Blood in semen (hematospermia): Is it a sign of cancer?

Any time you notice blood where it’s not supposed to be, it can be alarming. If you’ve ever seen blood in your semen, a condition known as hematospermia, you may be wondering if it’s a sign of something serious.

The good news: it’s usually not.

Here, I’ll share common causes for blood in the semen, when to see a doctor and how it’s treated.

Sperm vs. semen

Technically, sperm and semen are two different things.

Sperm are the male reproductive cells found in semen. Semen is a mix of sperm and fluid that the rest of the reproductive tract makes.

The prostate and seminal vesicles are part of the male reproductive tract and together produce the majority of the fluid found in semen. The prostate is located below the bladder. Each male has two seminal vesicles located behind the bladder and above the prostate.

Patients will often use “sperm” and “semen” interchangeably, saying they have “blood in their sperm” or “blood in their semen.” It’s fine either way – your doctor will understand that you’re seeing blood in your semen and not the actual sperm.

What causes blood in semen?

The most common reasons for blood in semen are:

• Infection
• Trauma
• Ruptured blood vessel(s)

Infection

Inflammatory conditions or infections in the male reproductive tract, such as prostatitis, orchitis or sexually transmitted diseases, are the most common causes for blood in semen. Though not as common, bladder infections and even tuberculosis can also cause it. However, tuberculosis is not very common in the U.S.

Trauma

You may see blood in your semen after a medical procedure, such as a vasectomy, prostate biopsy or cystoscopy.

Ruptured blood vessel(s)

Sometimes, small blood vessels in the reproductive tract can pop or rupture during ejaculation, causing blood in your semen.

Pay attention to other symptoms in your body

It is extremely rare for blood in semen to be caused by cancer, especially as the first symptom.

In very rare cases, blood in your semen may be due to prostate cancer, bladder cancer or testicular cancer. But it would be a very late sign, and it would most likely be accompanied by other symptoms, such as:

• Blood in the urine
• Suddenly having a hard time passing urine
• A decreased urinary stream
• A urinary stream that starts and stops
• Straining to urinate
• Pain or burning while urinating

These can be signs of cancer that is growing and starting to invade structures in the prostate and seminal vesicles. These structures make the fluid in semen. See a doctor if you have blood in your semen with any of the above symptoms.

When to see a doctor for blood in semen

If you see blood in your semen once, take note of it. But it’s usually not due to a serious condition, so you don’t need to see a doctor right away. Most of the time, it goes away on its own.

However, if you see blood in your semen multiple times or have other concerning symptoms, those are warning signs that something more serious may be going on. You should see your doctor.

How do you diagnose blood in semen?

To diagnose blood in semen, your doctor may perform one or several of the following:

• Blood test: A blood test checks your white blood cell count. This can help your doctor determine if you have an infection.
• Urinalysis: A sample of your urine is tested for bacteria or other infections.
• Physical exam of external genitalia: Your doctor will inspect your urethra to check for inflammation, tenderness or discharge. They will also look for inflammation or tenderness in the epididymis and scrotum.
• Digital rectal exam: Your doctor will insert a gloved finger into your rectum to feel for any abnormalities in the prostate.   
• Imaging tests: Your doctor may order a CT scan or an MRI of your prostate or pelvis.
• Cystoscopy: Your doctor will use a scope to look inside your bladder and urethra.
• Prostate-specific antigen (PSA) test: This blood test measures the amount of PSA in your blood. This can help doctors detect or rule out prostate cancer as well as benign conditions.  

How do you treat blood in semen?

Most cases of blood in semen will resolve on their own, so there’s no need for treatment.

Antibiotics

If the blood in your semen is from an infection, your doctor will prescribe antibiotics to treat the underlying infection. Bladder infections and sexually transmitted diseases will generally have a shorter course of antibiotics. Infections in the prostate or testicles typically require a longer course of antibiotics. So, that means you may need to take antibiotics for several weeks to treat the infection fully.

Medication

If doctors determine that the cause of blood in your semen is due to enlarged blood vessels in your prostate, they may prescribe an oral medication called finasteride. It works by shrinking the size of the prostate, thereby shrinking the enlarged blood vessels.

Cancer treatment

If you are diagnosed with cancer, your doctor will talk to you about the next steps for treatment. This can include any number of treatment options, from active surveillance to radiation therapy, surgery and more. Your doctor will work to develop the best treatment plan for you.

Does the color of the blood in my semen matter?

Blood in the semen can appear anywhere from bright red to dull brown. The color is an indicator of how old the blood is. For example, more recent bleeding in the genitourinary tract will be bright red. Conversely, if a blood vessel bursts days or weeks earlier, the blood will appear darker and more brownish in color once it works its way out in the semen.

Neither color is more or less alarming than the other, so you should approach blood in semen the same way – no matter the color.

Can too much masturbation cause blood in semen?

At one point, some urologists believed that if men abstained from sexual intercourse for a long time, they might see blood in their semen once they start back. And some anecdotes have said the opposite: that too much sexual intercourse or masturbation can cause blood in the semen. But there’s no scientific data supporting either theory.

What else should men know about blood in semen?

Blood in the semen is usually alarming because it’s not normal. But it usually is not a sign of a serious medical condition like cancer and often goes away on its own.

See your doctor if it happens often or if you have other concerning symptoms. They can figure out what’s going on and get you the proper treatment.

Lisly Chéry, M.D., is a urologic oncologist at UT MD Anderson in Sugar Land.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.