Men’s health centre

Blood in semen (haematospermia)

Seeing blood in the semen can make a man anxious. Fortunately, it doesn't always signal a major medical problem. For men younger than 40 with no related symptoms and no risk factors for underlying medical conditions, blood in semen often disappears on its own.

However, for men 40 and over, chances are higher that blood in the semen needs evaluation and treatment. This is especially true for men who:

• Have repeated episodes of blood in the semen.
• Have related symptoms while urinating or ejaculating.
• Are at risk of cancer, a bleeding disorder or other conditions.

Blood in the semen is called haematospermia or haemospermia. When men ejaculate, they typically don't examine their semen looking for blood. So it’s not known how common the condition is.

Causes of blood in the semen

Blood in the semen can come from several different sources:

Infection and inflammation. This is the most common cause of blood in the semen. Blood can come from an infection or inflammation, in any of the glands, tubes or ducts that produce and move semen from the body. These include:

• Prostate (the gland that produces the fluid part of semen)
• Urethra (the tube that carries urine and semen from the penis) 
• Epididymis and vas deferens (tiny tube-like structures where sperm mature before ejaculation)
• Seminal vesicles (which add more fluid to the semen)

It can also come from an STI (sexually transmitted infection) such as gonorrhoea or chlamydia or from another viral or bacterial infection. Infection and inflammation are the culprits behind nearly four out of every 10 cases of blood in the semen.

Trauma or a medical procedure. Blood in the semen is common after medical procedures. For instance, as many as four out of five men may temporarily have blood in their semen following a prostate biopsy.

Procedures done as treatment for urinary problems can also cause mild trauma that leads to temporary bleeding. This usually disappears within several weeks after the procedure. Radiotherapy, vasectomy, and injections for haemorrhoids can also be a cause. Physical trauma to the sex organs after pelvic fracture, injury to the testicles, excessively rigorous sexual activity or masturbation or other injury can cause blood in the semen.

Obstruction. Any of the tiny tubes or ducts in the reproductive tract can be blocked. This can cause blood vessels to break and release small amounts of blood. The condition called BPH, which causes the prostate to become enlarged and pinch the urethra, is also linked to blood in semen.

Tumours and polyps. One review of over 900 patients with blood in semen found only 3.5% actually had a tumour. Most of these tumours were in the prostate. Blood in semen, though, can be linked to cancer of the testicles, bladder and other reproductive and urinary tract organs. Men -- especially older men -- with risk factors for cancer should be evaluated if they have blood in their semen. Untreated cancer is a life-threatening disease.