Hematospermia(Blood in Semen): Causes , Diagnosis & Treatment

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Hematospermia(Blood in Semen): Causes , Diagnosis & treatment

Dr. Vijay Pal Singh, Consultant Urologist at Apollo Clinic Chandigarh, discusses the causes, diagnostic methods, and treatment of hematospermia: 

What is blood in semen or hematospermia?

It is a condition in which blood is present in semen or during ejaculation. 

Why does it affect men badly?

It is a problematic and anxiety-provoking condition for the patient as they believe it would affect their fertility or impair their erection. Hence, it causes significant anxiety in the patients.

Incidence of blood in semen

It is not that common. However, out of 1% of urological patients, 1-4% have blood in the semen.

What are the common causes of hematospermia?

Blood in the semen is benign and self-limiting. However, their course or blood may come up in weeks. Usually, it’s STI or inflammation if it starts commencing after the age of 40. But there may be other causes, like inflammation in minor vesicles or male reproductive organs. The stone formation can also lead to blood in the semen.

Other causes of blood in semen

There can be an obstruction in the ejaculatory duct or any vascular malformation like AV fistula, mucosal vessel, or hemangioma. After age 40, there is a suspicion of benign or malignant tumors in the prostate or urethra, but these are rare phenomena.

How to diagnose hematospermia?

Knowing patient history is the initial mode of diagnosis. It includes the amount of blood in semen and its frequency or quantity. In addition, urine condition, presence of any underlying conditions, and blood in the urine. Also, if the patient is on blood thinners or suffering from any hemolytic diseases, there are more chances of bleeding.

Physical Examination

In physical examination, the doctor checks vitals, temperature, sepsis or infection, and abdominal palpation. The doctor even performs an external genital analysis by evaluating testis, vas deferens, and epididymis. In addition, doing a penile urethra, palpitation is essential to detect abnormalities like stones or any tumour if present. 

Distal rectal examination

It is essential to opt for a distal rectal examination. One can detect giant tumours, stones, or distention in seminal vesicles. Also, prostate gland palpitates to inquire suspicious nodules that may indicate prostate cancer. 

Lab Test

Doctors ask for urine analysis, mandatory urine culture semen analysis, semen culture, and blood tests to diagnose this condition. To detect blood thinning and bleeding tendencies, doctors do PTI test

Do imaging techniques help in diagnosis?

Transrectal ultrasonography, pelvis MRI, and Vasography help better understand the condition. So doctors can use these individual tests or, in combination, make the proper diagnosis. 


Treatment includes anxiety relief, essential reassurance, and wait and watch. Apart from that, there are certain culture-specific antibiotics if there is an STD infection, like chlamydia or gonorrhoea. So they require different types of treatment and are beneficial.

Other Treatment Include

Doctors do ultrasound-guided aspiration if there is an underlying cause, like a seminal vesicle cyst or ejaculatory duct obstruction. It is one modality through which we can treat them. Patients suspected of Seminal vesicle stones or tumours need specific treatment according to the cause. If there is a tumor, doctors opt for surgical procedures and therapies. But this depends upon the patient’s condition and diagnosis.

Bottom line 

In most cases, it is self-limiting and heals on its own. However, if it starts at the age of 40, it is probably STIs for which one can easily take an antibiotic course. But if it persists for longer, accompanied by pain, then one must seek a doctor’s advice. 

Thank you.

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