Blood in semen can have several causes, such as infections, inflammation, trauma or recent exams. Learn when it’s a warning sign and how to treat it.
Blood in semen, known as hematospermia, can result from trauma, infections, inflammation or cancer. The symptom may also appear after certain medications, tests or surgeries. Read on to understand what blood in semen means and how to treat it.
What is blood in semen and how does it happen?
The most common explanations for blood in semen include sexually transmitted infections and changes in the prostate, testicles, urethra or seminal vesicles.
It can also be a symptom of prostate cancer. Depending on location, blood in semen may signal cancer of the testicles, bladder or urethra.
Finally, the issue may stem from certain drugs, sports-related impacts, vigorous sexual activity, exams or surgeries.
Main causes of blood in semen
Learn the nine leading causes of blood in semen:
1. Genital injuries
Cuts or knocks to the penis after exercise or intense sex are the top causes of blood in semen for men aged 40 or under. Other risk-raising injuries include:
- Tight clothing compressing the penis or testicles;
- Sitting on an object left in the back pocket;
- Sitting down hard on a solid surface;
- Long cycling or motorcycling sessions that press the perineum (area between anus and scrotum).
2. Urinary tract infections
According to this article, urinary and urogenital infections can cause blood in semen.
One example is urethritis—an infection of the urethra, the tube that carries urine out of the body—often due to bacteria such as Chlamydia trachomatis and Neisseria transmitted during sex.
3. Sexually transmitted infections
Sexually transmitted infections like chlamydia, gonorrhoea and genital herpes can cause blood in semen by inflaming the urethra, prostate or seminal vesicles.
4. Prostate changes
One is prostatitis, a bacterial inflammation often linked to Escherichia coli, Proteus spp and Klebsiella spp.
An enlarged prostate is another frequent cause of blood in semen among men over 50. Inflammation can press nearby vessels, leading them to rupture and leak blood during ejaculation.
5. Testicular changes
Infections such as orchitis weaken blood vessels, and testicular trauma can rupture them, causing the symptom.
6. Prostate cancer
Blood in semen may indicate advanced prostate cancer. In testicular cancer, bleeding is due to compression of local structures.
7. Urogenital schistosomiasis
In this disease, the parasite Schistosoma haematobium invades blood vessels in the bladder and genitals, leading to chronic inflammation and vessel rupture.
8. Prostate biopsy
A prostate biopsy collects tissue samples with a fine needle and may injure small vessels. Bleeding is usually normal but seek medical advice if it lasts over two weeks or comes with pain and fever.
9. Vasectomy
During vasectomy the vas deferens are cut or blocked, possibly injuring vessels and causing light bleeding for two to three weeks.
Risk factors for blood in semen
Being over 40 increases risk, as prostate enlargement and cancer become more common. Other factors include:
1. Anticoagulant medication
These drugs weaken vessel walls, making rupture easier.
2. Coagulation disorders
Haemophilia, a genetic disorder, slows clotting, so bleeding takes longer to stop.
3. Diabetes
High blood sugar damages vessel walls and heightens bleeding risk—during ejaculation, too. Uncontrolled diabetes can also cause neuropathy. Learn more about diabetes complications.
When is blood in semen a concern?
Hematospemia is usually mild, but worry if you notice:
- Persistent bleeding;
- Visible changes in penis or testicles;
- Swelling, pain, fatigue, fever or weight loss;
- Urinary changes;
- History of cancer.
How do doctors identify the cause?
Diagnosis involves:
- Medical history (e.g., sports injury or recent procedure);
- Physical exam for infection, inflammation or prostate changes;
- Imaging: testicular ultrasound, transrectal ultrasound, CT, MRI;
- Lab tests: urine analysis/culture, blood tests, semen analysis, STI testing;
- Special tests for vascular issues or urogenital schistosomiasis.
Treatments for blood in semen
Therapy depends on cause:
- Infections: antibiotics plus anti-inflam-matories for pain/swelling;
- Non-infectious inflammation: alpha-blockers for urinary symptoms and anti-inflam-matories for pain;
- Clotting disorders: medication review or change;
- Cancer: surgery, radiotherapy or chemotherapy;
- Vasectomy: painkillers and anti-inflam-matories;
- Prostate biopsy: anti-inflam-matories and cold compresses;
- Urogenital schistosomiasis: antiparasitic medication.
How to prevent blood in semen – care tips
- Use condoms every time you have sex;
- Get routine STI tests;
- Look after prostate health (digital rectal exam from age 40);
- Wear protection for contact sports;
- Avoid positions that over-press the genitals;
- Keep blood sugar under control if diabetic;
- See a doctor at the first sign of infection or inflammation.
When should you see a urologist?
Men should consult a urologist if bleeding persists, regardless of other symptoms. Professional guidance helps pinpoint the cause and choose the right treatment.
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