Unusual Symptom: Blood in the Semen

Blood in the semen, or hematospermia, is an alarming symptom that can a have a variety of etiologies, but, in general, is a self-limited symptom, especially in younger men. The following are the possible etiologies of such symptom:

                Prostate biopsy

                Prostatic calculi

                Chronic prostatitis

                Prostate cancer

                Neoplasm of the seminal vesicle

                Hypertension

                Sexually transmitted diseases

                Hemophilia

                Anticoagulants

                Testicular neoplasm

 Hematospermia refers to the presence of blood in the ejaculate and often leads to immense emotional distress. Hematospermia may result from inflammatory, infectious, neoplastic, systemic, or iatrogenic conditions, although many cases are idiopathic. Hematospermia results when blood enters the semen from the sexual glands (e.g., prostate, seminal vesicles), urethra, or bladder.  Many studies reveal prostatic disease to be the most common etiology overall.  Prostatic calculi may account for 20% of cases of hematospermia and chronic prostatitis for up to 13% of cases. Miscellaneous structural etiologies include vascular malformations, benign and malignant testicular tumors, and cysts.  Medical or systemic diseases are uncommon etiologies of hematospermia, the most common being uncontrolled hypertension and bleeding diatheses.  Patients under 40 years of age are more likely to have an inflammatory cause for hematospermia, although many cases remain idiopathic. However, older men have an increased incidence of prostatic malignancy as an etiology of hematospermia. Evaluation of hematospermia includes a meticulous genitourinary and prostatic examination with judicious use of laboratory and radiologic tests. Most patients should undergo urinalysis and culture, semen analysis, and, if the patient is over 50 years of age, a serum prostate-specific antigen (PSA). Prostatic ultrasound, magnetic resonance imaging (MRI), cystoscopy, or prostatic biopsy may be necessary in some patients. Therapy of hematospermia may consist of reassurance in the young man with idiopathic hematospermia and treatment of underlying prostatitis or prostatic malignancy in older men.