Intended for healthcare professionals

Practice 10-minute consultation


BMJ 2016; 355 doi: (Published 10 November 2016) Cite this as: BMJ 2016;355:i5124
  1. Tamsin Drake, ST6 Urology1,
  2. Luke Hanna, ST6 Urology1,
  3. Melissa Davies, Consultant Urologist2
  1. 1Royal Bournemouth Hospital, Bournemouth, UK
  2. 2Department of Urology, Salisbury District Hospital, Salisbury, Wiltshire, UK
  3. Accepted: 16 August 2016
  1. Correspondence to T Drake

What you need to know

  • Haematospermia is self limiting in most cases

  • Infectious causes are common—offer empirical antibiotics for those with suspected genitourinary infection

  • Offer refer to urology if symptoms recur, persist, or if you note abnormal findings on rectal examination

A 40 year old man complains of two episodes when he noticed blood in his ejaculate. He is otherwise well and has no comorbidities.

Visible blood in ejaculate—haematospermia or haemospermia—is usually an isolated symptom, and its incidence is unknown. In most cases, it is benign and self limiting, often caused by inflammation or infection of the prostate, urethra, or seminal tract.1 Possible causes are outlined in Box 1. Patients may describe haematuria, urinary frequency, dysuria, and scrotal, pelvic, or perineal pain, particularly at the time of orgasm.2

Box 1: Causes of haematospermia

  • Sexually transmitted diseases

  • Urinary tract infection

  • Trauma

  • Iatrogenic injury from prostate procedures

  • Systemic diseases—severe uncontrolled hypertension, bleeding disorders, lymphoma, leukaemia, and chronic infections—for example, tuberculosis, schistosomiasis, and amyloidosis (rare)

  • Prostatic disease—acute/chronic prostatitis, benign prostatic hyperplasia, prostatic calculi, and abnormal prostatic blood vessels

  • Testicular or epididymal disease—orchitis or epididymitis

  • Seminal vesicle/ejaculatory duct disease—cysts or calculi

  • Prolonged abstinence

  • Prostate, bladder, urethral, testicular/epididymal, seminal vesicle (rare) cancer …

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