ejaculate (blood in)

Last reviewed 01/2018

Haematospermia is the occurrence of blood in the ejaculate (1).

The accurate incidence of haematospermia remains unknown (1) but is thought to be approximately 1 in 5000 of urology patients

The majority of cases are painless, benign and self-limiting although for the patients this might be a distressing and an alarming occurrence (1). Many cases are assumed to be the result of minor trauma in the genital tract. Another possible cause is prostatitis where there is also perineal pain.

Management in primary care if no identifiable cause (2):

  • for men younger than 40 years of age who have had no more than three episodes of haematospermia within one month:
    • reassurance that a serious cause is extremely unlikely
    • the patient should be advised to return if more than three episodes of haematospermia occur or episodes of haematospermia continue for more than one month

  • for men of 40 years of age or older, those who have experienced more than three episodes of haematospermia, and those experiencing episodes of haematospermia for more than one month
    • then refer to a urologist for further assessment

Note though that RCGP guidance suggests referral if only a single episode of haematospermia if age > 40 years of age (3)

  • specialist urological assessment and investigations is indicated for patients with recurrent haematospermia or if the patient is > 40 yrs old (3)