Blood in semen (haematospermia)

Haematospermia is the medical term used to refer to the presence of blood in your semen. It’s usually painless, but the sight of blood in your semen can be scary. A single occurrence of haematospermia is usually nothing to worry about.

It’s difficult to know how common haematospermia is because people don’t always look at their semen after they ejaculate. People who do notice it might not talk to their doctor about it because they’re embarrassed or scared.

Among more than 26,000 American men screened for prostate cancer (aged 40 years or older), only 0.5% had haematospermia. It might be more common in men under 40 years, but available data isn’t reliable.

Blood in your semen may appear as a spot of bright red blood, or your entire ejaculate may be coloured.

Bright red blood is fresh and due to recent bleeding, whereas brown or black blood is older and suggests some time has passed since the bleeding occurred.

If you’re over 40 and haematospermia is observed over a prolonged period of time, it may be a symptom of a problem that needs treatment, especially if you have other symptoms such as pain or lower urinary tract symptoms (LUTS).

Infections, inflammation or small stones within the reproductive system are the most likely causes of haematospermia. Injury and trauma are other common causes of haematospermia, sometimes resulting from procedures used to diagnose or treat other conditions. Cancer is a rare cause of haematospermia.

People who have blood clotting problems, or who are taking blood-thinning medication, may get blood in their semen more often than those who don’t. Severely high blood pressure may also cause haematospermia.

In most cases, haematospermia is not caused by anything life-threatening. In lots of cases, the cause of haematospermia is not known, and it goes away on its own.

When you see your doctor about blood in your semen, they will perform a physical examination and ask questions to rule out the possibility that the blood is from somewhere else, like your urine or from your sexual partner.

Your doctor may take your blood pressure and ask for samples of urine or semen. They may refer you to a urologist if they think further investigations are needed.

Other investigations may include blood tests, imaging using ultrasound or MRI, and cystoscopy.

Treatment for haematospermia depends on the underlying cause. If it’s due to infection, the right antibiotics or other treatment should fix it. If your haematospermia might be due to something more serious, the priority will be to identify and treat that.

Injury or trauma should heal itself with time.

Haematospermia might alert you and your doctor to some underlying problem that may impact your health, but usually there are no implications for your health and wellbeing.

If you notice blood in your semen, you should go and see your doctor about it.