Blood in semen

Blood in semen, known medically as haematospermia, is when you notice blood in your ejaculate. It can look alarming, but most of the time it’s not serious, and it's most common in men between 30 and 40. It’s a good idea to speak to your GP as they can see what’s causing it and rule out anything more serious.

What are the common causes of blood in semen?

In men under 40, an infection is the most common cause. In older men, or when blood in semen keeps happening, it's more likely to be linked to a prostate problem.

Common causes include:

• An infection: Such as a urinary tract infection (UTI), a sexually transmitted infection (STI) like gonorrhoea or chlamydia, or prostatitis (inflammation of the prostate gland)
• A recent procedure: Such as a vasectomy, a prostate biopsy, a cystoscopy (a camera test of your bladder) or transurethral resection of the prostate (TURP)
• A prostate problem: Such as an enlarged prostate (benign prostatic hyperplasia, or BPH), or cysts or small stones near the prostate
• An injury: To your testicles, the tubes that carry sperm, or the seminal vesicles (the glands that make most of the fluid in semen)
• Sexual activity itself: As a small blood vessel can burst during ejaculation, similar to a nosebleed. This is more likely after a long gap without sex, or with very frequent sex.

Rarely, blood in semen is caused by cancer, such as prostate, testicular or bladder cancer. It would be unusual for this to be the first sign of cancer, and it would normally come with other symptoms too.

Other, less common causes include:

• high blood pressure that is not well controlled
• bleeding or blood clotting disorders, such as haemophilia, or taking blood-thinning medicines
• chronic liver disease
• tuberculosis or parasitic infections, which are rare in the UK.

Are there different types of blood in semen?

There isn't a formal set of types, but it helps to think about two things: how often it happens, and the colour of the blood.

• A single episode: This is the most common pattern. It often has no obvious cause, and usually clears up by itself without needing treatment, especially in men under 40.
• Repeated or persistent episodes: Blood in semen that keeps happening, lasts more than a few weeks, or comes with other symptoms is more likely to need further investigation.

The colour of the blood mainly tells you how recent the bleeding is, not how serious it is. Bright red blood suggests recent bleeding, while brown or reddish-brown blood usually means older blood that's clearing out of your system.

How is blood in semen diagnosed?

Your GP will ask when you first noticed the blood, how often it happens, and whether you have any other symptoms, such as blood in your urine, pain when urinating or ejaculating, or unexplained weight loss. They'll also ask about your sexual activity, medicines and any recent procedures.

They may also carry out or arrange:

• A physical examination: This includes a digital rectal exam, where the doctor gently inserts a gloved, lubricated finger into your bottom to feel your prostate for any swelling or lumps
• A urine test: This is to check for infection or blood
• A semen test: This is to look for infection
• Blood tests: These may include a prostate-specific antigen (PSA) test if you have a higher chance of prostate cancer
• Imaging: Such as an ultrasound, MRI or CT scan, to look at your prostate and surrounding organs
• A cystoscopy: Where a thin tube with a camera examines your bladder and the tube that carries urine out of your body (urethra).

Your GP may refer you to a urologist, a specialist in conditions of the urinary and male reproductive systems, especially if you have other symptoms or a higher chance of prostate cancer.

How is blood in semen treated?

You often won't need any treatment, particularly if you're under 40, have no other symptoms, and it's only happened once. When treatment is needed, it depends on the cause.

• Infections are usually treated with antibiotics.
• An enlarged prostate is treated with medication (often tamsulosin) or surgery.
• Inflammation may be treated with anti-inflammatory medicines.
• A blockage, such as from a stone or narrowing, may need a surgical procedure to clear it.
• Bleeding after a procedure, such as a vasectomy or prostate biopsy, usually settles by itself within the expected recovery time. Ask your surgeon what to expect.

If a cause such as prostate cancer is found, your doctor will discuss the most appropriate treatment with you, which may include surgery, radiotherapy or hormone therapy.

When should I see a doctor?

See a GP any time you notice blood in your semen. Most cases turn out to be harmless, but a GP can check for common causes and rule out anything more serious.

It's especially important to get checked if you:

• are over 40
• have had blood in your semen more than once
• have lost weight without trying
• have a family history of prostate cancer
• have blood in your urine, pain when urinating or ejaculating, or are peeing more often than usual
• have pain in your back, abdomen, pelvis or scrotum
• have a fever or chills
• have a condition that affects blood clotting, or take blood-thinning medicines.