Blood in semen: 14 causes and what to do next - Insider

• Common causes of bloody semen include infection, injury, and prostate cancer treatment.  
• Bloody semen may not have a specific cause, and it's usually not serious if it only happens once.
• Check in with a doctor if you're over age 40, have other symptoms, or the blood doesn't go away.

If you notice blood in your semen, you might feel pretty alarmed, but there's no need to head to the emergency room just yet. Hematospermia — the medical name for blood in your semen — usually doesn't suggest a serious health condition. 

Though sometimes caused by infections, this blood often has no clear cause and will usually go away on its own within a few days or weeks, according to Dr. Francisco Gelpi-Hammerschmidt, a urologist at Memorial Hermann. 

The best course of action usually involves waiting it out, Gelpi-Hammerschmidt says. 

Note: This blood may be bright red, or your semen may have a pink or brown tinge. You could also notice small blood clots in your semen. 

You're most likely to notice blood in your semen between the ages of 30 and 40. If you're under age 40, you generally don't need to worry, unless it keeps happening or occurs with other symptoms. 

After the age of 40, however, bloody semen can have more serious causes. So, to be on the safe side, you'll generally want to make an appointment with your doctor.  

Read on to get the details on 14 of the most common causes of hematospermia, plus what to do next.

1. Sexually transmitted infections 

Some sexually transmitted infections (STIs) can cause blood in your semen, including: 

These STIs won't always cause symptoms, but with any of these STIs you may experience burning, painful urination, and discharge from your penis. 

If you have symptoms of an STI, or believe you may have been exposed to one, you'll want to avoid sexual activity and get tested right away. A healthcare professional can make a diagnosis and prescribe antibiotics or other treatments. 

2. Prostatitis

Prostatitis, an infection of your prostate, usually develops due to a urinary tract infection (UTI). 

In addition to blood in your semen, you may experience:

• Frequent, painful urination
• Painful ejaculation
• Pain in the penis, testicles, or perineum

If you develop prostatitis after a UTI, your doctor can typically prescribe antibiotics to treat the condition. 

However, another type of prostatitis — chronic pelvic pain syndrome — has an unknown cause and may require a wider range of treatments, including:

• Medications: Your doctor may prescribe alpha blockers like alfuzosin and doxazosin

to relax the muscles around your prostate and bladder, or pain relievers such as amitriptyline and gabapentin.

• Dietary changes: Your symptoms may improve when you eliminate common bladder irritants, including alcohol, coffee and spicy foods.
• Physical therapy:  Pelvic floor exercises in physical therapy can help reduce tension in the muscles of your pelvic floor.

3. Urethritis  

Urethritis is when your urethra — the tube that carries urine out of your body — becomes inflamed. This condition most commonly develops after an STI or other type of infection.

The three types of urethritis include:

• Gonococcal urethritis: This most common type is caused by gonorrhea.
• Nongonococcal urethritis: This type has a known cause other than gonorrhea, such as a different STI or irritation of your urethra.
• Non-specific urethritis: This diagnosis refers to urethritis that doesn't have a known cause.

Other main causes of urethritis include: 

• Irritation from chemicals in products such as soap or spermicides
• Physical pressure on your urethra from doing things like riding a bicycle.

Along with blood in your semen, you might also notice: 

• Pain while urinating or during sex
• Itchiness at the tip of your urethra
• Discharge of pus or blood from your penis

A doctor may prescribe antibiotics to treat urethritis. They may also recommend avoiding bike riding, using scented soaps and shower products, and anything else that might further irritate your urethra. 

4. Epididymitis

Epididymitis is an infection of the epididymis — the tube at the back of each testicle that stores and carries sperm. It can be caused by E. coli and bacterial infections like chlamydia and gonorrhea.

Along with blood in your semen, epididymitis may also cause:

• Painful or urgent urination
• Discharge from your penis
• Pain in your testicle
• Swelling in your scrotum

If you suspect you might have epididymitis, it's best to make an appointment with your doctor — the treatment for this condition usually involves taking antibiotics for a week or two. 

5. Prostate biopsy

If your doctor suspects you may have prostate cancer, they'll likely order a prostate biopsy. This procedure involves collecting small tissue samples from your prostate gland with a needle. A specialist will then examine your tissue samples under a microscope for the presence of cancerous cells.

You might notice blood in your semen for two to three months after getting a prostate biopsy, but this side effect is common and not serious — up to 90% of people who get a prostate biopsy will have blood in their semen afterwards. 

That said, if blood in your semen lasts longer than a few months or the bleeding seems heavy, you'll want to check in with your doctor.

6. External beam radiation 

Blood in your semen can also happen as a side effect of external beam radiation, one of the standard treatments for prostate cancer. Up to 25% of people who receive this treatment notice blood in their semen afterward. 

Your care team may recommend this treatment:

• On its own, in the early stages of prostate cancer
• In combination with other treatments, like hormone therapy, in more serious cases 
• After surgery, to reduce the risk of cancer returning or if you show signs of cancer recurrence

If the blood in your semen happens as a side effect of external beam radiation, then it will usually go away on its own. But it's worth checking in with your doctor if the bleeding lasts longer than a week or two.

7. Brachytherapy

Prostate brachytherapy is a treatment for early stage and slow-growing prostate cancer. This procedure involves implanting small metal pellets that contain radiation into your prostate to kill cancer cells. 

Brachytherapy tends to have fewer side effects than other types of radiation therapy, but you may notice blood in your semen and urine for a few days after a brachytherapy procedure. 

If blood in your semen lasts longer than this, you'll want to let your doctor know right away.

8. Benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH), a non-cancerous enlargement of your prostate, may happen as you age. In fact, about a third of people with a prostate will experience symptoms by age 60, and about half by age 80.

BPH mostly causes urinary symptoms, but in some cases the enlarged prostate can pinch your urethra, causing blood in your semen. Other symptoms of BPH include:

• A frequent and urgent need to urinate
• Dribbling urine or a weak stream
• Difficulty starting urination

Treatment for BPH may consist of:

• Medication: Your doctor may prescribe medications to relax your bladder and shrink your prostate, including 5-alpha reductase inhibitors like finasteride and dutasteride or alpha blockers such as alfuzosin and tamsulosin.
• Minimally invasive surgery: Depending on your symptoms, your doctor may also recommend one of several different kinds of surgery to ease your urinary flow. 

9. Vasectomy  

A vasectomy involves sealing off the tubes that carry sperm from the testicles to the penis as a form of birth control. This short outpatient procedure prevents pregnancy nearly 100% of the time.

After a vasectomy, you might notice the following side effects: 

• Blood in your semen for up to a week afterward
• Bruising of your scrotum
• Swelling
• Mild pain or discomfort

10. Injury

Physical trauma to your genitals, perineum, or pelvis can cause blood in your semen, due to leaking blood from the damaged blood vessels. 

If you notice blood in your semen after an injury to your pelvic or genital area, a good next step involves checking in with your doctor. They can help rule out a serious medical concern and offer more guidance on next steps, if the blood in your semen doesn't go away on its own.

11. Cancer

A tumor may sometimes cause blood in your semen, but this isn't common — it only rarely happens as the first symptom of cancer. 

That said, blood in your semen may show up with several different types of cancer, including: 

Medical term: The seminal vesicles are the two glands behind your bladder that produce fluids for semen. 

12. Cysts

A cyst, or non-cancerous growth, can occur anywhere in the body. Cysts in your seminal vesicles or prostate can cause nearby blood vessels to rupture. This blood then flows out of your body in your semen.

Cysts of the prostate and seminal vessels are both rare. They often don't involve symptoms or require treatment, but you might notice: 

• Painful urination
• Blood in your urine
• Frequent UTIs

The treatment for both types of cysts involves removing or draining them. 

13. Prostate stones

Prostate stones, also called prostate calculi, can also cause blood in your semen. 

These stones tend to occur mostly after age 50. They often form due to chronic inflammation, but they may also develop if you have BPH. This happens because an enlarged prostate can block some of the ducts leading from your prostate to your urethra. 

Other symptoms of prostate stones include:

• Pain while urinating
• Pelvic pain
• Blood in your urine

Most cases of prostate stones won't cause symptoms. However, if you do experience any symptoms, you'll want to make an appointment with a healthcare professional who can help you get the right diagnosis.

If your stones cause symptoms, your doctor will most likely recommend removing them via endoscopy.

14. Underlying health conditions

Some conditions that typically don't have a direct impact on your genitals may also cause blood in your semen. 

Examples include:

If you notice blood in your semen, along with any symptoms of the above conditions, it's best to check in with your doctor as soon as you can.

When to get medical attention

Blood in your semen may not always pose a serious cause for concern. In fact, if you're over the age of 50, a lack of sexual activity can lead to buildup in your seminal vesicles, which may cause inflammation and bloody semen. 

Still, Dr. Justin Houman, urologist and the Medical Director for Bastion Health, recommends reaching out to a doctor or urologist anyway.

"There's no harm in being overly cautious to ensure there's nothing significant going on in your urinary tract or prostate,'' Houman says. 

It's particularly important to reach out to a healthcare professional right away if you: 

• Find blood in your semen regularly
• Are over the age of 40
• Also have urinary symptoms, like pain or blood in your urine

Your doctor might recommend: 

If those tests don't help determine the cause, they may also recommend imaging tests to check for visible obstructions or inflammation in your prostate. These tests might include a transrectal ultrasound, CT scan, or MRI. 

Insider's takeaway

Blood in your semen can have a number of possible causes — but most of the time it doesn't represent a serious medical concern. If you don't have any other symptoms, you likely have nothing to worry about. 

However, since bloody semen may, in some cases, have a more serious cause, you'll want to make an appointment with your doctor if it keeps happening, or if you're over the age of 40.  They can help identify the source and offer more information about your options for treatment.  

Adam Barnes