Hematospermia: Patient Information

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What is Hematospermia?
Hematospermia refers to the presence of blood in semen, which can appear as bright red or brown discoloration, depending on whether the bleeding is recent or old. Semen is a mixture of secretions from several organs, including:

  • Urethral glands: Produce a small amount of clear fluid.
  • Prostate gland: Contributes milky white secretions that form a minor part of semen.
  • Seminal vesicles: Responsible for the majority of semen, which is thick and viscous in consistency.

Incidence

Hematospermia is a condition that is not uncommon in men. It is most frequently associated with inflammation of the prostate gland or the seminal vesicles, which are key contributors to semen production.

Natural History

In the vast majority of cases, hematospermia is benign (non-cancerous) and self-limiting, resolving on its own within a few weeks without the need for extensive treatment.

  • For a small percentage of men, hematospermia may recur or persist over time. This chronic presentation can cause significant concern, prompting further medical evaluation to rule out serious conditions.

Causes of Hematospermia

Hematospermia can result from various conditions, including:

  1. Idiopathic Causes: In many cases, no clear cause is identified.
  2. Prostatitis: Inflammation or infection of the prostate gland.
  3. Seminal Vesiculitis: Inflammation or infection of the seminal vesicles.
  4. Genitourinary Tuberculosis (GUTB): A rare but serious cause involving tuberculosis of the urinary or reproductive system.

Appearance of Blood in Semen:

  • Blood can appear in different parts of the ejaculate:
    • Initial Portion: Often indicates bleeding originating from the prostate gland.
    • Later Portions: Typically suggests bleeding from the seminal vesicles.
  • Color Variations:
    • Bright red semen usually indicates fresh bleeding.
    • Rusty or brown-colored semen suggests older bleeding.

Evaluation of Hematospermia

To determine the underlying cause, healthcare providers perform the following evaluations:

1. Clinical Examination:

  • Digital Rectal Examination (DRE): Helps assess the size, shape, and consistency of the prostate gland, checking for signs of inflammation or abnormalities.

2. Laboratory Tests:

  • Urinalysis: Detects urinary infections or the presence of blood in urine.
  • Semen Culture: Identifies bacterial or other infections within the semen.
  • Prostate-Specific Antigen (PSA): A blood test used to evaluate prostate health and screen for prostate-related conditions.

3. Imaging Studies:

  • Transrectal Ultrasound (TRUS): A specialized imaging test performed through the rectum to visualize the prostate and surrounding structures. This test often detects:
    • Dilated seminal vesicles
    • Ejaculatory duct cysts
    • Blockages or abnormalities in the seminal vesicles
  • MRI: Recommended in cases where symptoms persist despite initial treatment or when more detailed imaging is required.

4. Additional Procedures:

  • Cystoscopy: A minimally invasive procedure that uses a small flexible scope to examine the bladder and the inner prostate for abnormalities or bleeding.
  • TRUS-Guided Biopsy: Performed in rare cases to rule out serious conditions such as prostate cancer when hematospermia is recurrent or does not respond to treatment.

Treatment of Hematospermia

1. Antibiotics:

  • Infections are the most common cause of hematospermia, and oral antibiotics are the primary treatment. These medications address underlying infections in the prostate, seminal vesicles, or urinary tract.

2. Monitoring and Follow-Up:

  • For most men, hematospermia resolves on its own after antibiotic treatment. Persistent or recurrent cases may require further diagnostic tests to identify an underlying cause.

3. Treatment for Specific Causes:

  • If a specific condition such as Genitourinary Tuberculosis (GUTB) or a structural abnormality is identified, targeted treatment plans, including medication or minimally invasive procedures, may be implemented.

By understanding the likely benign nature of hematospermia and seeking prompt medical evaluation when needed, patients can manage this condition effectively and address any underlying concerns.

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