Blood in semen, also called hematospermia, can be alarming but it usually doesn’t indicate a serious health condition. It can happen for many reasons, including inflammation, infection, an obstruction or a tumor.
Men should check in with their doctor if bloody semen happens more than once, or if it comes with other symptoms.
Infection
Blood vessels throughout the delicate structures involved in ejaculation — including the prostate, testicles, epididymis, and seminal vesicles — can be affected by infection. The condition is known as hematospermia. It’s usually a self-limiting problem, especially in men under 40. The cause of the problem is often unclear, but it may be caused by any disease or injury to a gland, duct, tube, or organ involved in the process, such as the prostate, testicles, or epididymis; bacterial or viral infections, including STIs (sexually transmitted diseases) like gonorrhea and chlamydia; and blockages or injuries, such as an injury during sports.
Blood in semen may also be a sign of more serious medical conditions, such as liver disease or leukemia; high blood pressure; and blood disorders that affect your body’s ability to clot, like hemophilia or von Willebrand’s disease. Cancers, such as testicular or epididymal cancer or prostate cancer, can also cause blood in semen.
If you see blood in your semen, make an appointment with your GP. They will ask you about your symptoms and perform a physical exam. They may refer you to a urologist for additional tests. If your doctor determines that the problem isn’t serious, you won’t need to receive treatment. However, if the bleeding persists, or you have other symptoms, you should seek further evaluation.
Inflammation
Seeing blood in semen can be a frightening experience for many people. While it can be alarming, it generally doesn’t signal a major health problem for men under 40 who don’t have other symptoms or risk factors for certain medical conditions. Blood in ejaculation is usually due to infection or inflammation of the prostate or seminal vesicles. It may be in amounts too small to see without a microscope, or it could be enough to give the sperm a pink or red tint.
Infection can be caused by a wide range of bacteria, including gonorrhea and chlamydia. Inflammation can be triggered by trauma to the pelvic or genital area, such as an injury from sports or car accidents. It can also occur after a medical procedure, such as a prostate biopsy or vasectomy. Inflammation in the urethra can lead to urethritis, which often produces painful episodes of bloody semen.
Other conditions that can cause blood in semen include bleeding disorders, like hemophilia or von Willebrand disease, or chronic liver disease, such as cirrhosis. Vascular abnormalities can also be the culprit, including dilated blood vessels (telangiectasia) in the testicles and epididymis or varices in the vas deferens. Rarely, blood in ejaculation occurs as the first symptom of cancer, such as testicular, bladder or prostate cancer. If you notice blood in ejaculation, consult your healthcare provider.
Tumor
Blood in semen (hematospermia) can occur in any of the tubes that carry sperm to and from the urethra. Inflammation, blockage or injury anywhere in the male reproductive system – testicles, epididymis, vas deferens or prostate gland – can cause this problem. Infections – bacterial, viral or parasitic – can also contribute to the condition.
Usually, blood in semen is not a sign of serious health problems, especially for men under 40. It may appear when a small blood vessel bursts with the force of ejaculation or as a result of a medical procedure, such as a prostate biopsy or surgery for a pelvic injury. It can also happen after a period of prolonged abstinence from sexual activity.
It is not unusual for the blood to be reabsorbed, with a subsequent return of normal semen. However, it is important to tell your doctor if this occurs, so that further investigations can be done.
In most cases, blood in the semen is not a serious problem, and it does not require treatment. It is best to see your GP, who can check for the most common causes of this symptom and refer you to a specialist if necessary. To help your GP diagnose the problem, they will ask you for details of your symptoms and your recent sexual history. They will also need to know if you have any other medical conditions and the history of any pain or other symptoms that have occurred.
Abstinence
Blood in semen is called hematospermia and it can be alarming but it doesn’t usually indicate a serious health problem. For men under 40 who don’t have any other symptoms, it often disappears on its own. If it keeps happening or you’re over 40, check in with your doctor.
The most common cause of blood in semen is leaking from small blood vessels during ejaculation — similar to how you might get a nose bleed after blowing it. Other causes include a sexually transmitted infection like gonorrhea or chlamydia; a prostate condition, such as benign prostatic hyperplasia; a urinary tract infection; or problems with the testes or epididymis, such as orchitis and epididymitis. Certain urological cancers, such as bladder, urethral or seminal vesicle cancer, can also cause blood in semen. It’s rare for these cancers to present as the first symptom, but they can cause other symptoms like pain while urinating or erection problems.
To diagnose the cause of blood in semen, your doctor will take a full medical history, including questions about your current symptoms, when you started seeing blood in semen and how often it’s been occurring. Your doctor will also do a physical exam of your genital area and a rectal exam, to feel for hard spots or cysts in the prostate. Your doctor may order a blood test, urine analysis and/or a urine culture to look for infections or other causes of the blood in your semen.
