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Blood in the semen

Blood in the semen, called hematospermia, is blood that is either too small to be seen (microscopic) or visible in the ejaculation fluid.

Alternative Names

Semen - bloody; Blood in ejaculation

Considerations

Symptoms that may occur with this condition include:

  • Blood in urine
  • Fever or chills
  • Lower back pain
  • Pain with bowel movement
  • Pain with ejaculation
  • Pain with urination
  • Swelling in scrotum
  • Swelling or tenderness in groin area
  • Tenderness in the scrotum

Common Causes

Blood in the semen is usually caused by inflammation of the seminal vesicles. It may also be caused by:

  • Blockage
  • Infection
  • Injury

It may be a sign of disease or a problem in the urethra, testicles, epididymis, or prostate.

Often, the cause cannot be found.

Home Care

You can treat minor injuries by resting, applying ice, and monitoring your symptoms. For major injuries you may need 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 usually treated with surgery. If cancerous tumors are causing the blockage, you may need radiation or chemotherapy .

Call your health care provider if

Always call your doctor if you notice any blood in your semen.

What to expect at your health care provider's office

The health care provider will perform a physical examination, looking for signs of:

  • Discharge from the urethra
  • Enlarged or tender prostate
  • Fever
  • Swollen lymph nodes
  • Swollen or tender scrotum

To diagnose the cause of the problem, your health care provider will ask medical history questions, such as:

  • How much blood was in the semen?
  • Did you ever have microscopic blood in the past when your 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
  • Semen analysis
  • Semen culture
  • Ultrasound of pelvis and scrotum
  • Urinalysis
  • Urine culture

If the blood does not clear, more tests should be done. These tests may include:

  • Semen analysis and culture
  • Urinalysis and culture
  • Ultrasound of the seminal vesicles, scrotum, and testes

References

Barry MJ, Collins MM. Benign prostate disease and prostatitis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 131.

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.

Small EJ. Prostate cancer. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 207.

Updated: 9/16/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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