The blood in the semen (also called hemospermia or hematospermia) means that at some point of the genital tract (starting from the testicle until the seminal vesicles, through a small tube called vas deferens), a capillary blood vessel broke and the bleed mixed up with sperms. The semen is usually pinkish, dark red or brown depending on the intensity and the bleeding time (fresh, recent or relatively old).
In many cases, we cannot determine the exact reason for blood in the semen. Generally, it is not serious, especially in 40 or younger.
However, in older people who have repeated episodes of hemospermia, having additional urinary and ejaculatory symptoms (mainly pain), or are at risk for cancer, bleeding disorders, or other conditions, a correct diagnosis should be made.
Infection/inflammation is the leading cause of blood in semen. Any point in the genital tract can be the source of bleeding:
Hematospermia as a single symptom is common, but in some cases, bloody semen may come with other lower urinary tract symptoms (LUTS) like painful urination (dysuria), frequent and urgent urination and genital pain. In these cases, the most frequent cause is a urinary tract infection (epididymitis or prostatitis).
Young people without any symptoms other than bloody semen, wait and see could be reasonable. Men aged more than 40-50 are at higher risk for prostate cancer and other malignancies. They should book a urology consultation at the earliest.
The treatment depends on the underlying cause of hematospermia.
In most cases, the treatment is conservative and ranges from “wait and see” to antibiotics and anti-inflammatory medicine.
If a blockage causes the blood in the genitourinary tract, surgery may be necessary.