blood in semen

What is blood in semen

Blood in semen is also called hematospermia, can be frightening, but the cause of this uncommon condition is usually benign. Blood in semen may be in amounts too small to be seen except with a microscope, or it may be visible in the ejaculation fluid. It’s unusual to find blood in your semen when you ejaculate, but try not to worry – it’s usually only temporary and the cause is rarely anything serious and goes away on its own. But you should NEVER diagnose yourself with blood in your semen – always see your doctor for a proper diagnosis. Always call your healthcare provider if you notice any blood in your semen.

The semen may be blood stained, brownish-red in color or have a pink tinge.

Most of the time, blood in the semen is caused by swelling or infection of the prostate or seminal vesicles. The problem may occur after a prostate biopsy.

Blood in the semen may also be caused by:

  • Blockage due to enlarged prostate (prostate problems)
  • Infection of the prostate
  • Irritation in the urethra (urethritis)
  • Injury to the urethra

In many cases, no obvious cause can be found for blood in the semen and it will clear up by itself.

Sometimes, the visible blood will last several days to weeks, depending on the cause of the blood and if any clots formed in the seminal vesicles.

Depending on the cause, other symptoms that may occur include:

  • Blood in the urine
  • Fever or chills
  • Lower back pain
  • Pain with bowel movement
  • Pain with ejaculation
  • Pain with urination
  • Swelling in the scrotum
  • Swelling or tenderness in the groin area
  • Tenderness in the scrotum
When to see a doctor

If you’re under age 40 and see blood in your semen, chances are it will resolve without treatment. However, it’s a good idea to make an appointment with your doctor for a physical exam and simple tests to rule out a cause, such as a sexually transmitted disease (STD).

If you have certain risk factors and symptoms, further testing may be necessary to rule out a more serious underlying disorder. See your doctor about blood in semen if you:

  • Are 40 or older
  • Have blood in semen that persists longer than three to four weeks
  • Have repeatedly recurring blood in semen
  • Have other symptoms, such as painful urination
  • Have other risk factors — such as a history of cancer, bleeding disorders, or genital or urinary system malformation — or have recently engaged in behaviors that put you at risk of sexually transmitted infections

What causes blood in semen

Semen consists of sperm and fluids released by the prostate and other glands. The fluids, also called ejaculate, join the sperm as they pass through a series of tubes to the urethra for ejaculation. A number of things can break blood vessels along this route or along the urinary route to the urethra. Broken vessels then leak blood into the semen, urine or both.

Your doctor will ask if you’ve had prostate surgery or a prostate biopsy recently, since these procedures can cause blood in semen for several weeks afterward.

Most often, no cause can be found for blood in semen. In some cases, particularly among men under age 40, infection is a possible cause. Infection is usually accompanied by other signs and symptoms, such as painful urination.

Severe or recurrent blood in semen and blood in semen in men age 40 and older might, in rare cases, be a warning sign for conditions such as cancer. As a result, a more careful evaluation might be needed. But the risk is low. In follow-up studies of men, mostly over 40, who had blood in their semen, prostate cancer developed in between 4 and 6 percent of participants.

Common causes of blood in semen include:

  • Vesiculitis – inflammation of the seminal vesicles (glands that produce most of the fluid in ejaculate)
  • Seminal vesicle cysts – small, fluid-filled sacs in the seminal vesicles
  • Prostatitis – inflammation or infection of the prostate gland (where semen is made)
  • Recent urological surgery – such as a prostate biopsy, cystoscopy or vasectomy
  • Sexually transmitted diseases (STDs) – such as genital herpes, chlamydia, gonorrhea or trichomoniasis

These problems generally aren’t serious and many will get better on their own without treatment, or after a course of antibiotics or anti-inflammatory painkillers.

Possible causes of blood in semen:

  • Brachytherapy
  • Epididymitis (testicle inflammation)
  • Excessive sexual activity or masturbation
  • External beam radiation for prostate cancer
  • Hemophilia
  • Orchitis (inflamed testicle)
  • Prolonged sexual abstinence
  • Prostate biopsy
  • Testicular trauma
  • Vasectomy

Less common causes

Less often, blood in the semen can be a result of:

  • severe high blood pressure (hypertension)
  • a blood clotting disorder
  • cancer – including prostate cancer, testicular cancer and bladder cancer
  • seminal vesicle calculi – small stones in the seminal vesicles

These conditions are more serious and may require specialist treatment.

Rare causes of blood in semen:

  • Amyloidosis (buildup of abnormal proteins in your organs)
  • Benign growths (cysts, polyps) in the bladder, urethra or prostate
  • Schistosomiasis
  • Testicular cancer
  • Tuberculosis
  • Warfarin side effects

Blood in semen diagnosis

Your doctor will try to determine whether the cause of the blood in your semen is likely to be serious or not.

They’ll need to consider a number of things, such as:

  • how many times you’ve noticed blood in your semen
  • whether you have any other symptoms
  • your age
  • your medical history

They may also need to carry out a number of simple tests, including:

  • checking your blood pressure
  • an examination of your genitals and abdomen (tummy)
  • a prostate examination (where your doctor inserts a finger into your bottom)
  • urine and blood tests

You may need the following tests:

  • PSA blood test
  • Semen analysis
  • Semen culture
  • Ultrasound of the prostate, pelvis or scrotum
  • Urinalysis
  • Urine culture

If you’re younger than 40, have only noticed blood in your semen once or twice, and tests don’t suggest you have a serious underlying condition, you shouldn’t need a hospital referral.

However, if you’re over 40, have persistent or recurrent symptoms, or tests have suggested a potentially serious underlying cause, your doctor should refer you to a urologist (specialist who treats problems of the urinary system).

A further assessment with a urologist may involve having a biopsy of your prostate gland or a scan, such as an ultrasound scan.

Blood in semen treatment

The treatment your doctor or urologist recommends will depend on what they think is the underlying reason for the blood in your semen.

In many cases, particularly if you have no other symptoms or the blood in your semen was an isolated incident, no treatment is necessary and the problem will usually resolve on its own.

If a clear reason is identified, the treatment you’re offered will depend on the specific cause. For example, you may be given antibiotics to treat an infection and cysts may need to be drained with a needle.

If there’s a serious underlying cause, such as a blood clotting disorder or cancer, you’ll be referred to an appropriate specialist for any necessary treatment.