Blood in the sperm - causes and therapy

Blood in the sperm - causes and therapy

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Blood in the sperm (hemospermia) is of great concern to most men. Because reddish colored ejaculate is often interpreted as an indication of cancer or another serious illness. Instead, it is often a relatively harmless cause, such as an infection of the seminal vesicle or a severe bruise, which are usually easy to treat. Nevertheless, there may also be more serious reasons such as inflammation of the prostate or epididymis, which can have unpleasant consequences if treatment is not carried out. In order to avoid any risk, a doctor should be consulted in any case for bloody sperm. This applies in particular if the symptoms do not subside after three to four days and other symptoms such as Fever, urination problems, and testicular or penile pain.

Causes of blood in the ejaculate

Anyone who discovers bloody reddish discoloration in the seminal fluid usually gets a big fright. Because many sufferers fear a serious background, whereby the fear of cancer is often the greatest. However, a tumor disease is rare with blood in the ejaculate (medically: "hemospermia"), rather, more than half (50-70%) of those affected cannot find a clear cause. In the other cases, there are often relatively "harmless" reasons such as an injury to the glans or a broken vein. In addition, mechanical triggers caused by an accident, bruising or sports activity or physical exertion can be the triggers. Uncontrolled movements during sexual intercourse as well as harsher sexual practices can injure the penis and thereby also cause blood admixtures in the ejaculate.

Cause prostate symptoms

One of the common causes is so-called “prostatitis”, which affects about 10% of the male population at least once in a lifetime. This is an acute or chronic inflammation of the prostate (prostate gland), which is located below the bladder in men. The disease can cause various complaints. In acute cases, the most common are a strong burning sensation when urinating, frequent urge to urinate, fever, chills and pain in the perineum. In the case of chronic or abacterial inflammation, there are usually additional symptoms. It can include testicular, abdominal and groin pain, erectile dysfunction, blood in the sperm, pain during bowel movements and ejaculation.

Prostatitis can have various causes. For example, bacteria are possible that penetrate the chestnut-sized gland and cause a defense reaction of the tissue. In most cases, intestinal bacteria (Escherichia coli, Enteroccocus faecalis) are the trigger, but other germs such as adhesives, enterococci or pathogens of certain venereal diseases such as chlamydia or gonococci (gonorrhea) are also possible.

If there is chronic inflammation, however, the cause can often not be clearly determined (idiopathic prostatitis). In some cases, bacteria can also be detected here, but more often it is an "abacterial" chronic prostatitis, which is also referred to as "chronic pelvic pain syndrome". This can be caused, among other things, by bladder emptying disorders or narrowing in the draining prostate pathways (e.g. by prostate stones, narrowing of the urethra). If there are no organic causes, psychological factors such as stress, fears or problems in the partnership are often suspected.

In addition, in the case of bloody sperm, a benign enlargement of the prostate (benign prostatic hyperplasia, in short: BPH) can be considered. This occurs in the majority of middle-aged to older men as a result of excessive cell proliferation, but is neither a form of cancer nor a precursor and, accordingly, is relatively harmless in itself. However, if the volume of the prostate increases so much that the urethra is constricted, a so-called "benign prostate syndrome" develops, which is associated with various complaints. Characteristic are above all gradually increasing problems with urination, e.g. strong urge to urinate, frequent urination at night and pain. In addition, there are inhibitory symptoms such as a weak or delayed urine stream, dripping and interrupted urination ("urine stuttering"). In the further course, it is often no longer possible for those affected to completely empty the bladder (“residual urine formation”), as a result of which additional urinary tract infections and, in part, urine loss and bladder stones occur.

If the disease is not treated appropriately at this point in time, finally, in phase three there is a risk of urinary retention due to the increasing pressure on the urethra and, as a result, a very painful bladder stretching. In addition, the backflow of urine into the kidneys can lead to a decrease in kidney function or even kidney failure. Accordingly, men should definitely consult a urologist at the first signs of benign prostate enlargement (delayed urination, thin urine stream, etc.). Because this can e.g. the complaints clarify quickly with a rectal examination and ultrasound and, if necessary, immediately initiate the necessary treatment steps.

Another trigger can be a so-called "prostate tuberculosis". This is a very serious and difficult to treat disease, as the disease is rarely limited to the prostate. Instead, tuberculosis foci usually form in other urogenital organs, with the epididymis and seminal vesicles being particularly often affected. In some cases, the disease initially remains symptom-free for a long time, sometimes sufferers suffer from general complaints such as fatigue, exhaustion, loss of appetite and mild fever.

Signs of the disease that are similar to chronic prostatitis are more common early on. This includes, among other things, an increased urge to urinate and stool, a feeling of pressure in the area of ​​the perineum and burning pain after urination. Frequently there are pus admixtures in the urine, severe pain during ejaculation and blood in the sperm, in highly advanced cases the semen is mostly not emptied. Prevention plays a particularly important role due to the poor healing chances of a once developed prostate tuberculosis. Accordingly, it is advisable to remove tubercular foci in other areas (e.g. in the epididymis) early. In addition, people who already have tuberculosis and are more susceptible, such as HIV-infected people, alcoholics, drug addicts as well as immunocompromised and old people must avoid gonorrhea infection or have it treated accordingly if it exists.

Prostate cancer

In addition to benign enlargement, in rare cases a malignant tumor of the prostate gland can also be responsible for blood after ejaculation. The so-called "prostate carcinoma" is one of the most common types of cancer in men with more than 60,000 new cases per year and occurs primarily from the age of 60. The disease is particularly treacherous because there are hardly any typical warning signs and usually no symptoms at the beginning. These only become clear in the advanced stage, which are often unspecific symptoms that can also indicate other prostate conditions. These include, for example, problems with urination and bowel movements, increased urge to urinate, pain in the prostate as well as with ejaculation, erectile dysfunction and blood admixtures, which can occur both in the urine and in the semen. If daughter tumors (metastases) have already formed in the bones, severe discomfort in the lower back, leg or hip pain may also occur.

The causes of prostate cancer are still not fully understood. However, there are some risk factors that can favor development from a medical perspective. This primarily includes age, hormones (testosterone) and a genetic predisposition. Accordingly, according to the German Cancer Research Center (DKFZ) there is e.g. in men up to 65 years of age with three affected brothers, the risk of illness is 23 times higher than for those without affected relatives. In addition to this, a possible connection with diet, smoking, alcohol and obesity is discussed again and again. So far, however, it has not been clarified whether or to what extent an “unhealthy lifestyle” actually has an impact on the development of prostate carcinoma.

If the cancer is recognized early, the prognosis is usually good. Since there are no typical symptoms at the beginning of the illness, this can only be identified by a preventive examination. Accordingly, doctors always strongly advise all men over the age of 40 to take advantage of the early detection offered by the statutory health insurance once a year.

Blood in the sperm after vasectomy

Another possible cause of bloody ejaculate is male sterilization ("vasectomy"). In this, the spermatic duct located in the spermatic cord is severed, as a result of which there are no longer any sperm cells in the ejaculate and fertilization of the egg cell becomes impossible. As a result, the procedure is one of the safest methods of contraception in which paternity can be excluded to almost 100%. In most cases, the vasectomy is performed on an outpatient basis under local anesthesia, depending on the treatment method, syringes (conservative and "non-scalpel vasectomy") or air pressure technology ("no-needle-no-scalpel") are used.

Classic or conservative vasectomy has been the standard in Germany for many years and is therefore the most widespread surgical method. In this method, the vas deferens are first uncovered by means of a small incision, then they are severed and a piece about one to three centimeters long taken. This is followed by the obliteration and suturing of the two ends with resorbable thread and the final application of a sterile bandage. In addition to the "non-scalpel" and the "no-needle-no-scalpel" vasectomy, there are two other surgical procedures that only differ in the type of anesthesia (needle or "jet injection"). There is no direct skin incision here; instead, the scrotum is punctured and stretched apart to expose the vas deferens. The further steps are similar to the conservative method, in which case the skin opening grows by itself and does not have to be sewn.

In general, sterilization in men is considered to be low-risk, regardless of the surgical method. If, in rare cases, complications occur during the vasectomy, it is usually a hematoma or a local infection, which causes redness in the affected area. In addition, some people may experience fever, redness and swelling of the scrotum, urinary problems, adhesions and wound healing disorders, as well as long-lasting and chronic pain in the operating area (post-vasectomy pain syndrome) and brown or light red colored blood admixtures to the sperm. If such complaints occur, the patient should immediately contact the appropriate urologist for safety reasons.

Inflammation of the seminal vesicle or epididymis

Inflammation of the seminal vesicles (spermatocystitis) is also an option if there is blood in the sperm. This can occur on one or both sides and take both an acute and a chronic course. Spermatocystitis can occur as a result of a urinary tract infection, less often the pathogens are also spread through the blood (hematogenic infection). In most cases, these are bacteria (e.g. gonococci) that get into the seminal vesicle from the prostate or urethra via the so-called "spray channel" (ejaculator duct). Inflammation at this point is typical of pelvic pain as well as problems with urination and bowel movements, pain during erection or ejaculation and bloody semen, as well as general symptoms such as fever and chills.

Inflammation of the epididymis (epididymis) can also trigger the symptoms. This usually occurs unilaterally and is mainly characterized by slowly increasing testicular pain as well as swelling, overheating and reddening of the affected area. In addition, pain when urinating, blood in urine and sperm, as well as fever, fatigue and chills can occur. At the beginning, the symptoms are usually limited to the epididymis. In most cases, however, the inflammation spreads, causing an additional testicular inflammation (orchitis). In this case, "orchie epididymitis" is medically spoken of.

In most cases, epididymitis is caused by rising germs due to prostatitis or a urinary tract infection such as inflammation of the urethra or bladder. The pathogens can also be transmitted via unprotected sexual intercourse. Here, chlamydia is considered to be a common trigger in men of younger age, but later bacteria, such as e.g. Escherichia coli or Klebsiella. It is also possible that the inflammation is caused by a serious injury to the epididymis (testicular torsion) as a result of a kick, blow or similar. or arises from an operation. There is also an increased risk in men who wear an indwelling catheter or e.g. are affected by malformations in the area of ​​the vas deferens. Rather rarely, it is a hematogenous infection in which the pathogens reach the epididymis via the bloodstream.

If the epididymitis is not treated appropriately, the epididymal tubules may become occluded, which can lead to infertility in the event of bilateral inflammation. In addition, an acute illness with insufficient healing can quickly take a chronic course and thereby lead to recurring complaints and complications such as an abscess or life-threatening blood poisoning. Accordingly, if there is pain and / or swelling in the testicles, a doctor should always be consulted promptly.

Treatment of blood in the sperm

In many cases, bloody ejaculate has a relatively harmless cause (broken vein, minor injury, etc.), so that the symptoms disappear on their own after a few days and no special treatment is required. Nevertheless, you should not hesitate for a long time, but as a precaution, a general practitioner or specialist (urologist) should always be consulted to avoid health risks and possible late effects, e.g. to avoid infertility.
The therapy depends on the cause and can therefore vary widely. Is the blood in the sperm e.g. Underlying an injury, the protection of the penis is particularly important. Accordingly, any mechanical irritation e.g. avoided through sexual intercourse or tight clothing.

With acute bacterial prostatitis, on the other hand, antibiotics are administered, which are normally taken for at least four weeks to prevent a chronic course. At the same time, pain and anti-inflammatory drugs are often used, sufferers also suffer from bladder emptying disorders with residual urine formation, an abdominal wall catheter may also be required. For example, if epididymitis is the cause, treatment is usually also carried out with anti-inflammatory and analgesic medication and, in the case of a bacterial infection, with antibiotics. For the pain, storing and cooling the testicles with cold envelopes can be very beneficial. In addition, especially in the case of fever until the symptoms have subsided, care should be taken to ensure bed rest.

In some cases e.g. in the case of benign prostate enlargement (BPH), surgical intervention may also be necessary. Different options are available here, with the so-called "transurethral prostate resection" (TUR-P) being one of the most frequently used procedures. This is a minimally invasive method that is performed without an external incision through the urethra. Surgery may also be indicated for prostate carcinoma (“radical prostatectomy”). Alternatively, depending on the age of the patient, the type and spread of the cancer, there are a number of other therapy options such as “Active observation”, radiation or hormone therapy are available.

Home remedies for bloody semen

If the cause of the bloody sperm has been clarified medically, in some cases home remedies are available to relieve the symptoms. However, it should be borne in mind here that these normally do not replace conventional medical treatment, but in the best case can represent natural and effective support. In order not to take any risks, it is therefore advisable not to use the procedures on your own, but to seek advice in advance from a naturopathic doctor or naturopath.

Home remedies have proven themselves many times, especially for prostate complaints. For example, in the case of benign prostate enlargement, various medicinal plants (phytotherapeutics), such as saw palmetto fruits, pumpkin seeds, rye pollen or the bark of the African plum tree (Prunus africana). Extracts from the stinging of the stinging nettle are also good for relieving urination problems due to benign enlargement of the prostate in old age.

Homeopathy recommends Sabal serrulatum (dwarf palm), among other things, when starting to enlarge the prostate, whereby the remedy (D3 to D6) can be used particularly well with frequent nocturnal urge to urinate, weakened urine stream and pain during urination. Pulsatilla pratensis (meadow pasque flower) is also suitable for enlargement and inflammation of the prostate gland, especially if there is an increased urge to urinate with a reduced amount of urine and a feeling of pressure in the perineum. In addition, e.g. help with nighttime urination Acidum Picrinicum or with weakened urine stream Clematis recta.

In order to prevent blood in the sperm, it is advisable to avoid excessive alcohol consumption and smoking and generally to pay attention to a healthy lifestyle with a balanced diet and plenty of exercise. In addition, existing illnesses and health problems such as Always take blood circulation problems or problems with urination and bowel movements seriously and have them checked regularly by a doctor. In this context, all men over the age of 40 should absolutely follow the advice of medical experts and take part in preventive examinations once a year. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese


  • Gerald L. Andriole: Prostatitis, MSD Manual, (accessed September 11, 2019), MSD
  • P. Leiner: Uro-News (2016) 20: 58., doi
  • Florian Wagenlehner et al .: Prostatitis and Male Pelvic Pain Syndrome, Dtsch Arztebl Int 2009; 106 (11): 175-83; DOI: 10.3238 / arztebl.2009.0175, (accessed September 11, 2019),
  • Guideline program oncology (German Cancer Society, German Cancer Aid, AWMF): Interdisciplinary guideline of quality S3 for early detection, diagnosis and therapy of the various stages of prostate cancer, long version 5.1, 2019, AWMF registration number: 043 / 022OL, (accessed on September 11, 2019), AWMF
  • Thomas Gasser: Basic knowledge of urology, Springer Verlag, 6th edition, 2015
  • Christoph Hammes, Elmar Heinrich, Tobias Lingenfelder: BASICS Urology, Urban & Fischer Verlag / Elsevier GmbH, 4th edition, 2019
  • Anuja P. Shah: Hematospermia, MSD Manual, (accessed September 11, 2019), MSD

Video: What are causes of Haematospermia Blood in Semen (July 2022).


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