Hematospermia
Conditions · Hematospermia (blood in semen)
Blood in semen (hematospermia): what brown, rusty or red semen means, where the blood comes from, and when it needs treating
Semen that is brown, rust-coloured, pink or streaked with red is frightening and, in the great majority of men, not dangerous. It is also not “nothing”: blood in the semen nearly always comes from the seminal vesicles and the prostate, and in the men we see the reason is almost always an inflammation of those glands that has been there, unnoticed, for some time. This page explains what the colours mean, every cause from the common to the rare, whether it can affect your partner, how it is investigated, how it is treated, and how long it takes to clear.
Hematospermia at a glance
What is hematospermia?
Hematospermia (or haematospermia) is the presence of blood in the ejaculate. It is less common than blood in the urine but far from rare, and because men look at their semen it is noticed at once and causes alarm out of proportion to its usual cause. The semen is made mostly by the seminal vesicles (about two thirds) and the prostate (about a quarter), with a small contribution from the testicles and the epididymis, and it leaves through the ejaculatory ducts and the urethra. Blood can enter it at any of these points, but by far the commonest source is the lining of the seminal vesicles and the prostate when they are inflamed. In most men it is painless, the only sign is the colour, and it stops within a few ejaculations, which is why it is so often dismissed, and why it so often comes back.
What the colour of the semen tells you
Bright red or pink, streaks or clots
Fresh bleeding, usually from the prostatic urethra or the ejaculatory ducts at the moment of ejaculation: an inflamed, congested prostate, a stone or small varicosity at the opening of the ducts, or the urethra itself. Pink semen is a small amount of fresh blood mixed through.
Brown, rust-coloured or dark semen
Old blood that has sat in the seminal vesicles for days or weeks before being expelled, which is why brown semen is the most common presentation and often lasts for several ejaculations as the vesicles empty. Dark brown semen is the typical sign of seminal vesicle inflammation (seminal vesiculitis), nearly always with the prostate inflamed as well.
Yellow or green with blood
Pus and blood together: active infection of the prostate and seminal vesicles, sometimes from a sexually transmitted organism. This deserves cultures before any antibiotic is started.
Blood in the urine as well
When the urine is also red or brown, the source is more likely the prostatic urethra or the bladder, and the investigation widens to include the whole urinary tract, with a cystoscopy if needed. See our page on blood in the urine.
Where the blood comes from: the causes of hematospermia
Inflammation of the prostate and seminal vesicles
The commonest cause by a wide margin, and in the men we investigate properly, with cultures and transrectal ultrasound, the cause in the large majority. Chronic prostatitis, whether bacterial on routine culture or “non-bacterial”, keeps the gland and the seminal vesicles congested and their lining fragile; the contractions of ejaculation tear the small vessels, and blood collects in the vesicles until the next ejaculation. Stones (calcifications) inside the prostate, dilated vessels (telangiectasia, varicosities) in the gland, and infection, stones or dilatation of the seminal vesicles belong to the same picture. The episodes recur because the inflammation is never treated, only the bleeding is waited out.
The urethra
Urethritis, including from chlamydia, gonorrhoea, mycoplasma and ureaplasma; warts, polyps or cysts in the prostatic urethra; and a urethral stricture, a narrowing left by an old infection or injury, which causes bleeding and raises the pressure in the ducts behind it.
Sexual activity
Prolonged abstinence followed by ejaculation, or unusually frequent and prolonged intercourse, interrupted intercourse, and vigorous masturbation congest the glands and can produce a single episode in a healthy man. Cycling for long hours on a hard saddle compresses the perineum and prostate and does the same.
Varicocele and the scrotum
A varicocele does not itself bleed into the semen, but it is very often found in the same men, because the venous congestion that produces it also congests the pelvic veins of the prostate and seminal vesicles, and because both go with chronic prostatitis. Epididymitis, injury to the scrotum and, rarely, a testicular tumour can also add blood to the ejaculate.
Bleeding and clotting disorders
Haemophilia and other clotting disorders, and anticoagulant medicines such as warfarin, the newer anticoagulants and high-dose aspirin, make any minor bleeding more visible and longer-lasting. They rarely cause hematospermia on their own; usually there is also an inflamed gland that would otherwise not have bled noticeably.
After procedures
Prostate biopsy, cystoscopy, catheterisation, radiotherapy and vasectomy commonly cause blood in the semen for some weeks afterwards; this is expected and settles.
Tumours: rare, but the reason not to ignore it
Cancer of the prostate, the seminal vesicles, the urethra or the testicle is an uncommon cause of hematospermia, found in a small minority of men, almost all of them over 40 with repeated episodes. It is why every man over 40, and every man of any age whose bleeding keeps recurring or is accompanied by blood in the urine, pain, weight loss or a hard prostate, is examined fully rather than reassured.
Can blood in the semen affect a woman?
Blood in the semen is not dangerous to a partner and cannot harm a pregnancy or an unborn child; bloody semen is not “contagious”. What can be passed on is the cause. When hematospermia comes from an infection of the prostate, seminal vesicles or urethra, the organisms, whether sexually transmitted ones such as chlamydia, mycoplasma, ureaplasma and gonorrhoea, or the ordinary bacteria of chronic prostatitis, are transmitted during intercourse and in women cause urethritis, cystitis, vaginitis and, over time, pelvic inflammation that affects fertility. Until the cause is known we advise a condom; once an infection is identified, the partner is tested and treated at the same time, because couples otherwise pass the organisms back and forth and the bleeding “mysteriously” returns.
How hematospermia is diagnosed
Transrectal ultrasound is the examination that most often provides the answer, because the seminal vesicles cannot be assessed any other way: enlarged, honeycomb-like vesicles with thickened walls, stones along the ejaculatory ducts and an inflamed prostate with increased blood flow on Doppler are the usual findings. The images on our infertility diagnosis page show what they look like.
Treatment of hematospermia
Treat the cause, not the colour
A single episode in a young man with a normal examination needs no treatment, only reassurance and a check that it does not recur. When it recurs, or when the examination finds an inflamed prostate and seminal vesicles, the inflammation is treated. A short course of antibiotics quietens the bleeding but seldom clears a chronic infection of the gland, which is why the episodes come back; our approach is the Georgiadis protocol: cultures, antibiotics delivered into the gland, drainage of the seminal vesicles, and the partner treated alongside.
The other causes
Urethritis from a sexually transmitted organism is treated with the specific antibiotic, for both partners. A urethral stricture is opened and dilated. Anticoagulants are reviewed with the prescribing doctor, never stopped on your own. Stones in the ducts and cysts that block them can be opened through the urethra. A tumour, when found, is treated at once, and finding it early is the whole point of the investigation.
Meanwhile
No need to abstain; regular ejaculation empties the vesicles and clears old blood faster. Avoid very prolonged or violent intercourse and long hours on a bicycle saddle until the glands have settled. Use a condom until an infection has been excluded or treated.
How long it takes, and what happens afterwards
Old blood in the seminal vesicles takes several ejaculations to clear, so brown semen can persist for two to four weeks even when the cause has stopped; fresh red blood from the urethra or prostate usually stops within days. Once the underlying inflammation has been properly treated the bleeding does not usually return, and the man has no restrictions on his activities. Where the cause cannot be fully removed, for example a man on anticoagulants with a stone in the prostate, occasional recurrence is possible and is not a cause for alarm once the serious causes have been excluded. The man can monitor his own semen at home and report any new episode, any change in colour, or any new symptom; further follow-up depends on the cause: cultures and ultrasound for treated prostatitis, PSA and examination for men over 40.
Any episode in a man over 40; episodes that keep returning or last beyond a month; blood in the urine as well; pain in the perineum, testicles or on urination; fever; difficulty urinating or a weak stream; a hard, irregular or tender prostate on examination; unexplained weight loss; a lump in the testicle; or a known bleeding disorder. None of these means cancer, which remains rare, but each is a reason for a full examination within days rather than weeks.
Brown or red semen, once or again?
Tell us when it started and how often it happens. In one visit we examine you, culture the urine, semen and prostatic fluid, and scan the prostate and seminal vesicles, and tell you honestly where the blood is coming from and what, if anything, needs treating.
Blood in semen: frequently asked questions
Is brown semen dangerous?
Usually not. Brown or rust-coloured semen is old blood from the seminal vesicles, and its commonest cause is inflammation of the vesicles and prostate, which is treatable. It should still be examined, especially if it recurs or you are over 40, because the rare serious causes are found by examination, not by waiting.
Can blood in sperm affect a woman or a pregnancy?
The blood cannot. An infection causing it can be transmitted and cause cystitis, vaginitis or pelvic inflammation in the woman, so use a condom until the cause is known and have the partner tested if an infection is found. Hematospermia does not harm a pregnancy or the baby.
Is hematospermia contagious?
No, but the organisms behind an infectious cause, from chlamydia to the bacteria of chronic prostatitis, are. Treating both partners prevents the infection, and the bleeding, from bouncing back and forth.
Can prostatitis cause blood in the semen?
Yes; chronic prostatitis with involvement of the seminal vesicles is the commonest cause we find. The congested, inflamed glands bleed with the contractions of ejaculation, and the blood collects in the vesicles until the next time. Treating the prostatitis stops it recurring.
Can a varicocele cause blood in the semen?
Not directly, but the two are often found together: the venous congestion behind a varicocele also congests the pelvic veins of the prostate and seminal vesicles, and both conditions commonly coexist with chronic prostatitis. A man with a varicocele and hematospermia needs his prostate and vesicles examined, not only his scrotum.
How long does hematospermia take to go away?
Fresh bleeding stops in days; old brown blood takes two to four weeks and several ejaculations to clear. If it has not cleared in a month, or it returns, the cause has not been treated.
Can cycling cause blood in the semen?
Yes, occasionally: long hours on a hard, narrow saddle compress the perineum, the prostate and the urethra, and can cause a single episode. A wider saddle and shorter rides prevent it; if it recurs, the prostate should be examined, because cycling is usually uncovering an inflammation rather than creating one.
What is the treatment for blood in sperm?
Treatment of the cause. For the common cause, inflammation of the prostate and seminal vesicles, a short course of antibiotics calms the bleeding but rarely clears the infection; a proper course directed at the gland, with the partner treated too, stops it coming back. Strictures, stones, polyps and the rare tumour each have their own treatment.
