Hematospermia is the medical term for the presence of blood in the ejaculated fluid (semen). While seeing blood in the ejaculate can be concerning, the condition is often temporary and benign, especially for younger men. Hematospermia is usually self-limiting and resolves without specific treatment. However, any instance of blood in semen warrants a medical evaluation to rule out underlying conditions.
Understanding Hematospermia
Semen is a complex fluid created by several organs in the male reproductive system before it is expelled during ejaculation. The blood that appears in the semen typically originates from structures located along the ejaculatory pathway. The seminal vesicles and the prostate gland are the two most common anatomical sources of bleeding, as they contribute the majority of the fluid volume to the semen. Bleeding from these areas can be caused by the rupture of tiny, fragile blood vessels during the forceful muscular contractions of ejaculation, similar to a minor nosebleed.
Primary Causes and Risk Factors
The causes of hematospermia are diverse, though often a definite cause is never identified. Infections and inflammatory conditions in the genitourinary tract are the most frequent causes, particularly in men under 40 years old. Inflammation of the prostate (prostatitis) or the epididymis (epididymitis) can lead to bleeding. Sexually transmitted infections (STIs) like chlamydia and gonorrhea are also potential infectious causes.
Trauma or recent medical procedures often account for a significant number of cases. For example, a recent prostate biopsy is a common cause of blood in the semen, which can persist for several weeks afterward. Other procedures, such as a vasectomy or radiation therapy, can also lead to temporary hematospermia. Even vigorous sexual activity or prolonged sexual abstinence can sometimes cause minor vessel rupture.
Structural or vascular abnormalities can also be responsible. These include cysts within the seminal vesicles or ejaculatory ducts, which can increase pressure and cause adjacent blood vessels to leak. Varices (swollen veins) or other vascular malformations in the area may also rupture during ejaculation. Systemic medical conditions, such as uncontrolled high blood pressure (hypertension) or underlying blood clotting disorders, can compromise the integrity of small vessels throughout the reproductive tract.
While rare, malignancy must be considered as a potential underlying cause, particularly for older individuals. Cancers of the prostate, seminal vesicles, or testes can present with hematospermia. Although blood in semen is seldom the first or only symptom of a genitourinary cancer, its presence warrants evaluation, especially in men over the age of 40.
Recognizing Serious Symptoms
It is important to know when hematospermia requires medical attention rather than being a self-limiting event. The duration and pattern of the bleeding are important factors. Any episode of blood in the semen that lasts longer than a few weeks or that repeatedly comes back should be evaluated by a healthcare provider, as persistence or recurrence suggests a more serious underlying issue.
Associated symptoms that appear alongside the blood are considered “red flags” that signal a potentially serious condition. These warning signs include fever, chills, or unexplained weight loss, which may suggest a systemic infection or an undiagnosed malignancy. Severe pain in the lower back, groin, or with urination or ejaculation also warrants a prompt medical workup. Furthermore, the presence of blood in the urine (hematuria) necessitates a full urological investigation.
Patient demographics also play a crucial part in assessing the severity. Men over the age of 40 are at a higher risk for malignancy, such as prostate cancer. Therefore, a first-time episode of hematospermia in an older patient without an obvious cause, like a recent biopsy, should prompt a more thorough evaluation.
Clinical Diagnosis and Treatment Approaches
Diagnosis
Diagnosis begins with a comprehensive medical history and physical examination. The initial physical exam typically includes a digital rectal exam to assess the prostate gland for any signs of enlargement or suspicious nodules. Laboratory tests are a foundational step, often starting with a urinalysis to check for infection or inflammation. Screening for sexually transmitted infections is routinely performed, especially in younger, sexually active men. For men over 40, a Prostate-Specific Antigen (PSA) blood test may be ordered to screen for prostate cancer. If the initial workup does not identify a clear cause, or if the bleeding is persistent, imaging studies may be indicated. A transrectal ultrasound (TRUS) can provide detailed images of the prostate, seminal vesicles, and ejaculatory ducts to check for cysts, stones, or tumors.
Treatment
The treatment for hematospermia is highly dependent on the underlying cause identified during the diagnostic process. If a bacterial infection, such as prostatitis, is confirmed, a course of antibiotics is the appropriate treatment. For cases linked to inflammation without a clear infection, anti-inflammatory medications may be prescribed. If the cause is idiopathic (no specific reason is found), treatment is often watchful waiting and patient reassurance. For benign cases, such as those following a procedure, the condition is expected to resolve on its own. If a structural abnormality like a seminal vesicle cyst is found, specialized procedures may be required to drain or remove the cyst. Malignancy necessitates a specific treatment plan, which may include surgery, radiation, or other targeted therapies.