Finding blood in your semen can be very distressing; however, it is rarely indicative of a serious health condition, especially for men under the age of 40. Your primary care doctor or urologist may prescribe a battery of tests to help find the underlying cause and accordingly suggest a treatment option.
Blood in semen can be caused by many conditions that affect the male genitourinary system, which includes the bladder, urethra, testicles, seminal vesicles and prostate gland. In a majority of cases, the presence of blood in semen, also known as hematospermia, will usually resolve itself, especially if there are no associated symptoms. However, men who have persistent hematospermia and are over the age of 40 or experience associated symptoms, such as swelling or tenderness in the groin area, may need further evaluation.
The symptoms associated with blood in semen may vary depending on the cause. The following are some symptoms that commonly accompany blood in semen:
- Blood in urine
- Chills or fever
- Lower back pain
- Pain when ejaculating
- Pain when urinating
- Swelling of testicles or scrotum
- Swelling or tenderness in the groin area
Semen is an organic fluid that carries sperm and is produced in the seminal vesicles, prostate gland and urethral glands. Hematospermia most commonly results from nonspecific inflammation of these organs. For some, the exact cause of blood in semen is never uncovered. Other common causes of hematospermia include:
- Infection. Infection accounts for approximately 40 percent of hematospermia cases. Common infectious agents that cause hematospermia include gram-positive/gram-negative uropathogens, or herpes simplex virus types 1 (sexually transmitted infection). With infection, blood in semen is usually accompanied by fever, genital or urinary pain, difficulty urinating, or blood in your urine.
- Direct trauma. This may be caused by such things as a prostate biopsy, radiation therapy, testicular trauma or vigorous sex.
- Benign and malignant tumors. This includes tumors of the bladder, urethra, prostate, seminal vesicles, spermatic cord, epididymis and testes.
- Sexually transmitted diseases.
- Inflammation. This includes such conditions as epididymitis, prostatitis, or seminal vesiculitis
- Bladder stones.
In order to diagnose the underlying condition causing blood in semen your doctor will initially perform a physical exam (this will include a genital and rectal exam) and take a comprehensive medical history. Your doctor may order the following tests in order to help identify the underlying cause of hematospermia:
- Urinalysis. Multiple tests performed on urine.
- Transrectal ultrasound. A transrectal ultrasound, provides images of the prostate gland and surrounding tissue. In order to perform this exam, your doctor will insert an ultrasound probe into the rectum. The probe will emit and receive sound waves through the wall of the rectum into the prostate gland, which is right in front of the rectum.
- Cytoscopy. A cystoscopy allows your doctor to closely examine the urinary bladder. During this procedure, your doctor will insert a cytoscope (a hollow scope with a lens) into the bladder through the urethra.
- PSA blood test. The prostate-specific antigen (PSA) measures the level of PSA in the blood.
- Prostate exam. Examines issues with the prostate to rule out any other underlying conditions.
The goal for treating blood in semen is to address the underlying cause, if a cause has been found. If the underlying cause is an infection, then antibiotics will be prescribed. If you have a blockage or tumor in the genitourinary system, then the appropriate treatment, which may include surgery or chemotherapy will be recommended.
In many cases, if blood in the semen is not associated with any symptoms or structural abnormalities in the urinary tract, then no treatment is recommended and the condition will usually resolve itself. Persistent hematospermia (for a month or more) even in the absence of other symptoms warrants further or follow-up evaluation.
Although, finding blood in semen can be a frightening experience, in most cases no serious associated health condition is found and usually does not require any medical intervention. You may experience intermittent bouts of hematospermia, but it is typically self-limited and does not pose a serious health risk to you or your partner.
For a majority of cases, hematospermia is caused by unexplained inflammation in the genitourinary system, infection, minor procedures such as a prostate biopsy, or certain sexual behaviors. It is rarely associated with malignant cancers of the testicles and prostate. Nevertheless, it is always advisable to consult your doctor as a precaution and monitor your urine to make sure that there are no signs of blood.