On a fairly regular basis, I come into an exam room and find a guy with a very worried look on his face. Sometimes it takes awhile for them to articulate their concern, but, eventually, I hear some variation of: “Doc…you know…it’s pink…my semen is pink.”

This is an understandably alarming situation – though, fortunately, it is seldom serious. My first task, in these situations, is to explain what’s happening and reassure my patient that this condition isn’t as strange or dire as it probably appears to him.

Semen, of course, is normally milky white. If it’s some shade of pink that means blood is mixing with the semen. The medical name for the condition is hematospermia. We believe the condition is common, but the prevalence of hematospermia is very difficult to calculate for the simple reason that many men ejaculate while inside their partner and, hence, they don’t actually take a look at their semen. Many cases, therefore, undoubtedly go unreported.

Most patients have more than one episode of hematospermia, occurring over weeks to months.

If blood in the semen persists for more than 10 ejaculations or for longer than 2 months, it should be formally evaluated.

Although hematospermia is usually benign, a thorough history, physical examination, and (maybe) laboratory testing should be conducted in order to rule out something serious. The most common cause of hematospermia is some kind of infection, either of the urethra, the prostate, or the seminal vesicles. In these cases, the condition often goes away once the infection clears up (either naturally or with the help of antibiotics). Sometimes the hematospermia is triggered by prolonged physical activity such as bicycle riding (the seat of the bicycle presses on the prostate which can aggravate the situation).

Less common causes of hematospermia include
  • Procedures to sample prostate tissue (prostate biopsy)
  • Calcium buildup inside the prostate (prostatic calculi)
  • Lesions or polyps of the urethra
  • Trauma (i.e. a blow or injury to the groin area)
  • Prostate cancer
In young men, hematospermia is very rarely serious – though, of course, infections should be treated promptly because they can impair a man’s fertility. If there are no signs of an infection, then other types of tests may be performed to rule out other causes. If the cause is some kind of abnormal growth or process in the urinary or reproductive tracts, surgery may be required to fix the problem.

Most of the time, however, the primary goal in the management of hematospermia is to allay the anxiety of the frightened patient. Fortunately, this is a rapid, painless, and inexpensive treatment!
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