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Blood in semen

Definition

Blood in semen (hematospermia) can be frightening, but the cause of this uncommon condition is usually benign. Typically, blood in semen goes away on its own.

Causes

Semen consists of sperm and fluids released by the prostate and other glands. The fluids, also called ejaculate, join the sperm as they pass through a series of tubes to the urethra for ejaculation. A number of things can break blood vessels along this route or along the urinary route to the urethra. Broken vessels then leak blood into the semen, urine or both.

Your doctor will ask if you've had prostate surgery or a prostate biopsy recently, since these procedures can cause blood in semen for several weeks afterward.

Most often, no cause can be found for blood in semen. In some cases, particularly among men under age 40, infection is a possible cause. Infection is usually accompanied by other signs and symptoms, such as painful urination.

For men age 40 and older, or if the blood in semen is severe or recurrent, in rare cases this might be a warning sign for conditions such as cancer. As a result, a more-careful evaluation might be needed. But the risk is low. In a follow-up study of 200 men, mostly over 40, who typically had multiple episodes of blood in their semen, prostate cancer developed in only 4 percent.

Possible causes of blood in semen:

  • Brachytherapy
  • Chlamydia trachomatis
  • Epididymitis
  • Excessive sexual activity or masturbation
  • External beam radiation for prostate cancer
  • Genital herpes
  • Forgotten (retained) tampon
  • Hemophilia
  • Interrupted sex
  • Orchitis
  • Prolonged sexual abstinence
  • Prostate biopsy
  • Prostate cancer
  • Prostatitis
  • Testicular trauma
  • Vasectomy

Rare causes of blood in semen:

  • Amyloidosis
  • Benign growths (cysts, polyps) in the bladder, urethra or prostate
  • Schistosomiasis
  • Testicular cancer
  • Tuberculosis
  • Warfarin side effects

When to see a doctor

If you're under age 40 and see blood in semen, you probably don't need to see the doctor as long as:

  • You have no other symptoms
  • You've had a recent prostate exam or vasectomy, which could explain short-term bleeding
  • There isn't a lot of blood in the semen and it happens infrequently, then goes away

Make an appointment with your doctor if:

  • You're 40 or older
  • Blood in semen persists longer than three to four weeks
  • The blood repeatedly recurs
  • You have other signs and symptoms, such as painful urination
  • You have other risk factors, such as a history of cancer, bleeding disorders or genital or urinary system malformation, or you've recently engaged in behaviors that put you at risk of sexually transmitted infections

Last updated: August 4th, 2015

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