Few things alarm men as much as seeing blood in their semen, a condition called hematospermia. But it’s not usually a symptom of serious disease, especially in men under 40.
Semen travels along a path through the testicles, epididymis, vas deferens, and seminal vesicles before reaching the urethra for ejaculation. Any of these structures can be damaged, resulting in blood in semen.
Infection
Seeing blood in your semen (hematospermia) can be frightening, but it’s rarely serious. Most of the time, it means that a blood vessel has burst in or around one of the delicate structures that are involved in ejaculation. The tubes that carry sperm from the testicles to the urethra (the tube that transports urine) and from the ejaculatory canal to the seminal vesicles have many small blood vessels, and they can break or leak.
Hematospermia can be caused by any condition that causes inflammation, infection or blockage of these structures, including the prostate gland, the urethra, the tubes that distribute sperm from the testicles (the epididymis and the vas deferens) and the seminal vesicles. Blood from these sources appears as light red to brown clumps in ejaculate, depending on the amount of time since the bleeding occurred.
Infections in the genital tract are most likely to cause bloody semen, especially sexually transmitted infections like gonorrhea or chlamydia and infections of the testicles, epididymis and urethra. Cancers of the urethra and bladder, or the seminal vesicles or prostate gland can also cause blood in semen, but they’re rare. Most people who notice blood in their ejaculate don’t need to see their doctor, unless they have other symptoms or are over 40. In these cases, the doctor can investigate further and find out what’s causing it.
Inflammation
Approximately four out of five cases of blood in semen involve infection or inflammation. This can happen because of urinary tract infections, STIs (such as gonorrhea and chlamydia), or other bacterial or viral diseases. It also can result from physical trauma to the genitourinary area or a medical procedure. For example, it’s common to have blood in ejaculation after a prostate biopsy or vasectomy. Blood in semen may also occur during prolonged abstinence from sex, intense sexual activity, or masturbation.
Inflammation causes irritation, which leads to the tubes and glands of the genitourinary system—the bladder, urethra, testicles, seminal vesicles, epididymis, and prostate gland—to become swollen. In some instances, this can lead to a condition called hematospermia. Blood in ejaculation from this type of ailment is usually bright red, but it can sometimes have a pink or brown tinge.
If a man notices blood in his ejaculate, he should see a doctor or urologist. The doctor will ask about symptoms, such as pain on ejaculation, and recommend tests to see what’s causing the blood. These tests include a pelvic exam, bloodwork, urine tests, and imaging tests such as a CT scan or ultrasound. If the underlying cause is found, treatment should begin. In many cases, this means antibiotics or having a cyst drained with a needle. If it’s a tumor or cancer, treatment will likely be more involved.
Tumor
Men who see blood in ejaculate (hematospermia) may worry that it’s a sign of a serious health problem, particularly those over 40. But the good news is that the condition usually doesn’t cause serious health problems, especially if it only happens once.
Blood in ejaculation often occurs because of inflammation. But it can also occur because of irritation elsewhere in the genitals or urinary tract, or from some other condition that affects the blood vessels and ducts that produce semen. These conditions include prostate cancer, benign prostatic hyperplasia, acute bacterial prostatitis, cysts and other disorders of the testis, epididymis and seminal vesicles.
These conditions can all break blood vessels that carry sperm through the tubes that connect the testis and epididymis to the vas deferentia and the prostate gland. The broken vessels can then leak blood into the ejaculatory duct and urine.
Bloody ejaculate also can occur from trauma after a urologic procedure, such as a vasectomy or prostate biopsy. The blood in ejaculation comes from the small blood vessels that burst during these procedures, the same way you might get a nose bleed after blowing your nose. It can also occur from a sexually transmitted infection or disease, such as gonorrhea and chlamydia. Chronic infections, such as tuberculosis and schistosomiasis, may also cause blood in the semen.
Trauma
All of the glands, tubes, and ducts involved in sperm production and transportation, including the vas deferens, epididymis, seminal vesicles, and prostate, have blood vessels that can break or bleed when they’re injured. These can happen due to infection or irritation, a tumor, or anything that causes an obstruction or puts pressure on them. Inflammation in the genital area from an infection, such as chlamydia or herpes, can cause these symptoms. An enlarged prostate gland, known as benign prostatic hypertrophy (BPH), can also lead to blood in semen.
The good news is that a single episode of blood in ejaculation usually doesn’t signal a serious problem, especially in men under 40. But if it happens again, or if you’re concerned about any other symptoms, see your doctor right away.
Your GP will ask about when it started and how often you’ve seen the blood, then do a physical exam of your groin and rectum. They’ll check your scrotum for pain on ejaculation, a feeling of fullness in the groin, painful urination, and any swelling in your groin or rectum. They’ll also take a sample of your semen to check for the presence of blood.
Screening tests, such as ultrasounds or CT scans, can help them find the cause of your blood in semen. If they can’t find a cause, your doctor may refer you to a urologist for further evaluation and treatment.
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