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

• Prostate
  • Prostatitis
  • Benign prostatic hyperplasia (BPH)
  • Prostate cancer
  • Transurethral prostate resection
  • Prostate biopsy

• 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.