The presence of blood in semen, medically termed hematospermia, can be an alarming experience. This is the result of bleeding somewhere along the path that semen travels, which includes the testes, epididymis, vas deferens, seminal vesicles, and prostate gland. While the sight of blood can cause immediate anxiety, the condition is often temporary and benign, especially for individuals under the age of 40. Any instance of hematospermia warrants a medical evaluation to determine the underlying cause and ensure no serious condition is overlooked.
Common and Temporary Causes of Blood in Semen
The most frequent causes of blood in semen are typically self-limiting and originate from inflammation or minor trauma within the reproductive tract. Infections and inflammation are the culprits in nearly 40% of cases, commonly involving the prostate (prostatitis), urethra (urethritis), or epididymis (epididymitis). These infections, which can include STIs like chlamydia or gonorrhea, cause localized swelling that makes small blood vessels fragile and prone to rupture during ejaculation.
Minor trauma to the genitourinary system is another common source of temporary bleeding. This can occur from vigorous sexual activity, prolonged sexual abstinence followed by ejaculation, or a sudden increase in blood pressure during orgasm. The small blood vessels within the prostate or seminal vesicles can break, similar to a nosebleed, leading to a single or few episodes of blood in the ejaculate.
Recent medical procedures are a common iatrogenic cause, particularly in older men. Following a prostate biopsy, for example, many men may experience temporary hematospermia that typically resolves within a few weeks. Other procedures like vasectomy or radiation therapy for prostate cancer can also cause mild trauma and subsequent bleeding that subsides on its own.
When Blood in Semen Signals a More Serious Issue
While most cases are benign, persistent or recurrent hematospermia, especially in men over 40, can indicate a more serious underlying issue. One possibility is the obstruction of the ejaculatory duct, which can cause pressure to build up and rupture nearby blood vessels. This blockage may be due to the formation of cysts or calculi (stones) within the seminal vesicles or prostate.
Systemic conditions that affect clotting ability can also manifest as blood in the semen. These issues include severe, uncontrolled high blood pressure (malignant hypertension), bleeding disorders, or chronic diseases such as liver cirrhosis. In these scenarios, hematospermia is a symptom of a larger problem that requires immediate management.
Hematospermia can be a symptom of malignancy, such as prostate, testicular, or bladder cancer. This is particularly a concern when the bleeding is accompanied by other symptoms, including blood in the urine (hematuria), unexplained weight loss, fever, or bone pain. These associated symptoms, along with advanced age, prompt a more urgent investigation to rule out a tumor.
Navigating the Medical Evaluation Process
The first step in evaluation is a detailed medical history, where a physician will ask about the duration of the symptoms, any accompanying pain, recent procedures, and sexual activity. A physical examination is performed to check for signs of infection, masses, or tenderness, and it typically includes a digital rectal examination (DRE) to feel the size and texture of the prostate gland. Measuring blood pressure is also a routine part of the exam to check for severe hypertension as a systemic cause.
Initial laboratory testing often includes a urinalysis and urine culture to check for blood in the urine and to identify a urinary tract infection. Screening for sexually transmitted infections (STIs) is also standard, especially in younger men, as these are a common infectious cause. For men over 40, or those with other risk factors, a blood test to measure prostate-specific antigen (PSA) levels is frequently ordered to screen for prostate issues.
If the hematospermia is persistent, recurrent, or if the initial evaluation is inconclusive, imaging studies may be necessary. A transrectal ultrasound (TRUS) is often the preferred next step, as it provides clear images of the prostate, seminal vesicles, and ejaculatory ducts, helping to identify cysts, calculi, or masses. Magnetic resonance imaging (MRI) or cystoscopy may be used if the TRUS is non-diagnostic.
Treatment Approaches Based on the Underlying Cause
Treatment for hematospermia is entirely dependent on the specific cause identified during the medical evaluation. If an infection, such as prostatitis or epididymitis, is the confirmed source, a course of antibiotics is typically prescribed. For many patients, particularly those under 40 with a single, self-limited episode, the cause is never definitively found, and the recommended approach is often watchful waiting, as the condition resolves spontaneously.
Inflammation without a clear infection may be managed with anti-inflammatory medications to help reduce swelling in the affected glands. If an enlarged prostate (benign prostatic hyperplasia) is contributing to the bleeding, medications such as finasteride may be used to shrink the prostate and stabilize the fragile blood vessels.
For structural issues, such as an obstructing cyst or calculus in the ejaculatory duct, a urologist may recommend a minimally invasive procedure. Endoscopic techniques, like transurethral incision of the ejaculatory ducts, can be used to open blockages and relieve pressure. If a systemic condition or malignancy is the cause, the hematospermia is managed as part of the overall treatment plan for that primary disease.