Blood in semen

How common is blood in semen?

Blood in semen (haematospermia) is not uncommon and it can affect men of any age after puberty. However, the most common age group affected is men aged 30-40 years.

More than 9 out of every 10 patients with blood in their semen have not had any previous genital or urinary symptoms or conditions.

Haematospermia usually causes painless blood staining of the semen. This is seen with ejaculation. The blood causes the ejaculate to be a brownish to red colour. There may be no other symptoms in primary haematospermia.

Secondary haematospermia may cause other symptoms because of the underlying condition. For example, haematospermia occurring with painful ejaculations or pain in the area from the testicles to the back passage (this area is called the perineum). This may indicate a prostate condition such as prostatitis.

Primary haematospermia

The cause is often not known and there is no underlying condition to explain the haematospermia. Some men only have just one episode and it never happens again.

However, most men with haematospermia have repeated episodes. Primary haematospermia is harmless and gets better without any treatment.

Secondary haematospermia

Haematospermia caused by an underlying condition is called secondary haematospermia. The possible underlying causes include:

• Immediately after a prostate biopsy or vasectomy.

• Injury to the groin, scrotum or pelvis.

• Trauma caused by prolonged sexual intercourse or masturbation.

• Prostate infection (acute prostatitis or chronic prostatitis).

• Stones in the prostate gland (prostatic calculi).

• Prostate cancer.

• Urinary tract infection.

• Inflammation of the tubes that carry sperm from the testicles (epididymo-orchitis).

• Stones in the urinary tract (urinary calculi).

• Tuberculosis.

• Liver cirrhosis.

• Severe hypertension.

• Conditions that cause abnormal bleeding - for example, haemophilia.

• Tropical infections - for example, schistosomiasis or trachoma.

Is blood in semen a sign of cancer?

There are many causes of blood in the semen - as above. Prostate cancer is just one of them and is more common in older males (aged over 40 years) who would usually also have other symptoms. The symptoms usually involve the bladder and how you pee. They include frequency, hesitancy, dribbling and getting up to pee at night. These symptoms can be common in older men, so if they are present with blood in the semen, it is sensible to see your GP to be checked.

Testicular and bladder cancer can rarely also cause blood in the semen, but only when the cancer is very advanced. It would be very unlikely to be unaware of the cancer by that stage.

The doctor will examine you, including checking your scrotum and prostate gland to see if there is any suggestion of an underlying condition.

Any tests will depend on whether your doctor finds anything abnormal on examination. The test may include:

• Urine sample to test for infection.

• Blood test for PSA to check for prostate cancer.

• Tests for any sexually transmitted infection.

• Ultrasound scan of your scrotum and urinary tract.

If the haematospermia persists or keeps happening then you may be referred to a urology specialist for further tests. These tests may include cystoscopy and scans using either computerised tomography (CT) or magnetic resonance imaging (MRI).

Primary haematospermia usually resolves without the need for any treatment.

The treatment for secondary haematospermia will depend on the underlying condition. The haematospermia itself does not need any treatment.

Medicines

If you have persistent haematospermia without an identified cause then a type of medicine called a 5-alpha reductase inhibitor such as finasteride or dutasteride may be effective. However, it may take six months before the haematospermia improves.

For younger men with persistent haematospermia of unknown cause, a one-month treatment with an antibiotic medicine called doxycycline may be useful.

Many men don't routinely look at their semen, so if they notice blood in it they will become very anxious. The most common causes of blood in the semen are infection and medical procedures, such as vasectomy or prostate biopsy. Many other causes can be easily identified and managed by a GP. Seeing a GP to work out what has caused it is very sensible.

When to see a doctor about blood in semen

If you are young and otherwise healthy and have just had one episode, there is no immediate reason to see the doctor. If you are very anxious, are over 40 years old, have multiple episodes, have other symptoms, or have a family history of prostate problems, it is sensible to see a doctor.