in my semen caused by something more serious?
  • Are there any risks to my partner?

Things to think about before your appointment

  • When did you first notice the blood in your semen?
  • How many times have noticed blood in your semen?
  • Have you noticed any blood in your urine? Does it burn or sting when you pass urine?

Source: HEALTHY MALE ORGANISATION


Blood in Semen (Hematospermia)

Seeing blood in the semen can make a man anxious. Fortunately, it doesn’t always signal a major medical problem. For men younger than 40 with no related symptoms and no risk factors for underlying medical conditions, blood in semen often disappears on its own.

But for men 40 and over, chances are higher that blood in the semen needs evaluation and treatment. This is especially true for men who:

  • Have repeated episodes of blood in the semen
  • Have related symptoms while urinating or ejaculating
  • Are at risk for cancer, a bleeding disorder, or other conditions

Blood in the semen is called hematospermia or hemospermia. When men ejaculate, they typically don’t examine their semen looking for blood. So it’s not known how common the condition is.

Causes of Blood in the Semen

Blood in the semen can come from several different sources:

Infection and inflammation 

This is the most common cause of blood in the semen. Blood can come from an infection or inflammation, in any of the glands, tubes, or ducts that produce and move semen from the body. These include:

  • Prostate(the gland that produces the fluid part of semen)
  • Urethra (the tube that carries urine and semen from the penis)
  • Epididymis and vas deferens (tiny tube-like structures where sperm mature before ejaculation)
  • Seminal vesicles (which add more fluid to the semen)
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It can also come from an STI (sexually transmitted infection) such as gonorrhea or chlamydia, or from another viral or bacterial infection. Infection and inflammation are the culprits behind nearly four out of every ten cases of blood in the semen.

Trauma or a medical procedure

Blood in the semen is common after medical procedures. For instance, as many as four out of five men may temporarily have blood in their semen following a prostate biopsy.

Procedures done as treatment for urinary problems can also cause mild trauma that leads to temporary bleeding. This usually disappears within several weeks after the procedure. Radiation therapy, vasectomy, and injections for hemorrhoids can also cause blood. Physical trauma to the sex organs after pelvic fracture, injury to the testicles, excessively rigorous sexual activity or masturbation, or other injury can cause blood in the semen.

Obstruction

Any of the tiny tubes or ducts in the reproductive tract can be blocked. This can cause blood vessels to break and release small amounts of blood. The condition called BPH, which causes the prostate to become enlarged and pinch the urethra, is also linked to blood in semen.

Tumors and Polyps

One review of over 900 patients with blood in semen found only 3.5% actually had a tumor. Most of these tumors were in the prostate. Blood in semen, though, can be linked to cancer of the testicles, bladder, and other reproductive and urinary tract organs. Men — especially older men — with risk factors for cancer should be evaluated if they have blood in their semen. Untreated cancer is a life-threatening disease.

Polyps in the reproductive tract, which are benign growths that don’t cause any medical problem, can also cause blood in semen.

Blood vessel problems

All of the delicate structures involved in ejaculation, from the prostate to the tiny tubes that carry sperm, contain blood vessels. These can be damaged resulting in blood in the semen.

Other medical conditions

Markedly elevated high blood pressureHIVliver disease, leukemia, and other medical conditions are also associated with blood in semen.

As many as 15% of cases of blood in semen can’t be traced to a known cause. Many of these cases are also self-limiting. That means that the blood in the semen goes away by itself without medical treatment.

Related Symptoms

When looking for an underlying cause of blood in the semen, the doctor will ask about any related symptoms, including:

  • Blood in the urine (called hematuria)
  • Hot, burning urination or other symptoms of painful urination
  • Difficulty emptying your bladder completely
  • A painful bladder that feels distended
  • Painful ejaculation
  • Swollen or painful areas on the sex organs or obvious scrapes from injury
  • Penis discharge or other signs of an STD
  • Fever, racing pulse, and higher-than-normal blood pressure
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Blood in Semen: Tests and Evaluation

To diagnose blood in the semen the doctor will take a complete medical history. That will include a history of any recent sexual activity. The doctor will also perform a physical exam. This will include examining the genitals for lumps or swelling and a digital rectal exam to check the prostate for swelling, tenderness, and other symptoms. The doctor may also ask for the following tests:

  • Urinalysis or urine culture to identify infection or other abnormalities.
  • STD testing if a sexually transmitted disease is suspected.
  • The “condom test” if there’s a possibility that blood in the semen is actually coming from a sexual partner’s menstrual cycle. The man will be told to wear a condom and then examine the “protected” semen for blood.
  • PSA testing, to test for prostate cancer by measuring a substance called prostate-specific antigen in the blood.
  • Other urological tests such as cystoscopy, ultrasound, CT, and MRI to further evaluate the patient.

Treatment for Blood in Semen

Treatments target the known cause:

  • Antibiotics are used for infections.
  • An anti-inflammatory medication may be prescribed for some types of inflammation.
  • If an STD or medical condition such as high blood pressure or liver disease is the culprit, the doctor will treat that condition.
  • When blood in semen stems from a recent urology procedure, such as a prostate biopsy, it usually disappears by itself in a matter of weeks.

In younger men, blood in the semen that happens just once or twice without any additional symptoms or history of certain medical conditions can disappear on its own without treatment.

If you have repeated episodes of blood in the semen along with painful urinary or ejaculatory symptoms, the doctor may refer you to a urologist.

If the doctor suspects prostate cancer, or another form of cancer, the doctor may ask for a prostate biopsy to evaluate the tissue for cancer. The incidence of prostate cancer is low in younger men — only 0.6% to 0.5% of cases occur in men younger than 45. But for men of any age with risk factors for cancer, testing that rules out prostate cancer may be the most reassuring part of treatment for blood in semen.


WebMD Medical Reference Reviewed by Jennifer Robinson, MD on August 12, 2019

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