The most common causes for blood in semen and urine and the danger signs to look out for.
We look at the symptoms and possible causes for bleeding from the penis, and when to see your doctor:
1. Sexually transmitted infection
In most cases, these infections are spread through oral, vaginal or anal sex and blood or discharge from your penis can be a symptom of a sexually transmitted infection (STI) including gonorrhoea, genital herpes, and chlamydia.
If symptoms include painful or burning urination and unusual discharge from your penis, this can lead to serious health consequences, so make an appointment with your local sexual health clinic to get it checked out. Never ignore symptoms of a possible STI as if left untreated there can be potential long-term complications such as infertility or infection spreading to other body areas.
An injury to the penis can cause blood in the urine or semen. If you notice any bruising or unfamiliar marks on your penis caused by a sports injury, vigorous or rough sex or an accident, make an emergency appointment with your GP.
3. Surgery complications
If you have recently had a surgical procedure and experience blood coming out of your penis, make an appointment with your surgeon or GP to get it checked out. In most cases this will settle with no treatment but should always be assessed.
4. Systemic diseases
Severe uncontrolled high blood pressure, bleeding disorders such as haemophilia, lymphoma, leukaemia, and chronic infections – for example, tuberculosis, schistosomiasis can cause blood in semen and urine.
If you are under 40 and don’t have any underlying medical conditions, blood in semen often disappears on its own so try not to panic. For men over 40, make an emergency appointment with your GP.
5. Prostatic disease
Blood in semen can be due to acute or chronic prostatitis, benign prostatic hyperplasia (BPH), prostatic calculi (stones), or abnormal prostatic blood vessels, and the prostate is a common reason for haemospermia or haematuria. As men get older, it is natural for the prostate gland to slowly increase in size (BPH) and experience symptoms from this – the usual ones are frequent urination, difficulty in urinating with a poor flow, dribbling of urine or stop-start urination – but there can also be blood in the urine as a result. This is often too small an amount to be seen with the naked eye but can be detected on a urine test.)
6. Testicular orchitis or epididymitis
If your symptoms include swollen and painful testicles, it may be epididymitis, which is often caused by an infection and is easily treated with antibiotics, or orchitis. Epididymitis is inflammation of the epididymis which is the tube at the back of the testicles that carries sperm out of the testicles. Orchitis often feels similar to epididymitis but symptoms can include a raised temperature, nausea, painful swelling of one or both testicles and sometimes blood in the urine or semen. It often develops from a bacterial or viral infection and is usually treated with antibiotics if bacterial, and painkillers and rest if viral.
7. Prolonged abstinence
If you do not ejaculate for a prolonged amount of time, usually greater than three months, this could lead to blood in your semen. This is harmless and no specific treatment is required. Further ejaculations are usually clear of blood.
8. Urological cancers
Certain urological cancers can cause blood in semen including prostate, bladder, urethral, testicular/epididymal and seminal vesicle cancers. Bladder cancer can cause intermittent bleeding, and at first this may be the only symptom but later on there may also be pain or difficulty on passing urine. Prostate cancer often develops with no symptoms initially before some develop such as blood in the urine or semen, erection problems, painful ejaculation and pain or burning when urinating.
9. Urinary tract infection
If you experience blood in your semen and/or urine, if the symptoms include a burning sensation when you urinate and your pee smells strong or unfamiliar, it could be a urinary tract infection (UTI). This can occur anywhere in the urinary tract, including the urethra, ureters, bladder, and kidneys but is typically located in the bladder or urethra. Urine infections are less common in men than women and and it’s important that you always get it checked out by your GP. If confirmed then a short course of antibiotics is typically given to clear the infection away.
10. Strenuous exercise
High impact exercise can cause blood in urine from an exercise-induced hematuria or dehydration. This can also be triggered by intensive cycling. with prolonged periods spent sitting on a hard saddle. It is usually temporary, lasting less than 2-3 days, but if symptoms persist, visit your GP.
11. Sexual activity
Extreme sexual activity or rough sex can cause blood in urine. It usually goes away after a short while, but if symptoms persist get it checked out by a sexual health clinic.
12. Penile injury
An injury to the penis can cause blood in the urine. If you notice any bruising or unfamiliar marks on your penis caused by a sports injury, sex or an accident, make an emergency appointment with your GP.
13. Kidney disease
Kidney cysts, tumours, cancer, nephritis and stones can all cause blood in urine with kidney stones usually being the most common of these. These are often tiny hard deposits of minerals that form in the kidneys and then travel down the tube between the kidneys and bladder (the ureters) where they can trigger extreme waves of pain. Other symptoms include pain in passing urine, and discoloured or reddish urine. If these symptoms arise make an emergency appointment with your GP.
14. Prostate disease
Blood in urine can be a symptom of benign prostate enlargement, infection of the prostate (prostatitis) and prostate cancer. Classic prostate symptoms include a weak or slow urinary stream, frequently getting up in the night and difficulty starting to urinate.
15. Bladder cancer
This often presents with painless obvious bright red blood in the urine. However some patients with this type of cancer can also present like prostate disease, so always speak to your GP if you see blood in your urine.
16. ‘Fake’ blood
Have you been snacking on raw beetroot or blood oranges? Red urine due to coloured foodstuffs is not that uncommon! Others include rhubarb and blackberries.
17. Anticoagulation drugs
For patients on anticoagulation drugs such as warfarin or the newer oral anticoagulant drugs known as DOACs, passing blood can mean the drug levels are higher than they should be and the dose may need to be altered. Other medicines that can affect urine include overuse of anti-inflammatories such as ibuprofen and immunosuppressants.
What will the doctor do about penis blood?
Your doctor will carry out the following examinations:
Blood in your semen
If you experience blood in your semen your doctor will do a detailed history and examination which might be followed by an ultrasound and a blood test depending on the likely cause.
Blood in your urine
Blood in urine is more complicated than semen due to the large number of causes. If you experience blood in your urine your doctor will carry out a urine dipstick test initially and if confirmed then look for a underlying cause. For example, if it’s a simple infection they will prescribe antibiotics. If you are in an older age group you will likely be referred for scanning and a cystoscopy to rule out cancer.