What is the cause of hematospermia (blood in semen)?

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Last updated: April 26, 2025View editorial policy

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Differential Diagnosis for Blood in Semen

  • Single most likely diagnosis
    • Prostatitis: This is often the most common cause of hematospermia (blood in semen), especially in younger men. Prostatitis, which is inflammation of the prostate gland, can cause bleeding into the semen.
  • Other Likely diagnoses
    • Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate can lead to bleeding into the semen, especially in older men.
    • Ejaculatory Duct Obstruction: Blockage of the ejaculatory ducts can cause blood to appear in the semen.
    • Urethritis: Inflammation of the urethra can lead to bleeding, which may then be present in the semen.
    • Seminal Vesiculitis: Inflammation of the seminal vesicles can cause hematospermia.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Prostate Cancer: Although less common, prostate cancer can cause bleeding into the semen. It's crucial to rule out this potentially life-threatening condition.
    • Testicular Cancer: Though rare, testicular cancer can also lead to hematospermia and must be considered to ensure timely diagnosis and treatment.
    • Genitourinary Trauma: Trauma to the genital or urinary tract can cause bleeding into the semen and may require urgent medical attention.
  • Rare diagnoses
    • Amyloidosis: A condition characterized by the deposition of amyloid (a protein) in various tissues, which can rarely cause hematospermia.
    • Tuberculosis of the Genitourinary Tract: Although rare in many parts of the world, genitourinary tuberculosis can cause a variety of symptoms, including hematospermia.
    • Vasculitis: Inflammation of the blood vessels can rarely affect the genital tract and cause bleeding into the semen.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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