What is blood in semen?

Blood in semen is also called haematospermia.

Finding blood in your semen (blood in sperm) can be alarming. However, in most cases it is not serious, and is reasonably common.

Blood in semen is mostly seen in adult males aged less than 40 years. In most cases, where blood in semen is the only symptom, it clears up without the need for treatment.

What are the symptoms of blood in semen?

Blood in your semen appears brownish-red or red in colour. It is usually painless.

What causes blood in semen?

There are many possible causes of blood in your semen. Blood in semen can be caused by issues in the male reproductive system, including problems with your:

• testicles
• epididymis
• vas deferens
• seminal vesicles
• prostate gland

These issues may be:

• inflammation
• infection
• blockage
• injury

Infections

In younger men (under 40 years), infection is the most common cause of blood in semen. This can be due to:

• a urinary tract infection
• sexually transmitted infections (STIs), such as gonorrhoea or chlamydia

Urological procedures

Blood in your semen can also happen after urological procedures such as:

• vasectomy
• prostate biopsy

After a prostate biopsy, it may take 20 ejaculations before there is no blood present.

Sexual activity

Blood in the semen can also be caused by sexual activity, such as:

• after prolonged abstinence from sexual intercourse
• excessive sexual intercourse or masturbation

Prostate problems

Benign prostate enlargement where your prostate gland gets bigger, can cause changes to urination (weeing). It is also known as BPH or benign prostatic hypertrophy. This can sometimes cause blood in the semen.

Prostate cancer can also cause blood in the semen. But this is not a common cause.

Other causes

Other causes of blood in your semen, although rare, include:

• severe, uncontrolled high blood pressure
• tuberculosis
• parasitic infections

• testicular cancer
• blockages, such as a cyst or deposits of calcium (calcifications)
• diseases that affect blood clotting, like haemophilia and chronic liver disease
• anticoagulant medicines

When should I see my doctor?

You should see your doctor if you notice any blood in your semen, especially if you have any risk factors.

Risk factors for blood in semen include if you are over 40 years old, or if you have:

• experienced blood in your semen more than once before
• other symptoms such as weight loss or pain when ejaculating
• a family history of prostate cancer
• a history of injury to your pelvis
• a history of a disease that affects blood clotting
• had a urological procedure

Seeing your doctor is the best place to start. They can refer you to a urologist if necessary.

How is blood in semen diagnosed?

To diagnose the cause of blood in semen, your doctor will ask you about your symptoms. If you have noticed any other symptoms, such as blood in your urine or pain on ejaculating, let them know.

The doctor may also:

• do a physical examination of your genitals
• do a blood test
• do a rectal examination to check your prostate, by inserting a gloved finger into your bottom
• take your blood pressure and temperature

The doctor will ask you for a urine (wee) sample. They can check this for things which may only be visible under a microscope, such as:

• signs of a urinary tract infection
• blood

You may also be asked for a semen sample.

If you are aged over 40 years, the doctor will probably suggest you have a prostate-specific antigen (PSA) test. This a blood test that helps find prostate cancer and other prostate problems.

If you are referred to a urologist, there are other tests that may help in diagnosis. These include:

• ultrasound of your prostate or scrotum
• MRI (magnetic resonance imaging)
• CT scans of your pelvis
• cystoscopy, where a thin tube with a camera is used to look at your bladder and urethra

How is blood in semen treated?

The treatment for blood in semen depends on the underlying cause. Blood in semen often has no obvious cause, and no treatment is needed.

If it is caused by an infection, you may need antibiotics.

If an enlarged prostate is the cause of the blood, there are medicines that help to shrink your prostate. This may take several months.

If blood in your semen is an after-effect of a procedure like a vasectomy, your surgeon can advise you on how long this is expected to last.

If the cause is a blockage, a urologist may carry out a procedure to clear the blockage.

Prostate cancer is treated with:

• surgery
• radiation therapy
• hormonal therapy

Can blood in semen be prevented?

Blood in semen can be caused by many things. This makes it hard to prevent.

You can reduce your risk of blood in semen caused from infection by:

• protecting yourself against sexually transmitted infections
• avoiding travel to areas with tuberculosis or schistosomiasis (parasitic worms)

Complications of blood in semen

A common worry about blood in the semen is whether it will affect your fertility. Rest assured that most causes of blood in semen will have no effect on fertility.

A rare cause that may affect fertility is cancer of the testicles.

Resources and support

For more information, you can visit the Healthy Male website.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.