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Hematospermia (also known as haematospermia, hemospermia, or haemospermia) is the presence of blood in the ejaculate. It is most often a benign symptom. Among men age 40 or older, hematospermia is a slight predictor of cancer, typically prostate cancer. No specific cause is found in up to 70% of cases.
Cause
Though haematospermia may cause considerable distress to patients, it is often a benign and self-limiting condition caused by infections, particularly in younger patients. An isolated episode is usually considered benign and not likely to be associated with malignancy. Recurrent haematospermia may indicate a more serious underlying pathology particularly in patients over 40 years of age.[4]
Infection and inflammation
Infection or inflammation is considered the most common cause of the condition. Implicated pathogens include; Gram-negative bacteria (often E. coli), gonococci, T. pallidum, C. trachomatis, N. gonorrhoeae, echinococcus (rarely), HSV type 1 or 2, and HPV. The condition may also rarely be caused by some chronic systemic infections like tuberculosis or schistosomiasis. Additionally, testicular, prostate, and epididymal inflammation in general may present with haematospermia as feature.
Neoplasm
Some neoplasms of the genitourinary system may present with haematospermia. Malignant causes of haematospermia include; prostate cancer, testicular or epididymal tumours, seminal vesicle carcinoma (rarely), and urethral tumour.[4] Lymphomas and leukaemias may also feature haematospermia as symptom.[5]
Prostate
Various prostate pathologies (including prostatitis, calculi (stones), cysts, benign prostatic hyperplasia, bacterial infection, etc.) may result in blood occurring in the ejaculate.
Other
Systemic conditions like malignant hypertension, liver dysfunction, or bleeding disorders, and amyloidosis may sometimes present with haematospermia as symptom. Trauma to the region may also cause the condition. Additionally, structural anomalies of genitourinary anatomy (e.g. vascular anomalies, polyps, urethral malformations, etc.) may result in haematospermia as symptom.
Excessive sex or masturbation, prolonged sexual abstinence, interrupted sex, and certain sexual behaviours may also result in (mostly isolated events of) haematospermia.
Unknown
The exact cause cannot be determined in up to 70% of patients.
Diagnosis
The main focus of an evaluation should be to determine its cause (if possible) and rule out infection and malignancy. It is important to rule out pseudo-haematospermia where blood originates from the partner during intercourse.
Epidemiology
Though the exact incidence is unknown, haematospermia has been reported in one per 5,000 patients in initial examinations at urological out-patient clinics. Most patients are between 30–40 years of age. It is thought to make up ~1% of all urological symptoms.
History
Traditionally, the condition was thought to be a clinically insignificant consequence of prolonged sexual abstinence or intense sexual experiences.
What is blood in the semen?
Hematospermia is another name for blood in semen.
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, several 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 include, but are 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
What are the symptoms of blood in the semen?
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
How is blood in the semen diagnosed?
Several 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 the blood in the semen is not associated with any known abnormality or 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.
What is the prognosis for patients with blood in the semen?
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.
What is blood in semen (hematospermia)?
The presence of blood in your semen is known medically as hematospermia (also called hemospermia). Hematospermia may naturally cause concern for men who experience it. However, it is not likely to be a sign of a major health problem.
Is blood in semen a common condition in men?
It’s not clear how common the symptom of blood in semen is because men usually do not examine their semen after ejaculation.
Having blood in your semen can affect men of any age, but it is more common in men aged 30 to 40.
Is seeing blood in my semen normal?
No, seeing blood in your semen is not normal, but it could be a result of:
- Leaking of blood from a small blood vessel that bursts during ejaculation the same way that a person gets a nose bleed after blowing their nose.
- Trauma from a recently performed urologic procedure, such as a vasectomy or prostate biopsy.
- An injury to a structure of the male reproductive system (testes, epididymis, vas deferens, seminal vesicle, prostate gland).
- An infection.
Is having blood in my semen dangerous?
Although it’s frightening to see blood in your semen, it’s rarely a symptom of a major health problem. A single episode of blood in your semen is usually not a sign of cancer. However, you may still want to see your healthcare provider to be reassured, to fully discuss this symptom and get an exam and perhaps other tests if your provider thinks they’re needed.
Symptoms and Causes
What are the causes of blood in semen?
The most likely cause of blood in semen are:
- Trauma from a prostate biopsy. You may see blood for up to four weeks after the procedure.
- Trauma from a vasectomy. You may see blood for over a week.
- Treatment of prostate cancer with external beam radiation or brachytherapy.
- A seminal tract infection or inflammation.
- Leaking of blood from a small blood vessel that bursts during ejaculation — the same way that a person gets a nose bleed after blowing their nose.
Other potential causes or associated conditions may include:
- Sexually transmitted infections (STI): Including gonorrhea, chlamydia, or other viral or bacterial infection.
- Prostate conditions: Including benign prostatic hyperplasia, acute bacterial prostatitis, cysts and polyps.
- Testicular and epididymis conditions: Including orchitis, epididymitis.
- Seminal vesicle disorders: Including stones (calculi) and cysts.
- Blood disorders: Including clotting disorders or sickle cell disease.
- Chronic infections: Including tuberculosis or schistosomiasis.
- Cancers: Including testicular/epididymal cancer, prostate cancer, bladder cancer, seminal vessel cancer, urethral tumor. It’s rare for such cancers to present with their first symptom of blood in semen.
- Other medical problems: Including severe, uncontrolled high blood pressure; human immunodeficiency virus (HIV), liver diseases, and leukemia (blood cancer).
Diagnosis and Tests
How is blood in semen diagnosed?
Initial evaluation
Your healthcare provider will:
- Take a full medical history, including asking questions about your current symptoms, when you first noticed the blood, how often you’ve seen blood in your semen, and your sexual activities/practices. You will also be asked about medications you take, if you’ve had any recent medical procedures, have any bleeding disorders, or have any symptoms of a urinary tract infection.
- Conduct a physical exam to check for lumps, swelling, redness or discharge from your genitals.
- Perform a rectal exam to check the prostate for swelling, tenderness or a lump.
- Check your blood pressure.
Diagnostic tests
Your healthcare provider may order one or more of these tests:
- Urine culture to check for infections or abnormalities.
- STI test to detect any sexually transmitted infections.
- Prostate Specific Antigen (PSA) test to check for prostate cancer.
Specialized tests
The results of your exam and tests may not show the cause of blood in your semen. Your provider may refer you to a urologist (a doctor who specializes in the urinary tract and male reproductive organs) if your initial evaluation and urinalysis are not normal or if blood in your semen in present for longer than a month. Your urologist may order some or all of the following tests:
- Transrectal ultrasound to diagnosis prostate problems including cysts, calculi, varices, inflammatory changes.
- Computed tomography (CT-scan) or magnetic resonance imaging (MRI).
Management and Treatment
How is blood in semen treated?
Treatment is based on extent and duration of the presence of blood in your semen, your age and presence of other symptoms.
If you are under the age of 40, have no urinary tract symptoms, have no risk factors for other medical conditions, and there’s been only a single episode of blood in your semen, you’ll likely not need any treatment. The symptom will resolve on its own.
If a cause for blood in your semen is identified, your provider will prescribe appropriate treatments, including:
- Antibiotics if you have an infection.
- Anti-inflammatory drugs.
- Finasteride (Proscar), a medication used to shrink an enlarged prostate can often stop hematospermia if due to fragile/friable blood vessels on the prostate.
- Medicines to treat other medical conditions
If other underlying causes are determined, appropriate treatment should be given.
When should I see my doctor?
It’s always wise to be safe and see your healthcare provider any time you develop a new symptom, especially one that’s as alarming as blood in your semen. It’s usually not a serious health issue. However, do see your provider if you see blood in your semen and additional symptoms.