Blood in the semen is called hematospermia. It may be in amounts too small to be seen except with a microscope, or it may be visible in the ejaculation fluid. Can happen to men at any age after puberty.
It is most common in men aged 30 to 40 years and in men over 50 years of age with benign prostate enlargement (BPH). The majority of cases go away in time without treatment.
What causes blood in semen?
Most of the time, blood in the semen is caused by swelling or infection of the prostate or seminal vesicles. The problem may occur after a prostate biopsy.
The male reproductive system is made up of many organs, glands and ducts (tubes). Sperm are made in the testes, and as they travel through the male reproductive system, fluid is added to protect and feed the sperm.
Sperm mix with fluid from the seminal vesicles and travel through the ejaculatory ducts and prostate gland, where more fluid is added, before being expelled out of the penis through the urethra.
Bleeding can happen anywhere along the way.
Blood in semen may be caused by inflammation, infection, blockage, or injury anywhere along the male reproductive system.
The seminal vesicles – a pair of pouch-like glands located on either side of the bladder – and the prostate are the main organs that contribute the fluid to the sperm, so an infection, inflammation or trauma in any of these organs will cause blood in the semen.
Blood can be found in semen as a symptom on its own (primary haematospermia) or linked to other symptoms (secondary haematospermia).
Blood in the semen may also be caused by:
- Blockage due to enlarged prostate (prostate problems)
- Infection of the prostate
- Irritation in urethra (urethritis)
- Injury to urethra
- Often, the cause of the problem cannot be found.
Depending on the cause, other symptoms that may occur include:
- Blood in urine
- Fever or chills
- Lower back pain
- Pain with bowel movement
- Pain with ejaculation
- Pain with urination
- Swelling in scrotum
- Swelling or tenderness in groin area
- Tenderness in the scrotum
What is primary haematospermia?
Primary haematospermia is when blood in the semen is the only symptom. No blood is found in the urine, and a physical examination does not find any other problems.
If there is blood in semen but no other symptoms, it is common for no cause to be found.
What is secondary haemotaspermia?
Secondary haematospermia is when there is a suspected or known cause for the bleeding, such as after a prostate biopsy or a urinary or prostate infection or, in rare cases, if cancer is present.
Blood in semen can also happen in men over 50 years of age with benign prostate enlargement (BPH) with calcifications (deposits of calcium) that can be seen on ultrasound.
In very rare cases, secondary haematospermia can be caused by tuberculosis, parasitic infections, or any diseases that affect blood clotting such as haemophilia and chronic liver disease, and some medications that thin the blood.
An ultrasound-guided biopsy of the prostate can cause blood in semen in about one third of men. It is very rare for cancer of the testes to be linked with blood in semen.
Prostate cancer can cause blood in semen, however most men with prostate cancer do not present with this symptom unless they have had a previous prostate biopsy.
What other symptoms may be present with blood in semen?
If blood appears in semen due to a prostate gland infection, other symptoms may be present, including:
- pain with urination
- pain with ejaculation
- pain with bowel movement
- swelling or tenderness in the scrotum
- swelling or tenderness in the groin area
- lower back pain
- fever or chills
- blood in the urine.
Can blood in semen be caused by sexually transmitted infections?
Blood in semen is very unlikely to be caused by any sexually transmitted infection (STI). Some STIs can be transmitted through blood and semen, but they do not usually cause blood to appear in semen.
Can blood in semen be caused by injuries or rough sex?
Blood in the semen can be noticed during/after sex, but rough sex is not the cause of the bleeding. Severe trauma to the genital/urinary tract can cause blood from the urethra but this is different to haematospermia.
The following steps may help ease discomfort from a prostate infection or urinary infection:
- Take over-the-counter pain relievers such as ibuprofen or naproxen.
- Drink plenty of fluids.
- Eat high-fiber foods to make bowel movements easier.
- When to Contact a Medical Professional
- Always call your doctor if you notice any blood in your semen.
What to Expect at Your Office Visit
The health care provider will perform a physical exam and look for signs of:
- Discharge from the urethra
- Enlarged or tender prostate
- Swollen lymph nodes
- Swollen or tender scrotum
You may need the following tests:
- Prostate exam
- PSA blood test
- Semen analysis
- Semen culture
- Ultrasound of prostate, pelvis or scrotum
- Urine culture