Blood in Semen (Hematospermia)

• Blood in the semen is known as hematospermia.
• Prostate biopsy is the most common cause of blood in the semen.
• Blood in the semen can be caused by tumors, infections, anatomical abnormalities, stones, or inflammation in many sites throughout the genitourinary system.
• Usually blood in the semen is benign and resolves on its own.
• Treatment, if indicated, depends upon the underlying cause.
• In most cases, hematospermia has no underlying cause, is benign, self-limited, and no treatment is required.

The presence of blood in the semen (ejaculate) is also called hematospermia. Hematospermia is not always noticed; therefore, it is difficult to make estimates of its incidence.

Blood in semen can be caused by many conditions affecting the male genitourinary system. Areas affected may include the bladder, urethra, the testicles, the tubes that distribute semen from the testicles (known as the seminal vesicles), the epididymis (a segment of the spermatic ducts that serves to store, mature, and transport sperm), and the prostate gland.

Blood in the semen is most commonly a result of a prostate gland biopsy. A majority of men who undergo a prostate biopsy may have some blood in their semen that persists for three to four weeks. Likewise, vasectomy can lead to bloody semen for about one week after the procedure.

In men with hematospermia who have not had a recent prostate biopsy or vasectomy, a number of benign and malignant conditions of the male genital system may be the cause. In many situations, no definitive cause is found.

The following conditions have been reported in association with hematospermia:

• Benign or malignant tumors of the prostate, bladder, testes, or seminal vesicles
• Infections including, but not limited to, chlamydia, herpes, cytomegalovirus, and trichomoniasis
• Inflammation of the prostate (prostatitis), epididymis (epididymitis), or urethra (urethritis)
• Calculi (stones similar to kidney stones) in the seminal vesicles or prostate
• Polyps in the urethra
• Ejaculation duct obstructions
• Metastatic cancers (that have spread from other sites in the body) located in the genitourinary system
• Cysts, hemorrhage, or other abnormalities in the seminal vesicles

The symptoms that can occasionally accompany blood in the semen may be any of the following, depending upon the cause (these are not all inclusive):

• Painful urination
• Pain with ejaculation
• Blood in urine
• Lower back pain
• Fever
• Tenderness in the testes and/or scrotum
• Swelling in the testes and/or scrotum
• Swelling or tenderness in the groin area

A number of diagnostic tests may be performed after the clinical history is evaluated and a physical examination is performed. Some of the most commonly performed diagnostic tests are a urinalysis and cultures to identify any sexually transmitted or other infections. When indicated, imaging studies such as ultrasound or MRI may reveal tumors or other abnormalities. In some situations, a semen analysis, in which the semen is analyzed under a microscope, may be recommended.

Treatment of blood in the semen is directed toward the underlying cause if a cause has been found. Sometimes, treatment with antibiotics for a presumptive diagnosis of prostatitis (inflammation of the prostate gland) is given, since some studies have shown that up to about one-fourth of men with hematospermia have prostatitis. However, the benefit of such treatment has not been definitively established.

In most cases, if blood in the semen is not associated with any known abnormality of other troubling symptoms, no treatment is given, and the condition usually resolves on its own with time in these situations. Persistent hematospermia (for a month or more) even in the absence of other symptoms warrants further or follow-up evaluation.

The prognosis relates to the underlying cause of blood in the semen if a cause can be identified. However, most cases of hematospermia are benign and resolve without treatment. While cancer is a rare cause of blood in the semen, the majority of cases are not related to cancer, especially in younger men.