Blood in the semen, called hematospermia, may be undetectable (microscopic) or visible in the ejaculation fluid.

Associated symptoms may include:

• Pain with urination
• Pain with ejaculation
• Pain with bowel movement
• Tenderness in the scrotum
• Swelling in scrotum
• Swelling or tenderness in groin area
• Lower back pain
• Fever or chills
• Blood in urine

Blood in the semen may be caused by inflammation, infection, blockage, or injury anywhere along the male reproductive tract. It may indicate disease or a problem within the urethra, testicles, epididymis, or prostate.

Blood in the semen is usually the result of inflammation of the seminal vesicles, and will usually go away on its own. Often, the cause cannot be determined. If the blood does not clear and ejaculate is persistently stained with blood, more tests should be done. These tests may include urinalysis and culture, semen analysis and culture, and ultrasound of the seminal vesicles.

Minor injuries may be treated with rest, applying ice, and monitoring symptoms. Major injuries may require reconstructive surgery.

Infections can often be treated with antibiotics taken by mouth (or intravenous antibiotics if symptoms are severe).

Blockages are typically treated with surgery. If cancerous tumors are the source of obstruction, radiation or chemotherapy may also be indicated.

Always call your doctor if you notice any blood in semen.

The doctor will perform a physical examination. The doctor will look for fever, swollen lymph nodes, a swollen or tender scrotum, discharge from the urethra, or an enlarged or tender prostate.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• How much blood was in the semen?
• Was microscopic blood ever noticed in the past when the semen was examined for another reason?
• When was this first noticed? Is it present all the time?
• Is there anything that seems to have caused this symptom?
• What other symptoms do you have?

The following diagnostic tests may be performed:

• Triple-void urine specimens are collected for urinalysis and urine culture:
  • Initial stream
  • Midstream
  • After examiner massages the prostate
• Semen analysis
• Semen culture
• Ultrasound of pelvis and scrotum

The urinalysis may show high white blood cells.

A culture of the urine after prostatic massage may show bacterial growth and high levels of white blood cells. However, your health care provider may choose not to massage your prostate if it is obviously swollen and tender, because massage may potentially spread the infection. This could lead to bacteremia or sepsis (generalized infection in which bacteria are present in your bloodstream, not just the prostate).