Hematospermia: Patient Information
Hematospermia is the presence of blood in the semen. The semen is composed of secretions from the testes, epididymis, urethral glands, prostate gland, and seminal vesicles. The clear secretions from the urethral glands account for a tiny amount of the semen, the milky white prostate gland secretions account for a small amount of the semen, and the viscous secretions from the seminal vesicles account for the majority of the semen.
Incidence – Hematospermia is not uncommonly encountered in men and usually results from prostate or seminal vesicle inflammation.
Natural history – It is almost always benign and self-limited, resolving in several weeks. In a very small minority of individuals, hematospermia may become recurrent or chronic, causing great concern and anxiety.
Cause of hematospermia
- Idiopathic
- Prostatitis
- Seminal vesiculitis
- Genitourinary Tuberculosis (GUTB)
Hematospermia may cause blood in the initial, middle, or terminal portion of the ejaculate. Typically, blood arising from the prostate occurs in the initial portion, whereas blood arising from the seminal vesicles occurs later. The color of the semen can vary from bright red, indicative of recent or active bleeding, to a rust or brown color, indicative of old bleeding.
Evaluation for hematospermia
- Digital rectal examination of the prostate to check the size and consistency,
- Urinalysis to check for urinary infection and blood in the urine
- Semen culture
- PSA (prostate specific antigen)
- Imaging
- Transrectal USG of prostate – Prostate sonography, done by the trans-rectal route, will commonly show dilated seminal vesicles, ejaculatory duct cysts, and ejaculatory duct or seminal vesicle
- MRI in refractory cases
- Cystoscopy – Cystoscopy, a visual inspection of the lower urinary tract with a small-caliber, flexible instrument will enable inspection of the inner aspect of the prostate and urinary bladder.
- TRUS guided biopsy of prostate in refractory cases
Treatment of hematospermia
- Antibiotics – Hematospermia is managed with oral antibiotics. Only if the bloody ejaculations fail to respond is further workup required.