Hematospermia, the medical term for blood in the semen, is a symptom that can be alarming. The ejaculate may appear pink, red, or rust-colored, depending on the volume of blood and how recently the bleeding occurred. While the sight of blood causes distress, in the vast majority of cases, especially in men under 40, the condition is temporary and not a sign of a serious underlying disease. It originates from an issue along the path that semen travels, which includes the testes, epididymis, vas deferens, seminal vesicles, and prostate.
Common and Benign Reasons for Bleeding
The most frequent causes of bleeding originate from inflammation or minor trauma within the male reproductive tract. Semen is largely composed of fluid produced by the seminal vesicles and the prostate gland, making these structures the most common source of blood. Inflammation or infection, known as vesiculitis or prostatitis, is a leading cause of hematospermia, especially in younger men.
These infections can be bacterial, often involving organisms responsible for urinary tract infections, or sexually transmitted infections like chlamydia and gonorrhea. Inflammation irritates the small, fragile blood vessels lining the ducts or glands, causing them to rupture during ejaculation. This type of hematospermia is often accompanied by mild symptoms, such as discomfort during urination or a feeling of heaviness in the groin area.
Physical trauma is another common, non-serious origin for bloody semen. This includes injury to the perineum or groin, or minor internal trauma from overly vigorous sexual activity or prolonged sexual abstinence followed by ejaculation. The bleeding is often from a temporary rupture of a tiny vessel in the prostate or seminal vesicle, which quickly clots and resolves on its own.
Recent medical procedures are a common trigger, known as iatrogenic trauma. For example, a transrectal ultrasound-guided prostate biopsy, used to sample prostate tissue, almost universally causes temporary hematospermia that can persist for up to four weeks. Other procedures like a vasectomy or certain injections can similarly cause a brief period of bleeding into the ejaculate.
Less Common, More Serious Causes
While most cases are benign, persistent or recurrent hematospermia signals a need to investigate less common, though more concerning, underlying conditions. Age is a significant factor; hematospermia in men aged 40 or older warrants a comprehensive evaluation. This is due to a slightly increased risk of malignancy, specifically prostate cancer, which presents in a small percentage of older patients with this symptom.
Structural abnormalities within the reproductive plumbing can cause chronic irritation and bleeding. These include cysts or stones (calculi) forming within the prostate or seminal vesicles. A seminal vesicle cyst can obstruct fluid flow and cause vessels to dilate and bleed repeatedly. The presence of such structural issues can lead to persistent or recurring hematospermia that does not resolve without intervention.
Systemic issues that affect the body’s vascular or clotting systems may also manifest as blood in the semen. Uncontrolled, severe hypertension can cause fragile vessels in the reproductive tract to break. Similarly, bleeding disorders, liver disease that impairs clotting factor production, or the use of anticoagulant medications increase the likelihood of blood appearing in the ejaculate. If hematospermia is persistent, recurrent, or accompanied by other symptoms like unexplained weight loss, fever, or bone pain, a medical consultation should be scheduled promptly.
Medical Assessment and Diagnostic Steps
The medical assessment begins with a detailed patient history to ascertain the duration, frequency, and amount of bleeding, as well as any associated symptoms like pain or difficulty urinating. A physical examination is then conducted, including checking vital signs and performing a genital examination to check for masses or tenderness. A digital rectal examination (DRE) allows the physician to assess the size, texture, and tenderness of the prostate gland.
Laboratory tests are a standard next step, often starting with a urinalysis and urine culture to check for infection or blood in the urine (hematuria). Testing for sexually transmitted infections is routinely recommended, especially for younger patients. For men over 40, a Prostate-Specific Antigen (PSA) blood test is often included to screen for prostate issues.
If the initial assessment and lab results do not identify a cause, or if the bleeding is persistent, imaging studies may be ordered. Transrectal Ultrasound (TRUS) is often the first imaging choice, providing clear pictures of the prostate and seminal vesicles to detect cysts, stones, or structural lesions. In select cases, Magnetic Resonance Imaging (MRI) may be used for a more detailed view of the pelvic anatomy. Treatment is always directed at the underlying cause, whether it involves a course of antibiotics for an infection or simply observation for a benign, self-limiting event.