Although surprisingly common, the presence of blood in the semen can be very frightening. It usually occurs without warning, and even a tiny bit of blood in the semen can look like much more. The most common cause is a ruptured blood vessel in the urethra. However, infection and malignancy must be ruled out.
Infection in the prostate. Prostatitis, or prostate infection, may also cause blood in the semen. Prostate infection can be acute, with severe pain in the area of the prostate (between the scrotum and the anal area), fever, chills, and difficulty urinating, or chronic, with subtler symptoms.
Infection in the urethra. Any of the possible causes of infection in the urethra(chlamydia or the other NGU bacteria, gonorrhea, trichomonas, or the intestinal bacteria for men who perform anal sex) can cause inflammation producing blood in the semen, although this is not common. However, urethral infection must nevertheless be eliminated as a possibility in a man with blood in his semen. There may or may not be other symptoms of infection, such as discharge from the penis, burning with urination, and irritation inside the penis.
Prostate cancer. More common among older men, usually those over the age of fifty, prostate cancer usually does not cause symptoms, but there may be blood in the semen or, if the enlarged prostate obstructs the urethra, difficulty urinating. A prostate examination and blood and imaging tests are used to make a diagnosis.
Ruptured blood vessel. The rupture of a blood vessel is very common and harmless. It usually occurs after masturbation or ejaculation during sex. There is usually no pain and no other symptoms consistent with infection. The rupture resolves on its own after a few days to a week in most cases. This is a diagnosis of exclusion; the other possible causes of blood in the semen listed above must be ruled out first.
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