Hematospermia is the medical term used to describe the presence of blood in the semen. The ejaculate may appear pink, red, or brownish-red, depending on the amount of blood and how long it has been present. While the sight of blood can cause alarm, hematospermia is overwhelmingly considered a benign and self-limiting condition in most cases.
The condition occurs when a blood vessel leaks blood into the seminal fluid anywhere along the male reproductive tract, from the testes to the urethra. This system includes the prostate gland and the seminal vesicles, which contribute the majority of the ejaculate volume.
Identifying Common Causes
The most frequent causes of blood in the semen involve inflammation or infection within the genitourinary system. These infectious processes commonly affect the organs responsible for producing and transporting semen, such as the prostate (prostatitis) or the seminal vesicles (vesiculitis). In men under the age of 40, these inflammatory or infectious conditions are considered the most likely source of hematospermia.
Other sources of inflammation include the urethra (urethritis) or the epididymis, the coiled tube behind the testicle where sperm mature. These infections are often treated with antibiotics and typically result in the prompt resolution of the bleeding. However, in a large percentage of cases, the exact cause is never identified, and the condition is classified as idiopathic.
Trauma is another common source of bleeding, often occurring after urological procedures or intense sexual activity. Iatrogenic causes, meaning those resulting from medical intervention, are among the most frequently cited reasons for hematospermia. The most common of these is a prostate biopsy, which can result in visible blood in the semen for a period after the procedure.
Less frequent causes involve systemic conditions that affect the body’s clotting ability or blood vessel integrity. Uncontrolled high blood pressure (hypertension) can cause delicate capillaries within the reproductive organs to rupture. Similarly, underlying bleeding disorders or the use of blood-thinning medications may also contribute to the presence of blood in the ejaculate.
Typical Duration and Resolution
For the majority of individuals, hematospermia is a transient event that resolves without specific medical intervention. The duration of the bleeding is highly variable, but most self-limiting cases resolve within a few days to a few weeks following the initial observation.
When the cause is related to a medical procedure like a prostate biopsy, the bleeding may persist for a slightly longer period. In these instances, the blood may be visible in the ejaculate for up to one month, though it often lessens in severity over that time. Cases not caused by infection, inflammation, or malignancy resolve spontaneously in over 88% of patients, with a mean duration of about six weeks.
The color of the semen offers a clue regarding the timing of the bleeding. Bright red blood indicates fresh bleeding, while a rusty or brownish color suggests the blood is older, indicating the body is clearing the residual blood. Patients should monitor the frequency and appearance of the blood over several ejaculations. Persistence beyond a few months or recurrence is the primary factor requiring further investigation.
When Medical Evaluation is Necessary
While most episodes of hematospermia are benign, specific circumstances necessitate a medical evaluation. The two most important factors guiding the need for professional intervention are the duration of the symptoms and the patient’s age. If the blood in the semen persists beyond the typical resolution period, generally defined as four to six weeks, or if it recurs frequently, a doctor should be consulted.
Age is a significant differentiating factor. Hematospermia in men over 40 years old carries a slightly higher risk of being associated with malignancy or structural abnormalities. Therefore, any man in this age group experiencing hematospermia should undergo an investigation to exclude serious conditions like prostate cancer. This evaluation typically includes a physical examination, laboratory tests, and often a prostate-specific antigen (PSA) test.
The presence of associated symptoms is another red flag that warrants immediate medical attention, regardless of the patient’s age. These symptoms include fever, chills, unexplained weight loss, or persistent pain in the lower back or groin area. Finding blood in the urine (hematuria) alongside hematospermia also requires prompt investigation, as it suggests a separate issue in the urinary tract.