Hematospermia - Blood in the Semen

Overview, Causes, & Risk Factors

Blood in the semen is uncommon. Seeing it can make people quite anxious, but it is rarely serious.

What is going on in the body?

Most cases of blood in the semen are from unknown causes. It usually goes away on its own.

What are the causes and risks of the condition?

Most cases are from an unknown cause. Known causes include:

  • infections of the prostate gland, called prostatitis. Prostatitis may be acute, chronic, or nonbacterial.
  • infections of the seminal vesicles, which are two structures that secrete some of the fluid found in semen
  • infections of the urethra, known as urethritis. The urethra is the tube that carries urine and semen to the outside of the body.
  • urethral strictures, or narrowing in an area of the urethra. This may be caused by trauma or a previous infection.
  • certain sexual habits, such as prolonged abstinence from or lack of sex or unusually frequent sex
  • bleeding or blood clotting problems, such as hemophilia A or hemophilia B. Clotting problems can also occur in men who are taking too much of the blood-thinning drug warfarin.
  • tumors or cancer, a rare cause. The cancer may be in the prostate, seminal vesicles, or urethra.

    • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Seeing blood in the semen can be quite frightening. Men with this symptom are often asked several questions by the doctor, including:

  • how many times blood has been seen in the semen
  • when the bleeding started
  • if there is blood in the urine or bleeding in other areas of the body
  • if the man has any pain
  • how often the man has had sex recently
  • if the man has ever had a sexually transmitted disease
  • what kind of sexual practices the man engages in

    • Other questions may be asked as well.

    Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis begins with a medical history and physical. This may be all that is needed in some cases. In other cases, further testing may be done. Urine tests, including a urinalysis and urine culture, are commonly used to look for infection or bleeding. Imaging studies or X-ray tests may be used to look for a urethral stricture.

    Prevention & Expectations

    What can be done to prevent the condition?

    Most cases cannot be prevented because the cause is unknown. Urethral stricture and infection of the urethra are often due to sexually transmitted diseases. So practicing safer sex could prevent some cases of blood in the semen.

    What are the long-term effects of the condition?

    There are usually no long-term effects. Many affected men have repeated episodes of blood in the semen with no other symptoms or problems. Urethral strictures are usually permanent unless they are treated. Cancer is quite rare but could possibly result in death.

    What are the risks to others?

    Blood in the semen itself is not contagious. If the cause is an infection such as a sexually transmitted disease, the infection may be contagious.

    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment is directed at the cause, if one can be found. A man may be given antibiotics for a short time in case there is an infection. A man with cancer or urethral strictures may need surgery.

    What are the side effects of the treatments?

    Antibiotics may cause allergic reactions, stomach upset, or headaches. All surgery carries a risk of bleeding, infection, and other complications.

    What happens after treatment for the condition?

    Many men continue to have occasional episodes of blood in their semen. Others may only have it once. Treatment doesn't seem to affect this.

    A man with a known cause for the blood usually gets better with treatment. After treatment, most men have no limitations on activities.

    How is the condition monitored?

    The man can monitor his semen at home for further episodes of bleeding. Changes or response to treatment can be reported to the doctor. Other monitoring is related to the cause. For example, a man who takes a blood thinner such as warfarin usually has regular prothrombin time, called PT, blood tests. Any worsening symptoms should always be reported to the healthcare provider.

    Attribution

    Author:Adam Brochert, MD
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:06/25/02
    Reviewer:Gail Hendrickson, RN, BS
    Date Reviewed:06/07/01

    Sources

    The Merck Manual, 1995, Berkow et al.