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Blood in Semen

By

Geetha Maddukuri

, MD, Saint Louis University

Last full review/revision May 2021| Content last modified May 2021
Click here for the Professional Version

Blood in semen (called hematospermia, because sperm are mixed with blood in the semen) can be a frightening symptom, but it is usually not a sign of a serious problem. Blood in semen is not usually a sign of cancer and does not affect sexual function.

Semen is composed of sperm from the epididymis and fluids from the seminal vesicles, prostate, and small mucous glands that provide fluids to nourish sperm. Thus, blood could come from injury to any of these structures. (See also Overview of Urinary Tract Symptoms Overview of Urinary Tract Symptoms Kidney and urinary tract disorders can involve one or both kidneys, one or both ureters, the bladder, or the urethra, and in men, the prostate, one or both testes, or the epididymis. Problems... read more .)

Causes of Blood in Semen

Most cases of blood in semen are

  • Idiopathic, that is they arise without warning and doctors cannot find a cause

Such cases resolve on their own within a few days to a few months.

The most common known cause is

Less common causes include benign prostatic hyperplasia Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is a noncancerous (benign) enlargement of the prostate gland that can make urination difficult. The prostate gland enlarges as men age. Men may have difficulty... read more (a benign enlargement of the prostate gland), infections (for example, prostatitis Prostatitis Prostatitis is pain and swelling, inflammation, or both of the prostate gland. The cause is sometimes a bacterial infection. Pain can occur in the area between the scrotum and anus or in the... read more , urethritis Urethritis Urethritis is infection of the urethra, the tube that carries urine from the bladder out of the body. Bacteria, including those that are sexually transmitted, are the most common cause of urethritis... read more , or epididymitis Epididymitis and Epididymo-orchitis Epididymitis is inflammation of the epididymis (the coiled tube on top of the testis that provides the space and environment for sperm to mature), and epididymo-orchitis is inflammation of the... read more ), and prostate cancer Prostate Cancer The risk of prostate cancer increases as men age. Symptoms, such as difficulty urinating, a need to urinate frequently and urgently, and blood in the urine, usually occur only after the cancer... read more Prostate Cancer (in men over 35 to 40 years). Occasionally, blood in semen occurs in men who have tumors of the seminal vesicles and testes. A mass of abnormal blood vessels (hemangioma Hemangiomas Hemangiomas are abnormal overgrowths of blood vessels that can appear as red or purple lumps in the skin and on other parts of the body. (See also Overview of Skin Growths and Overview of Growths... read more Hemangiomas ) in the urethra or the ducts that connect the testes to the urethra (spermatic ducts) may cause quite a bit of blood to appear in semen.

Evaluation of Blood in Semen

Although blood in semen can be alarming, it is not usually serious, and it does not require an immediate evaluation. The following information can help men decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

Certain symptoms and characteristics are cause for concern. They include

  • Bleeding lasting longer than 1 month (unless there was a recent prostate gland biopsy)

  • A lump that can be felt in the scrotum

  • Travel to a region where schistosomiasis is prevalent

When to see a doctor

Men who have warning signs should see a doctor. Timing is not critical, and a delay of a week or so is not harmful. Men who do not have warning signs and are younger than age 35 do not need to see a doctor unless they have other symptoms, such as pain in the scrotum Scrotal Pain Pain in the scrotum (the sac that surrounds and protects the testes) can occur in males of any age, from newborns to older men. The testes are very sensitive, so even minor injuries may cause... read more or groin or pain during urination Pain or Burning With Urination Burning or pain during urination may be felt at the opening of the urethra or, less often, over the bladder (in the pelvis, the lower part of the abdomen just above the pubic bone). Burning... read more . Men who do not have warning signs and are over 35 should see a doctor within a few weeks.

What the doctor does

Doctors first ask questions about the man's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the blood and the tests that may need to be done.

Doctors ask

Doctors examine the genitals for redness, a lump, or tenderness. A digital rectal examination is done to examine the prostate for enlargement, tenderness, or a lump.

Doctors can often determine what causes are likely after taking a history and doing an examination. For example, the following kinds of information can provide clues. In men with an abnormal prostate detected during a digital rectal examination, a prostate disorder is likely, such as prostate cancer Prostate Cancer The risk of prostate cancer increases as men age. Symptoms, such as difficulty urinating, a need to urinate frequently and urgently, and blood in the urine, usually occur only after the cancer... read more Prostate Cancer , benign prostatic hyperplasia Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is a noncancerous (benign) enlargement of the prostate gland that can make urination difficult. The prostate gland enlarges as men age. Men may have difficulty... read more , or prostatitis Prostatitis Prostatitis is pain and swelling, inflammation, or both of the prostate gland. The cause is sometimes a bacterial infection. Pain can occur in the area between the scrotum and anus or in the... read more . In men with urethral discharge, urethritis Urethritis Urethritis is infection of the urethra, the tube that carries urine from the bladder out of the body. Bacteria, including those that are sexually transmitted, are the most common cause of urethritis... read more is likely. In men with tenderness of the epididymis, epididymitis is likely. However, such abnormalities may not be the cause of blood in semen. For example, most older men have benign prostatic hyperplasia, yet few of them have blood in semen.

In men who have bleeding that lasted less than a month, have not been in areas where schistosomiasis Schistosomiasis Schistosomiasis is infection caused by certain flatworms (flukes), called schistosomes. People acquire schistosomiasis by swimming or bathing in fresh water that is contaminated with the flukes... read more is prevalent, and have no warning signs or abnormalities on examination, a cause cannot usually be found.

Testing

In most cases, especially in men younger than 35 to 40 years, and men who recently had a prostate biopsy, blood in semen is not serious and resolves on its own. Urinalysis Urinalysis and Urine Culture Urinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A... read more Urinalysis and Urine Culture and urine culture Urinalysis and Urine Culture Urinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A... read more Urinalysis and Urine Culture are usually done. Further testing is not usually needed unless there are urinary symptoms that suggest an infection or other disorder. However, if the doctor suspects certain potentially serious disorders, further testing is done, for example, some doctors typically do tests for prostate cancer on men over 40.

Treatment of Blood in Semen

Treatment is directed at the cause if known. Often no treatment is needed, and the blood goes away on its own. Sometimes, as is the case after a prostate biopsy, the blood in semen may persist for several months.

Key Points

  • In most cases, a cause cannot be found or bleeding occurs after a prostate biopsy.

  • Blood in semen is not usually a sign of cancer and does not affect sexual function.

  • More detailed evaluation is needed mainly for men with symptoms that last longer than a month, who are over 40, or who have abnormal findings.

  • Doctors may need to test for schistosomiasis in men who have traveled to Africa, India, or certain parts of the Middle East.

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