Blood in the semen

Also known as: Semen - bloody and Blood in ejaculation

Definition

Blood in the semen, called hematospermia, may be undetectable (microscopic) or visible in the ejaculation fluid.

Considerations

Associated symptoms may include:

Pain with urination
Pain with ejaculation
Pain with bowel movement
Tenderness in the scrotum
Swelling in scrotum
Swelling or tenderness in groin area
Lower back pain
Fever or chills
Blood in urine

Common Causes

Blood in the semen may be caused by inflammation, infection, blockage, or injury anywhere along the male reproductive tract. It may indicate disease or a problem within the urethra, testicles, epididymis, or prostate.

Blood in the semen is usually the result of inflammation of the seminal vesicles, and will almost always go away on its own. Often, the cause cannot be determined. If the blood does not clear and ejaculate is persistently stained with blood, more tests should be done. These tests may include urinalysis and culture, semen analysis and culture, and ultrasound of the seminal vesicles.

Home Care

Minor injuries may be treated with rest, applying ice, and monitoring symptoms. Major injuries may require reconstructive surgery.

Infections can often be treated with antibiotics taken by mouth (or intravenous antibiotics if symptoms are severe).

Blockages of the urinary tract system are typically treated with surgery. If cancerous tumors are the source of obstruction, radiation or chemotherapy may also be indicated.

Call your health care provider if

Always call your doctor if you notice any blood in semen.

What to expect at your health care provider's office

The health care provider will perform a physical examination, and will look for fever, swollen lymph nodes, a swollen or tender scrotum, discharge from the urethra, or an enlarged or tender prostate.

To help diagnose the cause of the problem, your health care provider will ask medical history questions, such as:

How much blood was in the semen?
Was microscopic blood ever noticed in the past when the semen was examined for another reason?
When did you first notice this problem? Is it present all the time?
Is there anything that seems to have caused this symptom?
What other symptoms do you have?

Tests that may be done include:

Prostate exam
PSA blood test
Urinalysis
Urine culture
Semen analysis
Semen culture
Ultrasound of pelvis and scrotum

References

Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 3.

Review date:: September 30, 2009
Reviewed by:: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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