The presence of blood in semen, medically termed hemospermia, can be an alarming discovery, often prompting immediate concern. Semen is a mixture of fluids produced by the testes, seminal vesicles, and prostate, meaning the source of bleeding can be located anywhere along this path. While the sight of blood can be frightening, this condition is frequently benign and self-limiting, particularly for men under the age of 40. Most instances of hemospermia resolve spontaneously without specific medical intervention, but persistent or recurrent cases warrant a medical evaluation to rule out serious underlying conditions.
Common Reasons Blood Appears in Semen
The most frequent cause of blood in the ejaculate is inflammation or infection within the male reproductive tract. Since the prostate gland and seminal vesicles contribute the majority of seminal fluid, inflammation in these areas, known as prostatitis or vesiculitis, is a common culprit. An infection, such as a urinary tract infection or a sexually transmitted infection like chlamydia, can cause this inflammation, leading to a rupture of small, fragile blood vessels in the affected tissues.
In younger men (under the age of 40), an infectious or inflammatory process is the most commonly identified cause, or the condition is considered idiopathic, meaning no specific cause is found. The source can also be related to mechanical factors, such as minor trauma from vigorous sexual activity or prolonged sexual abstinence followed by ejaculation. This minor injury can cause a small vessel in the seminal vesicle or prostate to break, similar to a nosebleed.
Another cause is related to recent medical procedures, known as iatrogenic hemospermia. Procedures that involve instrumentation of the urinary or reproductive tract, such as a prostate biopsy or vasectomy, can lead to temporary bleeding that appears in the semen for several weeks afterward. Less common causes involve blockages in the ejaculatory ducts, potentially due to cysts or stones, which cause pressure resulting in bleeding. For men over 40, the likelihood of a more serious issue increases, necessitating a thorough diagnostic approach.
Recognizing When Medical Evaluation Is Necessary
While many cases of hemospermia resolve on their own, age is a primary factor; men over 40 require greater scrutiny than younger men. In this older age group, there is a slightly increased, though rare, possibility of malignancy, such as prostate cancer.
The duration and pattern of the bleeding are also important markers. A single, isolated episode that clears up quickly is generally less worrying than persistent hemospermia that lasts longer than three to four weeks, or bleeding that repeatedly recurs over time. A medical consultation is necessary if the blood in the semen is accompanied by associated symptoms that suggest a broader issue.
Accompanying symptoms suggest a systemic condition or infection and require professional investigation. These include systemic signs and localized symptoms.
Systemic Signs
- Fever
- Chills
- Unintended weight loss
- Bone pain
Localized Symptoms
- Pain during urination or ejaculation
- Difficulty starting or stopping the urine stream
- Visible blood in the urine (hematuria)
Clinical Diagnosis and Management
The initial clinical evaluation for hemospermia begins with a detailed patient history to ascertain the duration of the bleeding and the presence of associated symptoms or risk factors. A physical examination, including a check of the external genitalia and a digital rectal examination (DRE) of the prostate, is performed to look for abnormalities, tenderness, or masses. These initial steps help determine if the case is likely benign and self-limited or if it warrants further investigation.
Basic laboratory screening typically includes a urinalysis to check for infection or blood in the urine, along with testing for sexually transmitted infections (STIs). For men over 40, a prostate-specific antigen (PSA) blood test is often included to screen for prostate issues. If initial tests are negative and the condition is isolated and acute, management may simply be watchful waiting and patient reassurance.
If hemospermia is persistent, recurrent, or associated with concerning symptoms, advanced imaging may be utilized to pinpoint the source of bleeding. Transrectal ultrasound (TRUS) is a common imaging tool used to visualize the prostate gland and seminal vesicles for signs of cysts, stones, or inflammation. In select cases, magnetic resonance imaging (MRI) or cystoscopy may be used for a more detailed examination of the reproductive and urinary tracts. Management is then directed at the diagnosed cause, such as prescribing antibiotics for a confirmed infection or addressing underlying systemic issues like hypertension.