Blood in the semen may be caused by inflammation, infection, blockage, or injury anywhere along the male reproductive tract. It may indicate disease or a problem within the urethra, testicles, epididymis, or prostate.
Blood in the semen is usually the result of inflammation of the seminal vesicles, and will almost always go away on its own. Often, the cause cannot be determined. If the blood does not clear and ejaculate is persistently stained with blood, more tests should be done. These tests may include urinalysis and culture, semen analysis and culture, and ultrasound of the seminal vesicles.
Minor injuries may be treated with rest, applying ice, and monitoring symptoms. Major injuries may require reconstructive surgery.
Infections can often be treated with antibiotics taken by mouth (or intravenous antibiotics if symptoms are severe).
Blockages of the urinary tract system are typically treated with surgery. If cancerous tumors are the source of obstruction, radiation or chemotherapy may also be indicated.
Always call your doctor if you notice any blood in semen.
The health care provider will perform a physical examination, and will look for fever, swollen lymph nodes, a swollen or tender scrotum, discharge from the urethra, or an enlarged or tender prostate.
To help diagnose the cause of the problem, your health care provider will ask medical history questions, such as:
- How much blood was in the semen?
- Was microscopic blood ever noticed in the past when the semen was examined for another reason?
- When did you first notice this problem? Is it present all the time?
- Is there anything that seems to have caused this symptom?
- What other symptoms do you have?
Tests that may be done include:
- Prostate exam
- PSA blood test
- Urine culture
- Semen analysis
- Semen culture
- Ultrasound of pelvis and scrotum
Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 3.