The blood in semen (also called hemospermia or hematospermia) means that at some point in the genital tract (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).
We cannot determine the exact reason for blood in the semen in many cases. Generally, it is not severe, especially in 40 or younger.
However, a correct diagnosis should be made in older people who have repeated episodes of blood in semen, have additional urinary and ejaculatory symptoms (mainly pain), or are at risk for cancer, bleeding disorders, or other conditions.
Infection/inflammation is the leading cause of blood in semen. Any point in the genital tract can be the source of bleeding:
Blood in semen 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 or ejaculatory pain. In these cases, the most frequent cause is a urinary tract infection (epididymitis or prostatitis).
The treatment depends on the underlying cause of blood in semen.
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.
Waiting and seeing could be reasonable for young people without any symptoms other than blood in semen. Men aged 40-50 are at higher risk for prostate cancer and other malignancies. They should book a urology consultation at the earliest.
Mathers MJ, Degener S, Sperling H, Roth S. Hematospermia—a Symptom With Many Possible Causes. Dtsch Arztebl Int. 2017;114(11):186-191. doi:10.3238/arztebl.2017.0186