Bloody Sperm – Causes of Blood in Semen, Ejaculation

Hematospermia is the term for blood in the semen and can vary from a light pink discoloration to red streaks in the ejaculate. At times the blood may not be visible and many men would not know that they have passed blood when ejaculating. It is rare for semen to be bloody to the extent that it masks the the natural color of ejaculate.

Pathophysiology of Hematospermia

Bloody semen may indicate a lesion somewhere along the genitourinary tract. Sperm is manufactured in the testicles (epididymis) and passed into the vas deferens which leads to the ejaculatory duct. Along with fluid from the seminal vesicles, prostate and other glands along the genitourinary tract, it is passed out as semen upon ejaculation. Less frequently, the blood noticed in the semen may be from a external source or bleeding lesions on the penis.

Causes of Hematospermia

It is important to identify if the blood is present upon ejaculating (semen) or with secretion of pre-ejaculatory fluid (before ejaculation).

Most cases of hematospermia is due to unknown causes (idiopathic) and spontaneously resolves within a few weeks. Other causes may be benign or hematospermia could be a sign of serious disorders affecting the genitourinary system.

  • Inflammation
    • May be due to chemical irritation, mechanical injury or infections.
    • Poisoning, chemical toxicity.
    • Catheter
  • Infections
    • Sexually transmitted diseases (STD’s)
    • HIV
    • Tuberculosis
    • Schistosomiasis (Schistosoma haematobium)
    • Echinococcosis (Echinococcus multilocularis)
  • Trauma
    • Surgery – prostate resection, vasectomy, circumcision.
    • Diagnostic procedures – prostate biopsy.
    • Injury to the perineum particularly to the penis or testicles (scrotum in general).
  • Tumors
    • Prostate and testicular cancer – hemangioma of the prostatic urethra or spermatic duct in particular.
  • Seminal vesicles
    • Amyloidosis of the seminal vesicles.
    • Cysts – acquired or congenital.
    • Hemorrhagic lesions
  • Urethra
    • Urethritis
    • Cysts
    • Polyps
    • Strictures
  • Penis
    • Blood from an external source.
    • Circumcision – immediately after the procedure.
    • ‘Sores’ from STD’s, allergic reactions to latex condoms, lubricating or spermicidal agents.
    • Phimosis resulting in minute tears upon intercourse.
  • Other
    • Bleeding disorders like von Willebrand’s disease.
    • Cirrhosis
    • Hypertension
    • Lymphoma
    • Causes of hematuria (blood in the urine) should also be considered as remnants of blood may be remaining in the urethra, although this is rare.
    • Use of penis enlargement devices or applications may also need to be considered.
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  • Yip

    For two days I have noticed blood in my urine. Not always, but at least once per day.
    Today, after ejaculating, I noticed the sperm was red. Not just ‘streaked’ red, but entirely red. ALL red. It looked as if I had ejaculated blood rather than semen.
    I’m a bit worried! I have no health insurance and wonder what – if anything – I should do.
    Comments would be appreciated. Thank you.

  • Dr. Chris

    Hi Yip

    If you ejaculated blood then you may have a rupture along the tract and this will need immediate medical attention. Other causes as mentioned above may also be a cause but an acute onset like this is either a result of a rapidly progressing infection or a perforation/rupture. Both are considered serious and will need medical treatment, if not surgery.

  • Rick

    Last week I noticed I’d ejaculated bloody streaks, this had never happened to me before. It was painful and felt a lot of discomfort in my testicles afterwards, I had a vasectomy performed about a year and a half ago, I was wondering if it could somehow be related, and if the procedure could have been compromised. Appreciate your comments.

  • Dr. Chris

    Hi Rick

    It is possibly related and you should see a urologist as soon as possible. Remember there are other possible causes so take note of any other symptoms that may be present and report this to your doctor as well.

  • Dave

    I was told i had i hydrocele. It is only painful after i ejaculate and a period of time (hours) goes by. I had a red streak of blood after i ejaculated, is this common?

  • carl

    Hi doc,
    I was curious if masturbation could result in bloody semen. It has happened to me twice in my life and it was not at all painful and it was jist a small streak towards the end of ejaculation. Do you think this is something I should be worried about or seek attention for?

    Carl

  • Dr. Chris

    Hi Carl

    It is unlikely unless you injured the penis during the process. You should seek medical attention as some causes can be serious and require immediate medical attention.

  • Dr. Chris

    Hi Dave

    It is not common in a hydrocele of the testis and it is important to verify whether there may be other conditions or even complications that have arisen which causes the blood in the ejaculate.