Blood In The Semen

Most cases of blood in the semen are from unknown causes. It usually goes away on its own.

Seeing blood in the semen can be quite frightening. Men with this symptom are often asked several questions by the healthcare professional, including but not limited to:

• how many times blood has been seen in the semen
• when the bleeding started
• if there is blood in the urine or bleeding in other areas of the body
• if the man has any pain
• how often the man has had sex recently
• if the man has ever had a sexually transmitted disease
• what kind of sexual practices the man engages in

Most cases are from an unknown cause. Known causes include:

• infections of the prostate gland, called prostatitis. Prostatitis may be acute, chronic, or nonbacterial.
• infections of the seminal vesicles, which are two structures that secrete some of the fluid found in semen
• infections of the urethra, known as urethritis. The urethra is the tube that carries urine and semen to the outside of the body.
• urethral strictures, or narrowing in an area of the urethra. This may be caused by trauma or a previous infection.
• certain sexual habits, such as prolonged abstinence from or lack of sex or unusually frequent sex
• bleeding or blood clotting problems, such as hemophilia A or hemophilia B. Clotting problems can also occur in men who are taking too much of the blood-thinning drug warfarin.
• tumors or cancer, a rare cause. The cancer may be in the prostate, seminal vesicles, or urethra.

Most cases cannot be prevented because the cause is unknown. Urethral stricture and infection of the urethra are often due to sexually transmitted infections. Practicing safer sex could reduce, but not eliminate, the risk of these cases.

In some cases, the diagnosis is obvious from the medical history and physical exam. In other cases, further testing may be done. Urine tests, including a urinalysis and urine culture, are commonly used to look for infection or bleeding. Imaging studies or X-ray tests may be used to look for a urethral stricture.

There are usually no long-term effects. Many affected men have repeated episodes of blood in the semen with no other symptoms or problems. Urethral strictures are usually permanent unless they are treated. Cancer is quite rare but could possibly result in death.

Blood in the semen itself is not contagious. If the cause is a sexually transmitted infection, the infection may be contagious.

Treatment is directed at the cause, if one can be found. A man may be given antibiotics for a short time in case there is an infection. A man with cancer or urethral strictures may need surgery.

Antibiotics may cause allergic reactions, stomach upset, or headaches. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

Many men continue to have occasional episodes of blood in their semen. Others may experience it only one time. A man with a known cause for the blood usually gets better with treatment. After treatment, most men have no limitations on activities.

The man can monitor his semen at home for further episodes of bleeding. Changes or response to treatment can be reported to the healthcare professional. Other monitoring is related to the cause. For example, a man who takes a blood thinner needs to have his clotting function monitored with periodic blood tests. Any worsening symptoms should always be reported to the healthcare professional.