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Blood in the semen

Definition

Blood in the semen is called hematospermia. It may be in amounts too small to be seen except with a microscope, or it may be visible in the ejaculation fluid.

Causes

Most of the time, the cause for blood in the semen is not known. It can be caused by swelling or infection of the prostate or seminal vesicles. The problem may occur after a prostate biopsy.

Blood in the semen may also be caused by:

• Blockage due to enlarged prostate (prostate problems)

• Infection of the prostate

• Irritation in the urethra (urethritis)

• Injury to the urethra

Often, the cause of the problem cannot be found.

Sometimes, the visible blood will last several days to weeks, depending on the cause of the blood and if any clots formed in the seminal vesicles.

Depending on the cause, other symptoms that may occur include:

• Blood in the urine

• Fever or chills

• Lower back pain

• Pain with bowel movement

• Pain with ejaculation

• Pain with urination

• Swelling in the scrotum

• Swelling or tenderness in the groin area

• Tenderness in the scrotum

Home Care

The following steps may help ease discomfort from a prostate infection or urinary infection:

• Take over-the-counter pain relievers such as ibuprofen or naproxen.

• Drink plenty of fluids.

• Eat high-fiber foods to make bowel movements easier.

When to Contact a Medical Professional

Always contact your health care provider if you notice any blood in your semen.

What to Expect at Your Office Visit

The provider will perform a physical exam and look for signs of:

• Discharge from the urethra

• Enlarged or tender prostate

• Fever

• Swollen lymph nodes

• Swollen or tender scrotum

You may need the following tests:

• Prostate exam

• PSA blood test

• Semen analysis

• Semen culture

• Ultrasound or MRI of the prostate, pelvis or scrotum

• Urinalysis

• Urine culture

References

Elsamra SE. Evaluation of the urologic patient: history and physical examination. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 1.

Kaplan SA. Benign prostatic hyperplasia and prostatitis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 114.

O'Connell TX. Hematospermia. In: O'Connell TX, ed. Instant Work-ups: A Clinical Guide to Medicine. 2nd ed. Philadelphia, PA: Elsevier; 2017:chap 30.

Small EJ. Prostate cancer. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier Saunders; 2020:chap 191.

Review Date: 7/1/2023

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.