Blood in semen, called haematospermia or hematospermia, is alarming but is often caused by a benign or inflammatory problem. A single episode in a man under 40 with no other symptoms often settles without extensive imaging. Recurrent or persistent episodes, age 40 or above, blood in urine, urinary symptoms, fever, weight loss, abnormal prostate findings or cancer risk deserve more detailed evaluation. Causes include infection/inflammation, recent instrumentation or biopsy, prostate/seminal-vesicle conditions, stones, vascular lesions, bleeding disorders and, less commonly, cancer.

What does blood in semen look like?

Fresh blood may make semen pink, red or streaked. Older blood can appear brown or rust-coloured. The colour alone cannot identify the cause. It is also important to confirm that the blood is actually from the ejaculate rather than urine or a partner.

Common causes of blood in semen

How worried should I be about cancer?

Most haematospermia is not caused by cancer. EAU guidance notes that malignancy is uncommon overall, while inflammation/infection accounts for a much larger proportion. Risk assessment changes with age, recurrence, PSA/prostate risk, blood in urine and associated symptoms. The goal is to avoid both unnecessary panic and inappropriate reassurance.

The first episode and the recurrent episode are different problems

A single painless episode in a younger man with no haematuria, urinary symptoms, fever, abnormal examination or cancer risk often needs reassurance plus targeted basic evaluation rather than immediate MRI or an extensive cancer work-up. The revised 2025 ACR criteria specifically rate routine imaging as usually inappropriate for transient haematospermia in men under 40 without associated symptoms.

The threshold changes with recurrent or persistent bleeding, age 40 or above, blood in urine, an abnormal PSA or prostate examination, systemic symptoms, anticoagulation/bleeding disorders or other concerning findings. In those settings, prostate and seminal-vesicle imaging may become appropriate.

Who needs more investigation?

• Age 40 years or older.
• Persistent or recurrent haematospermia.
• Blood in urine at the same time.
• Abnormal PSA, prostate examination or strong family history.
• Systemic symptoms such as unexplained weight loss or bone pain.
• Testicular lump or persistent scrotal symptoms.
• Bleeding tendency, anticoagulant use or uncontrolled hypertension.

Tests that may be used

Testing is selected according to risk rather than ordering every scan for every patient.

• Urinalysis and urine culture.
• STI testing when exposure or symptoms suggest it.
• Blood pressure measurement.
• CBC, liver tests or coagulation profile when a systemic bleeding problem is possible.
• PSA in appropriately counselled men, particularly over 40 or with prostate risk.
• Ultrasound, TRUS or MRI in persistent/recurrent or higher-risk cases when clinically indicated.
• Scrotal ultrasound if examination or symptoms suggest testicular disease.

Do younger men with one episode need imaging?

Often not. The 2025 ACR Appropriateness Criteria rates routine imaging as usually not appropriate for a man under 40 with transient haematospermia and no associated signs or symptoms. Clinical assessment is still important if there are infection symptoms or other concerns.

Treatment

Treatment depends on the cause. If no concerning cause is found, reassurance may be all that is needed. Proven infection is treated appropriately, systemic conditions are managed, and selected structural problems may require targeted endoscopic or other intervention.

• Do not repeatedly self-treat with antibiotics.
• Do not stop prescribed anticoagulants without the doctor who manages them.
• After prostate biopsy or instrumentation, temporary blood in semen can persist for a period and usually settles, but follow the treating team’s advice.

When to see a urologist

• Repeated episodes or symptoms lasting several weeks.
• Age 40 or above with new haematospermia.
• Blood in urine.
• Painful ejaculation or significant pelvic pain.
• Abnormal PSA or prostate examination.
• Testicular lump or swelling.

When blood in semen needs prompt assessment

• Fever with severe urinary or pelvic symptoms.
• Inability to pass urine.
• Heavy bleeding with clots in urine.
• Acute severe testicular pain or swelling.
• Dizziness/fainting with significant bleeding or anticoagulant use.

What to bring for haematospermia evaluation

Bring these if available:

• Photo only if needed to clarify appearance; do not repeatedly collect samples.
• Urine routine/culture and STI reports if done.
• PSA and prior prostate reports if relevant.
• List of blood thinners and other medicines.
• Recent prostate biopsy, cystoscopy, surgery or trauma history.
• Blood pressure readings and any bleeding-disorder/liver-disease records.

FAQs

Related reading

• Painful Ejaculation
• Low Semen Volume: Causes and Treatment
• PSA Test Explained
• Urinary Tract Infection in Men
• Blood in Urine: Causes and When to Worry
• Urologist in Latur

References

• European Association of Urology. Guidelines on Sexual and Reproductive Health (2026) https://uroweb.org/guidelines/sexual-and-reproductive-health
• American College of Radiology. ACR Appropriateness Criteria: Hematospermia (revised 2025) https://acsearch.acr.org/docs/70547/Narrative