What is hematospermia?

The presence of blood in the ejaculate is called hematospermia or hemospermia.

Who is at-risk for hematospermia?

Hematospermia is not uncommon and may affect men of any age, but its peak incidence is in men 30 to 40 years old. About 85 to 90 percent of all patients who have hematospermia will have repeated episodes.

What causes hematospermia?

In about 50 percent of patients the cause of hematospermia is not clearly understood or known. Semen originates from multiple organs, including the testicles, epididymis, vas deferens, seminal vesicles and prostate. Most of the semen comes from the seminal vesicles and prostate, and it is probably from these two organs that most hematospermia originates. Infections or inflammation of the organs listed above account for most of the other causes. Cancers are rarely causative and account for only a very small percentage of hemospermic diagnoses. With the introduction of ultrasound-guided prostate biopsies, we are seeing a large number of patients with hemospermia after the biopsy. This occurrence is expected in about a third of patients and is not cause for alarm.

Primary hematospermia

Hematospermia is usually categorized in two different groups: primary hematospermia and secondary hematospermia. Primary hematospermia is when blood in the ejaculate is the only symptom. That means no blood is found in the urine (either visually or under the microscope), the patient has no evidence of any urinary irritation or infection, and physical exam is completely unremarkable. Patients who have this type of hematospermia with no other findings almost always have no other problem. The condition is self-limited, which means it will go away in time without treatment. About 15 percent of patients will have one episode and never have another.

Primary hematospermia patients have been studied extensively in the past with X-rays and telescopic examination of the urinary tract. In every study, no other associated problems were found. Consequently, no treatment is considered needed for patients in whom hematospermia is the only complaint and the physical exam and urinalysis are normal. We do encourage patients who have had hematospermia to return to our office if any change in their bleeding occurs, if they develop symptoms of infection or pain, or if they see blood in their urine.

Secondary hematospermia

Secondary hematospermia is when a cause of bleeding is known or suspected, such as immediately after a prostate biopsy, or in the presence of a urinary or prostate infection or cancer. Unusual causes include tuberculosis, parasitic infections, and any diseases that affect blood clotting, such as hemophilia and chronic liver disease.

Patients who have hematospermia associated with symptoms of urinary infection or visual or microscopic blood in the urine require a complete urologic evaluation. If blood is seen in the urine, an X-ray of the urinary tract is indicated, as well as a telescopic examination of the bladder and prostate. If the prostate or seminal vesicle has suspicious areas on rectal examination, or if the screening test for prostate cancer is suspicious (prostate specific antigen or PSA), ultrasonic examination and biopsy is indicated.

How is hematospermia treated?

In the past, physicians have used female hormones, such as stilbestrol or Premarin, to treat primary hematospermia because the disease was believed to be an inflammation of the seminal vesicles. Female hormone treatment often resulted in relief from the bleeding, but the side effects included breast swelling and tenderness, and lack of libido. Its use has generally been discontinued. We recommend that no therapy be given for primary hematospermia.

Hematospermia can be a frightening occurrence for any male, but ultimately, most of these patients are found to have absolutely no abnormalities and require no therapy. Hematospermia is likely to continue on and off, but it is usually self-limited and carries with it no increased risk of any other disease, nor is the patient considered a risk to his sexual partner.