Hematospermia (Blood in Semen): What You Need to Know

Overview

Hematospermia, also called blood in semen, is a symptom where semen appears pink, red, brown, or has visible blood spots. It is far more common than many people realize, affecting up to 1 in 5 men at some point in their lives, and is almost always harmless, especially in men under 40. In most cases, it resolves on its own within a few weeks without any treatment, but it can sometimes be a sign of an underlying condition that needs medical care.

Signs & Symptoms

The primary sign of hematospermia is discolored semen, which may range from light pink to bright red or dark brown, depending on how long the blood has been present. Some men also notice small blood clots in their semen. In most cases, there are no other symptoms, but you may also experience pain or burning with urination, pain during ejaculation, fever, or pelvic pain if the underlying cause is an infection or inflammation.

Causes & Risk Factors

In many cases, no specific cause is found, and the blood in semen goes away without explanation. When a cause is identified, the most common reasons include:

• Inflammation or infection of the prostate (a small gland that produces fluid for semen, called prostatitis), seminal vesicles (glands that produce most of the fluid in semen), or epididymis (the tube that stores and carries sperm), which are the most frequent causes, often from bacterial infections
• Recent medical procedures involving the reproductive or urinary tract, such as a prostate biopsy, vasectomy, or cystoscopy, which can cause temporary bleeding
• Trauma to the genital area, including from vigorous sexual activity, prolonged abstinence, or injury
• Blockages or cysts in the seminal vesicles or ejaculatory ducts
• Rarely, more serious conditions including prostate or testicular cancer, or blood clotting disorders, which are much more common in men over 40

Risk factors for hematospermia include a history of urinary tract infections, recent reproductive or urinary tract procedures, unprotected sex that leads to sexually transmitted infections, and age over 40, which is associated with a higher risk of serious underlying causes.

Diagnosis

If you notice blood in your semen that lasts longer than a few days, or if you have other symptoms, your doctor will start with a physical exam, including a genital and prostate exam. They may order tests including a semen analysis to check for infection or abnormal cells, urine tests to look for urinary tract infections, and imaging tests such as an ultrasound of the prostate and seminal vesicles if needed. If you are over 40, or have risk factors for cancer, your doctor may also order a PSA (prostate-specific antigen) blood test to screen for prostate issues.

Treatment & Management

Treatment for hematospermia depends entirely on the underlying cause. If no cause is found and the symptom is not accompanied by other issues, no treatment is usually needed, as it will resolve on its own. If an infection is causing the symptom, your doctor will prescribe antibiotics or antifungal medications. For inflammation, anti-inflammatory medications or pain relievers may be recommended. In rare cases where a cyst, blockage, or other structural issue is causing the problem, minor surgery may be needed to correct it.

Living With It

Most men with hematospermia can continue their normal daily activities, including sexual activity, unless their doctor advises otherwise. If you are experiencing anxiety about the symptom, it can help to track when the episodes occur, how long they last, and any other symptoms you have, to share with your doctor. Avoid strenuous physical activity or heavy lifting if you have recent genital trauma, as this can worsen bleeding.