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Blood in the semen (Hemospermia or Hematospermia)

Blood in semen

Table of Contents


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:

  • Prostatitis;
  • Epididymitis;
  • Urethritis;
  • Obstruction (stones and calcifications). If the ejaculatory ducts are blocked, surrounding blood vessels can dilate and break;
  • Prostate enlargement is another obstructing situation where ejaculatory ducts are compressed and blocked;
  • Benign polyps or malignant tumours in the prostate, testicles, epididymis, or seminal vesicles could lead to hematospermia;
  • Vascular anomalies in the male genitals, such as vascular cysts;
  • Other conditions that increase generic bleeding risk. These include hypertension (high blood pressure) and haemophilia (a disorder that leads to easy and excessive bleeding). Other possibilities include leukaemia 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 the semen

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).

When it is better to see the doctor

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.

Treatment of blood in semen

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. 

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