Blood in the Semen (Hematospermia)

What is blood in semen (hematospermia)?

The presence of blood in your semen is known medically as hematospermia (also called hemospermia). Hematospermia may naturally cause concern for men who experience it. However, it is not likely to be a sign of a major health problem.

Is blood in semen a common condition in men?

It’s not clear how common the symptom of blood in semen is because men usually do not examine their semen after ejaculation.

Having blood in your semen can affect men of any age, but it is more common in men aged 30 to 40.

Is seeing blood in my semen normal?

No, seeing blood in your semen is not normal, but it could be a result of:

• Leaking of blood from a small blood vessel that bursts during ejaculation the same way that a person gets a nose bleed after blowing their nose.
• Trauma from a recently performed urologic procedure, such as a vasectomy or prostate biopsy.
• An injury to a structure of the male reproductive system (testes, epididymis, vas deferens, seminal vesicle, prostate gland).

• An infection.

Is having blood in my semen dangerous?

Although it’s frightening to see blood in your semen, it’s rarely a symptom of a major health problem. A single episode of blood in your semen is usually not a sign of cancer. However, you may still want to see your healthcare provider to be reassured, to fully discuss this symptom and get an exam and perhaps other tests if your provider thinks they’re needed.

What are the causes of blood in semen?

The most likely cause of blood in semen are:

• Trauma from a prostate biopsy. You may see blood for up to four weeks after the procedure.
• Trauma from a vasectomy. You may see blood for over a week.
• Treatment of prostate cancer with external beam radiation or brachytherapy.
• A seminal tract infection or inflammation.
• Leaking of blood from a small blood vessel that bursts during ejaculation -- the same way that a person gets a nose bleed after blowing their nose.

Other potential causes or associated conditions may include:

• Sexually transmitted infections (STI): Including gonorrhea, chlamydia, or other viral or bacterial infection.
• Prostate conditions: Including benign prostatic hyperplasia, acute bacterial prostatitis, cysts and polyps.
• Testicular and epididymis conditions: Including orchitis, epididymitis.
• Seminal vesicle disorders: Including stones (calculi) and cysts.
• Blood disorders: Including clotting disorders or sickle cell disease.
• Chronic infections: Including tuberculosis or schistosomiasis.
• Cancers: Including testicular/epididymal cancer, prostate cancer, bladder cancer, seminal vessel cancer, urethral tumor. It's rare for such cancers to present with their first symptom of blood in semen.
• Other medical problems: Including severe, uncontrolled high blood pressure; human immunodeficiency virus (HIV), liver diseases, and leukemia (blood cancer).

How is blood in semen diagnosed?

Initial evaluation

Your healthcare provider will:

• Take a full medical history, including asking questions about your current symptoms, when you first noticed the blood, how often you’ve seen blood in your semen, and your sexual activities/practices. You will also be asked about medications you take, if you’ve had any recent medical procedures, have any bleeding disorders, or have any symptoms of a urinary tract infection.
• Conduct a physical exam to check for lumps, swelling, redness or discharge from your genitals.
• Perform a rectal exam to check the prostate for swelling, tenderness or a lump.
• Check your blood pressure.

Diagnostic tests

Your healthcare provider may order one or more of these tests:

• Urine culture to check for infections or abnormalities.
• STI test to detect any sexually transmitted infections.
• Prostate Specific Antigen (PSA) test to check for prostate cancer.

Specialized tests

The results of your exam and tests may not show the cause of blood in your semen. Your provider may refer you to a urologist (a doctor who specializes in the urinary tract and male reproductive organs) if your initial evaluation and urinalysis are not normal or if blood in your semen in present for longer than a month. Your urologist may order some or all of the following tests:

• Transrectal ultrasound to diagnosis prostate problems including cysts, calculi, varices, inflammatory changes.
• Computed tomography (CT-scan) or magnetic resonance imaging (MRI).

How is blood in semen treated?

Treatment is based on extent and duration of the presence of blood in your semen, your age and presence of other symptoms.

If you are under the age of 40, have no urinary tract symptoms, have no risk factors for other medical conditions, and there’s been only a single episode of blood in your semen, you’ll likely not need any treatment. The symptom will resolve on its own.

If a cause for blood in your semen is identified, your provider will prescribe appropriate treatments, including:

• Antibiotics if you have an infection.
• Anti-inflammatory drugs.
• Finasteride (Proscar), a medication used to shrink an enlarged prostate can often stop hematospermia if due to fragile/friable blood vessels on the prostate.
• Medicines to treat other medical conditions

If other underlying causes are determined, appropriate treatment should be given.

When should I see my doctor?

It’s always wise to be safe and see your healthcare provider any time you develop a new symptom, especially one that’s as alarming as blood in your semen. It’s usually not a serious health issue. However, do see your provider if you see blood in your semen and additional symptoms.