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Finding blood in your semen (blood in sperm) can be alarming. However, in most cases blood in the semen (also called haematospermia) is not serious.
Blood in the semen may make the semen appear brownish-red or red in colour. It is usually painless.
Is blood in the semen normal?
Blood in the semen is not normal, but it is reasonably common. Most men who have it, have repeated episodes.
It can affect men at any age after puberty but is most common in men aged 30 to 40 years and in men over 50 years who have an enlarged prostate gland not caused by cancer. In most cases where blood in semen is the only symptom, it clears up without the need for treatment.
What causes blood in the semen?
Blood in semen can be caused by inflammation, infection, blockage or injury anywhere in the male reproductive system, including the testicles, epididymis, vas deferens, seminal vesicles and prostate gland.
Does blood in the semen mean I have cancer?
Prostate cancer is not a common cause of blood in the semen, but it is a more likely cause in men aged over 40 years of age than in younger men. However, the vast majority of men with blood in the semen who see a urologist do not have an underlying cancer.
What conditions can cause blood in the semen?
There are many possible causes of blood in the semen.
In younger men (under 40), infection is the most common cause. This can be due to urinary tract infection or sexually transmitted infections (STIs), such as gonorrhoea or chlamydia.
Blood in the semen may sometimes happen after a recent urological procedure, such as a prostate biopsy or a vasectomy. After a prostate biopsy, it may take 20 ejaculations before there is no blood present.
Prolonged abstinence from sex or prolonged sex or masturbation can also cause blood in the semen.
Benign prostate enlargement (known as BPH or benign prostatic hypertrophy) where the prostate gland enlarges, can cause changes to urination and sometimes causes blood in the semen.
Prostate cancer can cause blood in the semen, but it’s not a common cause.
Severe, uncontrolled high blood pressure can cause blood in the semen.
Other causes of blood in the semen, although rare, include:
- tuberculosis
- parasitic infections
- testicular cancer
- diseases that affect blood clotting, like haemophilia and chronic liver disease
- anticoagulant medicines
When should you see the doctor?
Please see your doctor if you notice any blood in your semen. Tell your doctor if you have any other symptoms, such as pain on ejaculation, or if there is anything that you think causes the symptom or makes it worse.
What are the tests for blood in the semen?
Your doctor will want to ask you about your symptoms. They will want to know if you have noticed any other symptoms, such as blood in your urine or pain on ejaculating.
They will do a physical examination, including looking at your genitals. They may take your blood pressure and temperature. They will want to check your prostate by a rectal examination, where the doctor inserts a gloved finger into your bottom.
The doctor will ask you to give a urine sample, so that they can check for blood, which may only be visible under the microscope, and for signs of a urinary tract infection. They may do a blood test. You may also be asked for a semen sample.
If you are aged over 40 years, the doctor will probably suggest you have a PSA (prostate-specific antigen) test. This a blood test that can help to detect prostate cancer and other prostate problems.
If you are referred to a urologist, there are other tests and investigations that may help in diagnosis. These include ultrasound of the prostate or scrotum, MRI (magnetic resonance imaging) or CT scans of the pelvis, and cystoscopy (where a thin tube with a camera is used to look at the bladder and urethra).
What is the treatment for blood in the semen?
The treatment for blood in the semen depends on the underlying cause. Sometimes it is just an isolated event with no other symptoms or underlying 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 the prostate but this may take several months.
If blood in the semen is an after-effect of a procedure like a vasectomy, you will have been advised what to expect. For example, after a prostate biopsy it may take up to 20 ejaculations before it clears up.
If the cause is a blockage, a cyst or deposits of calcium (calcifications), the urologist may clear or remove these using keyhole surgery, guided by ultrasound.
Prostate cancer is treated with surgery, radiation or hormonal therapy.
Will blood in the semen affect my fertility?
A common worry about blood in the semen is whether it can affect a man’s fertility. Rest assured that most causes of blood in the semen will have no affect on fertility. A rare cause that may affect fertility is cancer of the testicles.
