Why Is There Blood in Semen?

Semen is a fluid secreted by male reproductive glands during ejaculation, containing sperm and nutrients. Changes in the color and smell of semen can indicate pathologies of the reproductive system.

What is the normal color of semen?

The normal color of semen is usually whitish or grayish-white, determined by the presence of sperm, enzymes, proteins, and minerals. A yellowish color of semen may be normal after prolonged abstinence or due to a diet high in pigment-rich foods (such as carrots). Yellowing can also occur due to a small amount of urine remaining in the urethra before ejaculation. Red, brown, or pink semen often indicates pathologies of the urinary and reproductive systems.

The consistency of semen should be viscous and slightly gel-like immediately after ejaculation, but it usually liquefies and becomes thinner within 15-30 minutes. This liquefaction process is important for sperm to move easily through the female reproductive tract to reach the egg. Semen that is too thick or too thin may indicate health problems, including infections, inflammations, or hormonal imbalances.

What is the normal smell of semen?

Normally, the smell of semen resembles ammonia, bleach, or chlorine due to the alkaline nature of the seminal fluid (pH 7.2-8). A fishy, rotten, foul, or sharp smell in semen may indicate sexually transmitted diseases (e.g., trichomoniasis, gonorrhea) or prostate inflammation (prostatitis).

What is blood in semen?

Hematospermia is a condition in which traces and streaks of blood appear in semen, giving the fluid a reddish or brownish tint. In hematospermia, a man may find blood on his underwear or toilet paper. He may also notice that his semen has turned dark after sex or during masturbation. Blood clots in semen can occur due to damage to blood vessels in the reproductive tract, leading to blood clotting in the seminal fluid.

Is the presence of blood in semen normal?

Blood in semen can be normal after surgeries on the genitalia and pelvic organs, as well as after certain medical procedures (e.g., prostate biopsy or vasectomy). Blood from the penis may be present for several weeks and does not require a doctor’s visit unless there is a high fever, pain, or swelling. Blood during masturbation and after sexual intercourse is also often a normal occurrence (especially with intense friction during sex).

Why is there blood in semen?

One cause of blood in seminal fluid is a bacterial, viral, fungal, or parasitic infection of the urinary tract. With an infectious lesion, in addition to traces of blood in semen, the patient may experience frequent, painful, and difficult urination, pathological discharge from the penis (e.g., purulent, foul-smelling), weakness, and fever. Other causes of blood in semen include:

• Deformation of blood vessels (e.g., their entanglement);
• Inflammation of the urinary tract or genitalia;
• Prolonged abstinence from sex;
• Radiation therapy in the pelvic area;
• Cystoscopy (endoscopic examination of the bladder);
• Surgical contraception (vasectomy);
• Trauma to the genital organs (e.g., testicles, vas deferens, seminal vesicles, prostate) or pelvic area;
• Prolonged use of anticoagulant medications;
• Sexually transmitted diseases (e.g., chlamydia, gonorrhea);
• Prostate diseases (e.g., hyperplasia, cysts, polyps);
• Diseases of the testicles and appendages (including orchitis and epididymitis);
• Stones or cysts in the seminal vesicles;
• Blood disorders (e.g., sickle cell anemia, hemophilia);
• Chronic infections (tuberculosis, schistosomiasis, HIV);
• Liver diseases (e.g., cirrhosis, failure);
• Uncontrolled hypertension (high blood pressure);
• Oncology (testicles, prostate, bladder, urethra).

Blood in men during sexual intercourse can occur due to trauma to the urethra and the cavernous bodies of the penis as a result of sharp and intense actions, strong and prolonged stimulation. Due to excessive strain, the tissues of the penis may become damaged, especially if there is insufficient natural lubrication, increasing friction. Additionally, during intense compression of the cavernous bodies, which fill with blood for an erection, blood vessels may also be damaged during intercourse.

Blood after masturbation may appear due to mechanical damage to small blood vessels in the urethra or genital area during excessive stimulation. Strong pressure on the tissues or frequent masturbation can lead to micro-trauma, especially if the skin or mucous membranes are inadequately moist, increasing the likelihood of blood discharge from the penis.

Blood in semen during prostatitis occurs due to inflammation that causes swelling and increased blood circulation in the tissues of the prostate, making small vessels prone to rupture. In acute prostatitis, active destruction of tissues and vessels can occur due to the action of inflammatory mediators and infectious agents, leading to blood in semen in men. Inflammation may also affect neighboring structures, including seminal vesicles and the urethra, leading to blood in both semen and urine.

Blood in semen after prostate massage may be caused by micro-traumas to the capillaries of the prostate or urethra, which can be damaged by excessive or aggressive pressure during the procedure. The risk of blood contamination in semen is heightened in men with varicose veins or stones in the prostate due to irritation or damage to blood vessels and dense clumps of calcium, phosphorus, and proteins.

Blood in semen after a prostate biopsy is almost an inevitable consequence of the procedure. During a biopsy, a doctor takes several tissue samples from the prostate using a needle, damaging small blood vessels (capillaries). Since the prostate is closely associated with the seminal vesicles and vas deferens, blood from the damaged vessels can enter the semen. Additionally, not only the surface layers are traumatized but also deeper structures, which increases bleeding.

Types of Hematospermia

Red or brown semen may indicate pathologies of the male reproductive or urinary systems. Types of hematospermia:

• True hematospermia: Occurs when blood enters semen from the organs of the reproductive system, including the prostate, seminal vesicles, or vas deferens. In true hematospermia, blood mixes evenly with the semen, giving the fluid a red or brown color.
• False hematospermia: Arises when semen with blood results from bleeding in the urinary system (e.g., in the urethra, bladder, ureters, or kidneys). In false hematospermia, blood does not completely mix with the ejaculate, resulting in clots or streaks of blood in the semen.

Determining the cause of cloudy, pink, red, or brown semen is important for selecting the appropriate course of therapy. To establish the type, nature, and localization of the lesion causing blood to appear at the end of ejaculation after sexual intercourse or masturbation, a urologist will prescribe laboratory and instrumental studies.

Which Doctor to Consult About Blood in Semen?

If lumps in semen, changes in color and smell of ejaculate, or blood in seminal fluid are noticed, as well as redness of the skin and mucous membranes of the genitals, itching, burning, and tingling in the genital area, a consultation with a urologist is necessary. If hormonal disorders are suspected, the urologist may refer the patient to an endocrinologist, and for suspected cancer of the urinary or genital organs, to an oncologist.

What Tests and Studies May Be Prescribed When There Is Blood in Semen?

Blood in semen is not a diagnosis; to determine the cause, the urologist will analyze the symptoms and their timing, gather the patient’s medical history, and ask about past chronic and infectious diseases, surgeries, and procedures. Diagnosis of blood in semen may include:

• Physical examination: Involves examining the skin and mucous membranes of the genitals, palpating the abdomen, and assessing the overall condition of the patient. During the examination, the doctor may notice symptoms indicating tumors, inflammation, or trauma, as well as sexually transmitted diseases;
• Digital rectal examination: During the examination, the urologist evaluates the size and structure of the prostate. Enlargement, hardness, or tenderness of the organ may indicate the presence of diseases, including prostatitis, adenoma, or prostate cancer, which can lead to red or black semen;
• Semen analysis: A key test in assessing the condition of semen. The study allows for the detection of blood or pus in semen, assessing the number, motility, and morphology of sperm;
• Urine analysis: Allows for the diagnosis of false hematospermia by revealing pathologies of the urinary system. Through laboratory examination of urine, inflammation, urinary tract infection, as well as kidney or bladder stones can be detected;
• Infection smear: Involves taking a sample of discharge using a sterile swab inserted into the urethra and gently rotated to obtain biological material. This test will help identify the type and concentration of the pathogenic microorganism that may have caused inflammation and blood discharge in men;
• Prostate-specific antigen (PSA) test: Elevated levels of PSA (a protein produced by the prostate) may indicate inflammation, benign or malignant tumors.

For dark-colored semen, the doctor may also prescribe imaging studies (CT, MRI, or ultrasound). Ultrasound diagnostics will help assess the structure of the prostate, seminal vesicles, and testicles, as well as the organs of the urinary system. Using ultrasound, abnormalities in structure, inflammatory processes, tumors, cysts, or stones can be detected.

Computed tomography provides slices that help identify tumors, injuries, and assess the presence of inflammation in the pelvic area. Magnetic resonance imaging allows for a detailed assessment of the prostate and surrounding structures, identifying tumors, inflammation, and other pathological changes that may cause pink or red semen.

How is Hematospermia Treated?

The method of treating blood in semen is determined by the urologist based on the cause of hematospermia, age, medical history, and overall health of the patient. Medications for treating hematospermia may include:

• Antibiotics (Zithromax, Doxycycline), : Used to treat infections that cause hematospermia (e.g., prostatitis or urethritis), sexually transmitted diseases (chlamydia, trichomoniasis). They kill or suppress the growth of pathogenic microorganisms, helping to eliminate the source of inflammation and reduce the risk of transmitting the infection to a partner during sex;
• Anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce inflammation and pain associated with hematospermia. They reduce the production of prostaglandins, helping to alleviate symptoms and speed up recovery;
• Alpha-blockers: May be used to alleviate symptoms associated with enlarged prostate or spasms in the urinary tract. They relax smooth muscles, helping to improve urine flow and reduce discomfort;
• Hormonal medications: Prescribed for hormonal imbalances, helping to restore normal hormone levels, which can affect the function of the reproductive system;
• Antihistamines: If allergic reactions that may cause inflammation are present, antihistamines help reduce histamine levels in the body, alleviating allergy and inflammation symptoms;
• Medications to improve microcirculation: Help improve blood circulation in the pelvic area, which can aid in tissue recovery and reduce inflammation. Improving microcirculation can help decrease swelling and speed healing in inflammatory diseases;
• Immunostimulants: Help activate the body’s immune response, may be prescribed in the presence of infections or inflammatory processes, enabling the body to deal with pathogenic microorganisms more effectively and reduce inflammation.

Enzymes may be used to improve metabolism and reduce inflammatory processes. They help break down and eliminate products of inflammation and infection, potentially contributing to faster recovery. If hematospermia is associated with stress or anxiety, sedative medications may help reduce stress and anxiety levels.

What to Do If There Is Blood in Semen?

If there is blood in semen, it is important not to ignore this alarming symptom and avoid self-treatment. If blood appears after ejaculation in men, it is crucial to consult a urologist to rule out inflammatory, infectious, or chronic diseases of the reproductive and urinary systems.

Can Hematospermia Be Treated at Home?

Hematospermia can only be treated at home with medications prescribed by a urologist. It is also necessary to follow the doctor’s recommendations (for example, abstain from sexual intercourse, avoid visiting baths and saunas, and swimming in public pools and open waters).

Is It Possible to Have Sex and Masturbate with Hematospermia?

If hematospermia is caused by intense friction or trauma, it is better to temporarily avoid sex and masturbation to prevent further irritation or damage to the tissues of the genital organs. Unprotected sexual intercourse should also be avoided in the presence of infectious diseases of the urinary system due to the risk of transmitting pathogenic microorganisms to the partner. For chronic prostate, urethra, or kidney diseases, it is usually not necessary to abstain from sex or masturbation (except in the presence of other directives from the doctor).

Complications of Hematospermia

In most cases, hematospermia resolves on its own without irreversible consequences for the reproductive and urinary systems. However, blood in semen can indicate pathologies (including prostatitis, sexually transmitted diseases, or cancer) that may lead to infertility, chronic pain syndrome, or even death (e.g., in cases of oncology).

Prevention of Blood in Semen

Maintaining personal hygiene is an important aspect of preventing hematospermia, as it helps reduce the risk of infections that can cause inflammatory processes in the reproductive and urinary systems. Regular washing of the genital area with mild soap and water, as well as thorough hygiene after sexual intercourse, helps maintain cleanliness and prevent the proliferation of bacteria. Other recommendations for preventing blood in semen include:

• Preventing genital injuries (e.g., during work and physical activities);
• Controlling chronic diseases;
• Timely treatment of infections;
• Regular preventive examinations by a urologist;
• Taking medications only as prescribed by a doctor;
• Managing stress (through deep breathing, yoga, meditation);
• Balanced and healthy diet;
• Regular moderate physical activity;
• Avoiding harmful habits (smoking and alcohol consumption).

It is also important to avoid intense physical exertion, as it may lead to micro-traumas in the genital area, causing inflammation and blood in semen. Additionally, excessive physical activity may increase the risk of overheating and dehydration, negatively affecting overall health and potentially exacerbating reproductive system problems.