Blood in semen (haematospermia)

It's unusual to find blood in your semen when you ejaculate, but try not to worry – it is usually only temporary and the cause is rarely anything sinister.
The semen may be blood stained, brownish-red in colour or have a pink tinge – but in any case, you should see your doctor  for a full investigation.
In many cases, no obvious cause can be found for blood in the semen, in which case it may be the result of a forgotten or unnoticed injury to the genitals, such as a trouser-zip accident.
Some other likely causes of blood in the semen are outlined below. This is intended to give you a better idea of the underlying problem, but you should not use it to diagnose yourself with a condition – always see your doctor for a proper diagnosis.

Common causes

Common causes of blood in semen include:

• vesiculitis – inflammation of the seminal vesicles (glands that produce most of the fluid in ejaculate)
• seminal vesicle calculi – small stones in the seminal vesicles
• seminal vesicle cysts – small, fluid-filled sacs in the seminal vesicles
• prostatitis – inflammation of the prostate gland (where semen is made)
• benign prostatic hyperplasia (BPH) – a common condition in older men, where the prostate gland becomes enlarged
• having had a prostate biopsy (where a needle is used to remove small samples of tissue from your prostate gland) within the last three or four weeks

These problems are generally not serious and many will get better on their own without treatment, or after a course of antibiotics.

• sexually transmitted infections (STIs) – including genital herpes, chlamydia, gonorrhoea and trichomoniasis
• severe high blood pressure (hypertension)
• a blood clotting disorder
• cancer – including prostate cancer, testicular cancer and bladder cancer

These conditions are more serious and may require specialist treatment.

See your doctor 

Although it is often very difficult for a specific diagnosis to be confirmed, your doctor  will try to determine whether the cause of the blood in your semen is likely to be serious or not.
To do this they will need to consider a number of things, such as how many times you have noticed blood in your semen, whether you have any other symptoms, your age, and your medical history.
They may also need to carry out a number of simple tests, including:

• checking your blood pressure and temperature
• an examination of your genitals and abdomen (tummy)
• a rectal examination (where your doctor inserts a finger into your back passage)
• urine and blood tests

If you are younger than 40, have only noticed blood in your semen once or twice, and tests don't suggest you have a serious underlying condition, you shouldn't need a hospital referral.
However, if you are over 40, have persistent or recurrent symptoms, or tests have suggested a potentially serious underlying cause, your doctor  should refer you to a urologist (specialist who treats problems of the urinary system) for further assessment. This may involve having a biopsy of your prostate gland or scans such as an ultrasound scan.

Suggested treatment

The treatment your doctor or urologist recommends will depend on what they think is the underlying reason for the blood in your semen.
In many cases, particularly if you have no other symptoms or the blood in your semen was an isolated incident, no treatment is necessary and the problem will usually resolve on its own.
If a clear reason why you have blood in your semen is identified, the treatment you are offered will depend on the specific cause. For example, you may be given antibiotics to treat an infection and cysts may need to be drained with a needle.
If there is a serious underlying cause for the blood in your semen, such as a blood clotting disorder or cancer, you will be referred to an appropriate specialist for any necessary treatment.