Blood in the Semen: Should you be concerned?

by: Angelo E. Gousse, M.D.  and James Celestin, MSN, FNP-C, ARNP

Seeing blood in the semen can appear alarming for both males and their female counterparts. However, blood in the semen, also clinically known as hematospermia, is often a benign condition. The majority of the time, blood in the semen resolves on its own without any treatment.   

The male reproductive system consists of the testes, a system of ducts, and other glands near the ducts. First, sperm is made in the testes. When an orgasm takes place, muscle contractions move sperm from the testes to the vas deferens. Then, the prostate and seminal vesicles add fluid to protect and nourish the sperm. This compound of fluid and sperm transports through the urethra to the tip of the penis, where it is ejaculated or released. Blood in the semen can occur from anywhere in this process.

Now it is important to ask, what may actually cause hematospermia? Causes of blood in the semen include infection, inflammation, trauma, and other medical conditions. Furthermore, inflammation in the prostate, urethra, epididymis, vas deferens, and seminal vesicles can cause blood in the semen. Since all of these parts play a role in producing or moving semen in the genital tract, inflammation can cause tissue damage and result in bleeding. Sexually transmitted infections, such as chlamydia and gonorrhea, can also lead to blood in the semen. Traumatic episodes, such as testicular injuries, excessive rigorous sexual activity or even certain medical procedures, can cause temporary hematospermia. These medical procedures may include prostate biopsy, radiation therapy, and even vasectomy. Hematospermia may also be caused by other medical conditions, such as benign prostatic hyperplasia, tumors or polyps in the seminal vesicle.

When determining the cause of blood in the semen, it is also important to note any relating symptoms. Hematospermia associated with blood in the urine (hematuria) can suggest a traumatic etiology. On the other hand, hematospermia with painful/burning urination or penile discharge could indicate an infectious origin. Fever and increased heart rate can also signal an infection. If a patient with hematospermia also presents with a distended bladder or difficulty emptying his or her bladder, it may signal an obstruction of the lower urinary tract; while, swollen areas on the sex organs may indicate an infectious or inflammatory etiology.

After suspecting blood in the semen, one can benefit by visiting a health care provider to further evaluate this condition. One should expect the provider to take a complete medical history and perform a physical exam. After gathering more information, several tests, such as urinalysis,  Prostatic Specific Antigen (PSA), STD testing, condom collection test, cystoscopy or imaging studies, may be ordered for further evaluation. Urinalysis helps providers rule out infections or blood in the urine instead of the semen. If hematuria is present, a cystoscopy allows the urologist to visualize the lower urinary tract. Other imaging studies, such as ultrasound, CT scan, and MRI, also help evaluate areas of the urinary tract  that cannot be seen through cystoscopy.

Lesson to Remember

It is important to remember that the majority of cases of blood in the semen are self-limiting and do not cause any harm to the body. In selected cases, further testing may not even be necessary.  Reassurance is the treatment. However, if you notice repeated episodes of blood in the semen for longer than a month, it is recommended to visit a clinician in order  to have it evaluated.

Reference

Information from your family doctor. Hematospermia: blood in the semen. (2009). American Family Physician, 80(12), 1428.

Stefanovic, K., Gregg, P., & Soung, M. (2009). Evaluation and treatment of hematospermia. American Family Physician, 80(12), 1421-1427.

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