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)
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.
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.
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
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% 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.