Blood in the semen (Hemospermia or Hematospermia)

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 blood 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). The bloody semen does not affect a woman or your fertility, and often it comes without pain.

We cannot determine the exact reason for blood in the semen in many cases. Generally, it is not severe, especially for those 40 or younger. Most of the time this sign is benign and rarely it is a symptom of malignancy like prostate cancer.

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.

Causes of blood in semen

Infection/inflammation is the leading cause of blood in semen. Any point in the genital tract can be the source of bleeding:

• Prostatitis;
• Epididymitis;
• Urethritis;
• Obstruction (stones and calcifications). If the ejaculatory ducts are blocked, the surrounding blood vessels can dilate and break;
• Prostate enlargement is another obstructing situation where ejaculatory ducts are compressed and blocked;
• Benign polyps or prostate cancer, cancer of the testis, epididymis, or seminal vesicles could lead to hematospermia;
• Vascular anomalies in the male genitals, such as vascular cysts;
• Other conditions increase generic bleeding risk. These include hypertension (high blood pressure) and hemophilia (a disorder that leads to easy and excessive bleeding). Other possibilities include leukemia and chronic liver disease;
• Scrotal trauma while playing sports. Trauma can cause blood vessels to leak;
• A medical procedure like a prostate biopsy or a vasectomy can cause blood in the semen.

Other symptoms accompanying blood in semen

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).

Treatment 

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. 

Seek medical advice

The “wait and see” 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.

External Resources

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