Blood in semen

Specialty of Andrology

What is blood in the semen?

Blood in the semen is also known as haemastospermia. Normally, the amount of blood that appears is small and therefore it is not always noticeable. It is most apparent in ejaculation. The most common cause of haemastospermia is a prostate biopsy. Usually, the condition is benign and it resolves by itself.

What are the symptoms of haemastospermia?

The symptoms related to having blood in the semen vary, depending on the underlying cause but some of the most common signs are:

  • bleeding during urination
  • painful ejaculation
  • pain in bowel movements and urination
  • low back pain
  • fever and chills
  • swelling and tenderness in the scrotum and in the groin area
  • difficulty in emptying the bladder

Causes of blood in the semen:

In the majority of cases, blood in the semen is caused by infection and inflammation of the prostate or seminal vesicles. Haemastospermia can come from different sources, with the most common being:

  • Vesiculitis – inflammation of the seminal vesicles
  • Seminal vesicle cysts
  • Prostatitis – an inflamed prostate gland
  • Sexually transmitted infections (STIs) – such as genital herpes, chlamydia, gonorrhoea or trichomoniasis
  • Trauma or a medical procedure – prostate biopsy, radiation therapy and vasectomy.

The less common causes of haemastospermia are:

  • Severe high blood pressure
  • A blood clot disorder
  • Cancer – of the prostate or testicles, or small bladder stones in the seminal vesicles.

How is haemastospermia diagnosed?

One of the most commonly performed tests is a urinalysis to identify if there is a sexually transmitted infection or another infection. Imaging such as an ultrasound or MRI may highlight tumours or other abnormalities. A semen analysis may also be performed, which involves checking the semen under a microscope.

How is haemastospermia treated?

The treatment of blood in the semen depends on what the doctor identifies as being the underlying cause. If there are no other symptoms, or if it was an isolated occurrence, treatment is not necessary and it will resolve by itself. In other cases, the patient may be given antibiotics to treat an infection, or a cyst may be drained with a needle. If there is a more serious underlying cause, such as cancer, the patient will be referred to a specialist for necessary treatment.

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