What should I do if I have blood in my semen?
If you see blood in your semen, you should contact your GP for further advice although it is unlikely that there is a worrying underlying cause
Your GP will normally provide reassurance about blood in the semen. Most GPs will perform some simple, baseline tests. You may be commenced on antibiotics or anti-inflammatory drugs to treat presumed infection / inflammation (the commnest cause of blood in the semen).
It is not normally necessary for you to be referred for more detailed investigations, in hospital, unless your prostate gland feels abnormal, there is associated blood in the urine or your PSA blood test is abnormal.
What are the facts about blood in the semen?
The commonest cause of blood in the semen is low-grade infection or inflammation in the seminal tract (particularly in the prostate gland). It is important to be aware that:
- although possible, it is unlikely to be caused by sexually-transmissible infection;
- rarely, it can be due to cancer of the testis or the prostate gland;
- if it is associated with blood in the urine, whether visible or non-visible (found on a urine test), it should always be investigated fully;
- if it is associated with an abnormal prostate gland on rectal examination, or a raised PSA blood level, you will normally be referred to your local urology department on the "fast-track" (2-week wait) system;
- blood in the semen usually resolves, either spontaneously (by itself) or with the help of anti-inflammatory drugs; and
- recurrence over a long period of time is common.
What should I expect when I visit my GP?
Your GP should work through a recommended scheme of assessment for patients with blood in the semen. This will normally include some or all of the following:
A full history
Your GP will ask you questions about any recent symptoms (especially pelvic pain), any associated matters (including any drugs you are taking) and will enquire about smoking habits. You should inform your GP if you are taking blood-thinning drugs (warfarin, dicoumarin, rivaroxaban, prasugrel or dabigatran) or if you take anti-platelet treatment (aspirin, dipyridamole, clopidogrel). If the blood in the semen is painful or associated with blood in the urine, it is likely that your GP will arrange referral to a urologist.
A physical examination
A general physical examination will normally be carried out.
You will also have a rectal examination and assessment of your testicles.
Your blood pressure may be measured as part of this examination.
The usual tests performed are:
a. General blood tests
The actual tests performed will be left to your GP's discretion but it is common to measure kidney function, clotting factors, prostate-specific antigen (PSA) and to check the blood for anaemia or other problems
b. Urine testing
A urine test will normally be sent for infection. Your GP may commence you on antibiotics whilst awaiting the result of this test. If there is blood in your urine, fresh urine may be sent to the laboratory for microscopic examination, to look for cancerous cells.
Testing the semen for infection is not normally performed because harmless bacteria are often found in semen and are not the cause of any infection.
c. Other specific tests
Your GP may arrange an ultrasound scan of your kidneys and bladder, pictured right. This is more likely to be arranged by the urology department and they may also request a transrectal rectal ultrasound scan of your prostate and seminal vesicles.
What could have caused the blood in my semen?
Most patients with blood in the semen have low-grade prostate, urethral or seminal vesicle inflammation which requires no specific treatment and usually resolves spontaneously
Although there are many potential causes for blood in the semen, it is often difficult to identify a clear cause. Those most often found are:
- low-grade seminal tract infection (± urinary tract infection);
- blood disorders (e.g. sickle cell disease, clotting disorders, anticoagulant and anti-platelet drugs);
- recent urological surgery (e.g. cystoscopy, prostatic biopsy, vasectomy, vasectomy reversal);
- testicular or prostate cancer (very rare); and
- other causes, including less common infections (e,g. tuberculosis, schistosomiasis)
What happens next?
It is very unusual for men with blood in the semen to require urological referral
Your GP will reassure you that the condition usually improves by itself. If the blood in the semen persists, your GP will normally prescribe a 6-8 week course of antibiotics or anti-inflammatory drugs.
Urological referral may be considered if:
- your prostate feels abnormal on rectal examination and/or your PSA blood test is abnormal;
- examination or ultrasound reveals an abnormal testicle;
- there is blood in your urine (visible or invisible); or
- you have regular blood in the semen, despite adequate treatment, especially if you are over the age of 45 years.
This will involve an outpatient appointment when some or all of the following assessments will be performed:
- Detailed questioning about your urinary tract and any related symptoms
- A physical examination (including rectal & scrotal examination)
- Blood tests (if not already performed by your GP)
- Examination of the urine for cancer cells (if not already performed by your GP)
- X-rays or scans
This may include one or more of the following:
- MRI scan
- ultrasound scan of kidneys & bladder
- rectal ultrasound scan of the prostate
- ultrasound of the scrotum
- A flexible cystoscopy (if you have blood in your urine as well)
This is a telescopic check of the bladder. It is performed under antibiotic cover & local anaesthetic using a small, flexible telescope which allows the clinic doctor to see inside your bladder (pictured).
Download an information leaflet about flexible cystoscopy.
If you have concerns about a bladder examination under local anaesthetic, or you have experienced problems with local anaesthetic in the past, you should ask about having your examination under a brief general anaesthetic (i.e. whilst you are asleep).
Download an information leaflet about bladder examination under a general anaesthetic.
When your tests have been completed, the medical staff will advise you on what to do next:
If an abnormality requiring further treatment is detected, the medical staff will advise you on what treatment is necessary.
If no specific abnormality is found, you should keep a careful eye on your symptoms and report any further bleeding to your GP who will be informed of the result of your assessment.