Blood in Semen: Overview, Prognosis and Treatment

Blood in semen Overview

Blood in semen (hematospermia) can be frightening, but the vast majority of time, it’s not cause for serious concern. Blood in semen is uncommon, and, most often, it goes away on its own.

Blood in semen facts

• Blood in the semen is known as hematospermia.
• Prostate biopsy is the most common cause of blood in the semen.
• Blood in the semen can be caused by tumors, infections, anatomical abnormalities, stones, or inflammation in many sites throughout the genitourinary system.
• Usually blood in the semen is benign and resolves on its own.
• Treatment, if indicated, depends upon the underlying cause.

Causes of Blood in Semen

Blood in the semen can come from several different sources:

Infection and inflammation. This is the most common cause of blood in the semen. Blood can come from an infection or inflammation, in any of the glands, tubes, or ducts that produce and move semen from the body. These include:

• Prostate(the gland that produces the fluid part of semen)
• Urethra (the tube that carries urine and semen from the penis)
• Epididymis and vas deferens (tiny tube-like structures where sperm mature before ejaculation)
• Seminal vesicles (which add more fluid to the semen)

It can also come from an STD (sexually transmitted disease) such as gonorrhea or chlamydia, or from another viral or bacterial infection. Infection and inflammation are the culprits behind nearly four out of every ten cases of blood in the semen.

Trauma or a medical procedure. Blood in the semen is common after medical procedures. For instance, as many as four out of five men may temporarily have blood in their semen following a prostate biopsy.

Procedures done as treatment for urinary problems can also cause mild trauma that leads to temporary bleeding. This usually disappears within several weeks after the procedure. Radiation therapy, vasectomy, and injections for hemorrhoids can also cause blood. Physical trauma to the sex organs after pelvic fracture, injury to the testicles, excessively rigorous sexual activity or masturbation, or other injury can cause blood in the semen.

Related Symptoms of Blood in Semen

When looking for an underlying cause of blood in the semen, the doctor will ask about any related symptoms, including:

• Blood in the urine (called haematuria)
• Hot, burning urination or other symptoms of painful urination
• Difficulty emptying your bladder completely
• A painful bladder that feels distended
• Painful ejaculation
• Swollen or painful areas on the sex organs or obvious scrapes from injury
• Penis discharge or other signs of an STI
• Fever, racing pulse and higher-than- normal blood pressure

What is the prognosis (outlook) for patients with blood in the semen?

The prognosis relates to the underlying cause of blood in the semen if a cause can be identified. However, most cases of hematospermia are benign and resolve without treatment. While cancer is a rare cause of blood in the semen, the majority of cases are not related to cancer, especially in younger men.

Blood in semen: Tests and evaluation

To diagnose blood in the semen the doctor will take a complete medical history. That will include a history of any recent sexual activity. The doctor will also perform a physical examination. This will include examining the genitals for lumps or swelling and a digital rectal examination to check the prostate for swelling, tenderness and other symptoms. The doctor may also arrange the following tests:

• Urinalysis or urine culture to identify infection or other abnormalities.
• STI testing if a sexually transmitted infection is suspected.
• The “condom test” if there’s a possibility that blood in the semen is actually coming from a sexual partner’s menstrual cycle. The man will be told to wear a condom and then examine the “protected” semen for blood.
• PSA testing, to help determine prostate cancer by measuring a substance called prostate-specific antigen in the blood.
• Other urological tests such as cystoscopy, ultrasound, CT and MRI to further evaluate the patient.

Treatment for Blood in Semen

Treatments target the known cause:

• Antibiotics are used for infections.
• An anti-inflammatory medication may be prescribed for some types of inflammation.
• If an STD or medical condition such as high blood pressure or liver disease is the culprit, the doctor will treat that condition.
• When blood in semen stems from a recent urology procedure, it usually disappears by itself in a matter of weeks.

In younger men, blood in the semen that happens just once or twice without any additional symptoms or history of certain medical conditions can disappear on its own without treatment.

If you have repeated episodes of blood in the semen along with painful urinary or ejaculatory symptoms, the doctor may refer you to a urologist.

If the doctor suspects prostate cancer, or another form of cancer, the doctor may ask for a prostate biopsy to evaluate the tissue for cancer. The incidence of prostate cancer is low in younger men  only 0.6% of cases occur in men younger than 45. But for men of any age with risk factors for cancer, testing that rules out prostate cancer may be the most reassuring part of treatment for blood in semen.