Should I worry about finding blood in my semen?

Discovering blood in semen can trigger immediate concern, but the condition known as hematospermia is rarely a sign of serious illness. Research shows this condition affects approximately 1 in 5,000 men annually, with most cases resolving without treatment within a few weeks. Understanding what causes blood in your ejaculate and when medical evaluation becomes necessary helps you make informed decisions about your urological health.

What Is Hematospermia and How Common Is It?

Hematospermia refers to the presence of blood in semen during ejaculation. The condition can appear as pinkish, reddish, or brownish discoloration depending on whether the blood is fresh or has been present for some time. Many men don’t regularly examine their semen after ejaculation, which means the actual prevalence of hematospermia remains difficult to quantify—most medical professionals believe cases go unreported far more often than they’re diagnosed.

The condition occurs when blood enters semen anywhere along the reproductive tract, from the testicles through the vas deferens to the seminal vesicles and prostate. While the sight of blood in ejaculate understandably creates anxiety, studies consistently show that hematospermia is benign in the vast majority of cases, particularly in men under 40. According to research published by the National Institutes of Health, only 3.5% of over 900 patients with blood in semen actually had a tumor, and most of those were prostate-related.

Just as nosebleeds occur when small blood vessels in the nose burst under pressure, hematospermia often results from tiny blood vessels breaking during the physical stress of erection and ejaculation. For men experiencing this symptom, understanding your prostate health becomes particularly relevant since the prostate plays a central role in producing seminal fluid.

The Most Common Causes of Blood in Semen

Infections and inflammation account for 39-55% of all hematospermia cases, making them the leading cause. The reproductive system includes multiple structures where infection can develop: the prostate gland, seminal vesicles, urethra, and epididymis. Bacterial infections, sexually transmitted infections like chlamydia or gonorrhea, and even viral infections can all produce inflammation that leads to blood in semen, as Cleveland Clinic explains. Men experiencing symptoms of a urinary tract infection alongside hematospermia should seek evaluation promptly.

Medical procedures represent another significant cause. As many as 80% of men experience temporary blood in their semen following a prostate biopsy—a diagnostic procedure commonly performed when screening for prostate cancer. The condition typically resolves within several weeks or approximately 10 ejaculations after the procedure. Other interventions that can cause temporary hematospermia include vasectomies, radiation therapy for prostate cancer, treatments for enlarged prostate, and even hemorrhoid injections.

Physical trauma from intense sexual activity, injury to the testicles, pelvic fractures, or excessive masturbation can damage delicate blood vessels in the reproductive tract. Obstruction in any of the tiny tubes carrying sperm and seminal fluid can cause vessels to break and release blood. Benign prostatic hyperplasia (BPH), which causes prostate enlargement and can pinch the urethra, is also associated with hematospermia.

Less commonly, systemic conditions contribute to blood in semen. Severe uncontrolled hypertension, liver disease affecting clotting factor production, bleeding disorders like hemophilia or von Willebrand’s disease, and conditions such as leukemia or lymphoma can all present with hematospermia as a symptom. In 15-70% of cases, thorough medical evaluation fails to identify a specific cause—these idiopathic cases still typically resolve without treatment.

Age Matters: Why Men Over 40 Need Different Evaluation

Age significantly influences both the likely causes of hematospermia and the appropriate medical response. For men under 40 without risk factors or associated symptoms, a single episode of blood in semen often requires minimal investigation beyond basic reassurance. Most cases in younger men stem from minor infections or inflammation that resolve spontaneously, according to guidelines from the American Academy of Family Physicians.

Men over 40 face different considerations. While the condition remains predominantly benign even in older age groups, the probability of underlying pathology increases enough to warrant more thorough evaluation. Prostate conditions become more prevalent with age, including prostatitis, BPH, and prostate cancer. Research indicates that persistent or recurrent hematospermia in men over 40 should trigger comprehensive assessment including digital rectal examination, PSA testing, and potentially transrectal ultrasonography.

The distinction matters clinically: younger men experiencing a single episode with no additional symptoms typically need only a basic examination and urinalysis to rule out infection. Older men, particularly those with risk factors such as family history of urological cancers, smoking, or known prostate abnormalities, benefit from more extensive diagnostic workup to ensure no serious underlying condition goes undetected.

When Blood in Semen Requires Medical Attention

Several red flags indicate when hematospermia warrants prompt medical evaluation. Persistent or recurring episodes over multiple weeks suggest an underlying condition requiring diagnosis rather than simple observation. Associated symptoms including painful urination, difficulty starting or stopping urine flow, fever, weight loss, night sweats, or pelvic pain point toward infection, inflammation, or potentially more serious pathology that needs treatment.

Age over 40, even with a single episode, justifies medical consultation given the increased risk of conditions like prostate cancer or BPH. Men with risk factors including history of urological cancer, bleeding disorders, recent travel to regions where parasitic infections like schistosomiasis occur, or family history of prostate disease should seek evaluation regardless of age. Large volumes of blood or blood appearing with urination (hematuria) in addition to ejaculation requires immediate assessment.

The evaluation typically begins with a detailed medical history and physical examination, including a digital rectal exam to assess the prostate. Your urologist will perform urinalysis to check for infection, STI testing if appropriate, and blood pressure measurement. Depending on findings detailed in professional medical guidelines, additional tests may include PSA testing, transrectal ultrasound, MRI, or cystoscopy to visualize the bladder and urethra directly.

If you’re experiencing hematospermia along with other urological symptoms, St. Pete Urology’s experienced team provides comprehensive diagnostic services and personalized treatment plans. Our board-certified urologists use advanced imaging and minimally invasive techniques to identify causes and provide effective solutions.

When to Expect Resolution and Available Treatments

For most men, hematospermia resolves naturally within days to weeks without any intervention. The timeline varies based on the underlying cause: iatrogenic cases from medical procedures typically clear within 2-4 weeks, while infection-related hematospermia resolves once the infection is treated with appropriate antibiotics. Cases where no specific cause is identified—the idiopathic presentations—often disappear spontaneously over several weeks.

Treatment depends entirely on the identified cause. Infections respond to targeted antibiotic or antiviral therapy. Inflammation may improve with anti-inflammatory medications or, in cases of chronic prostatitis, longer courses of antibiotics that penetrate the prostate tissue effectively. Enlarged prostate causing recurrent hematospermia sometimes benefits from medications like finasteride, which both shrinks prostate tissue and strengthens fragile blood vessels. Structural abnormalities such as cysts, polyps, or obstructions may require minimally invasive procedures like transurethral resection or seminal vesiculoscopy.

For men whose hematospermia resolves quickly or occurs as a single episode without concerning features, reassurance may be the only intervention needed. Studies confirm that the vast majority of hematospermia cases carry excellent prognoses, with no impact on sexual function or fertility. However, any man experiencing this symptom deserves proper evaluation to ensure peace of mind and rule out the small percentage of cases with serious underlying causes.

References

• American Academy of Family Physicians. (2009, December 15). Evaluation and treatment of hematospermia. Retrieved from https://www.aafp.org/pubs/afp/issues/2009/1215/p1421.html
• Cleveland Clinic. (2025, July 25). Blood in semen (hematospermia): Causes & treatment. Retrieved from https://my.clevelandclinic.org/health/symptoms/blood-in-semen-hematospermia
• MSD Manual Professional Edition. (2024, September 9). Hematospermia – Genitourinary disorders. Retrieved from https://www.msdmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/hematospermia
• Mathers, M. J., Degener, S., Sperling, H., & Roth, S. (2017). Hematospermia—a symptom with many possible causes. Deutsches Ärzteblatt International, 114(11), 186-191. https://pmc.ncbi.nlm.nih.gov/articles/PMC5387851/