Possible causes of blood in the semen

Blood in semen, or hematospermia, may cause considerable distress to patients who experience it. Fortunately, it is most often a benign, self-limited and isolated symptom that resolves without any medical intervention. In fact, up to 70% of patients will experiencing hematospermia without any underlying cause.

But why is there blood in the semen? What are the possible causes and when should you be worried? Is it likely to be accompanied by other symptoms? How is it diagnosed and treated?

What is hematospermia?

Even though the presence of blood in the semen is unusual, it is difficult for medical authorities to estimate how common the condition really is, for the simple reason that when a man ejaculates he is unlikely to examine the semen looking for blood. When blood is noticed, the semen may be blood-stained, have a pink tinge or look brownish-red in colour.

In men under 40 who have no associated symptoms and no risk factors for an underlying cause, the condition almost always disappears of its own accord. For men over 40, the risk of an underlying condition is higher, and so it is more likely that your GP will refer you for evaluation. This is particularly the case for men who experience repeated episodes of blood in the semen, who show other related symptoms and/or who are at risk of cancer or other serious conditions.

What causes blood in the semen?

The most common cause of blood in semen, is a minor injury caused by a surgical procedure. For example, following a prostate biopsy as many as 80% of patients will experience this phenomenon. The same might happen after procedures to treat urinary problems and in both cases, it disappears after a few weeks. It can also happen as a result of  a vasectomy, radiation treatment or injections for haemorrhoids. Other direct physical trauma to the genitals such as a fractured pelvis, injury to the testicles or even vigorous sexual activity can result in some bleeding as well.

Where there is no physical trauma that could explain it, other possibilities to consider would include:

• Obstruction of one of the small tubes or ducts in the reproductive organs, causing breakage of a blood vessel and bleeding

Less common causes of hematospermia include serious conditions that would need further investigation, such as: severe high blood pressure, a blood-clotting disorder, prostate, testicular or bladder cancer, or small stones in the seminal vesicles known as seminal vesicle calculi.

How is hematospermia diagnosed?

Your GP is likely to carry out some tests to assess whether or not your condition is serious. They will take into account how many episodes you had, your age, your medical history and whether you have other symptoms. For an initial assessment not only will they do a physical examination to check your blood pressure, abdomen, genitals and rectum, but also a urine test will be performed. Below the age of 40, no further tests are usually required, especially if finding blood in the sperm is not recurrent and preliminary tests do not reveal any underlying condition. Otherwise, your GP will refer you to an urologist, who may arrange for additional tests.

How is blood in the semen treated?

In most cases, and particularly if the blood in the semen was an isolated occurrence, no treatment will be necessary. In the case of an identified reason the treatment will, of course, depend on the underlying cause.

Does blood in the semen cause infertility?

Infertility is not an issue you need to worry about in the majority of cases. The rare instances where the underlying cause is a cancer of the prostate or testicles could, however, be a different matter. If you are faced with such diagnosis and the need for treatment, it is vital that you talk to your urologist about your prospects for parenthood. There are two main possibilities:

• If the tumour is confined and showing a slow-growing evolution, an initial regime of watchful waiting, or active surveillance may be appropriate.
• If you do require surgery or other treatment such as radiotherapy or chemotherapy, you may need to consider ‘banking’ your sperm. This consists of freezing one or more sperm samples, so that in the event of the treatment resulting in infertility, you could still father a child through the use of your own frozen sperm by an IVF procedure.

In the UK, it may be possible to have this done through the NHS. Depending on your local However, you should be aware that NHS fertility treatments vary across the UK and that waiting times can be very long in some areas.

Contacting IVI

Alternatively, you can contact us at IVI for a swift response and follow-up action. Most people experiencing blood in the semen can rest assured that there’s nothing to worry about, but if you are one of the rare cases where it’s reasonable for alarm bells to ring, do get in touch. Use our online contact form, or give us a call on free call 0800 52 00 161.