Hematospermia, the clinical term for blood in semen, can be an alarming discovery. The fluid may appear brownish-red or have a brighter red color. While unsettling, blood in the ejaculate is frequently a benign issue, especially for men under 40. When it is the only symptom, the condition often resolves on its own without medical intervention.
Common Causes of Hematospermia
Hematospermia often originates from inflammation or infection within the male urogenital tract. Prostatitis (inflammation of the prostate gland) or urethritis (inflammation of the urethra) can cause fragile blood vessels to leak blood into the seminal fluid. Infections in the epididymis, the tube that stores and carries sperm, can lead to the same result. These infections can be caused by bacteria, including sexually transmitted infections (STIs) like chlamydia and gonorrhea.
Trauma or medical procedures are another frequent source of temporary hematospermia. A prostate biopsy is a common medical cause of blood in semen, and it is not unusual to see blood for up to four weeks. A vasectomy can also cause bleeding that may persist for over a week as the area heals. Vigorous sexual activity or masturbation can occasionally cause minor trauma leading to temporary bleeding.
In a significant portion of instances, especially in men under 40, a definitive cause is never identified. These situations are termed idiopathic, and the condition typically resolves without specific treatment. This outcome is common and usually not a cause for concern when no other symptoms are present.
When Hematospermia May Indicate a More Serious Condition
The significance of hematospermia often changes with age. For men over 40, the presence of blood in semen warrants a more thorough evaluation, as the likelihood of an underlying issue increases. If the condition is persistent (occurs repeatedly) or does not resolve on its own after a few weeks, it is advisable to consult a healthcare provider regardless of age.
Accompanying symptoms indicate that a more detailed investigation is needed. Pain during urination or ejaculation, fever, or unexplained weight loss are signs that should prompt a visit to the doctor. It is also important to distinguish hematospermia from hematuria (blood in the urine), as visible blood in the urine is a separate symptom that requires evaluation.
While rare, hematospermia can sometimes be a sign of a systemic disease or a malignancy. Unmanaged severe high blood pressure or certain blood clotting disorders can manifest with blood in the semen. Cancers of the prostate, bladder, or testicles are an uncommon cause of hematospermia and it is rarely the first symptom. However, the possibility of malignancy is a primary reason that evaluation is recommended for men over 40 or those with other risk factors, such as a family history of prostate cancer.
The Diagnostic Process
When evaluating hematospermia, a physician will begin by taking a detailed medical history and performing a physical examination. The history will cover recent medical procedures, sexual activity, potential injuries, and any associated symptoms. The physical exam typically includes a genital examination and often a digital rectal exam (DRE), which allows the doctor to feel the prostate gland to check for abnormalities in size, shape, or texture.
Initial laboratory tests are usually straightforward and non-invasive. A urinalysis will be performed to check for infection or blood in the urine. If a sexually transmitted infection is suspected based on the medical history, a urine test can be used to check for organisms like chlamydia and gonorrhea. For men over 40, or for those with an abnormal DRE or other risk factors, a blood test to measure prostate-specific antigen (PSA) levels is often recommended.
Should the initial evaluation not reveal a clear cause, or if there are concerning findings from the exam or lab tests, further imaging may be ordered. A transrectal ultrasound is a common next step, which uses sound waves to create images of the prostate and seminal vesicles. This can help identify structural issues like cysts, stones, or tumors that might be causing the bleeding. This type of advanced imaging is typically reserved for cases that are persistent or present with other red flags.