Hematospermiaor blood in semen is not infrequent in males. Blood stained ejaculate creates lots of stress and anxiety in the patients. But usually it is self limiting, benign and most of the time no cause is found. But may be a recurrent phenomenon.
It can affect any age group. In less than 40 years of age usual cause is infection, like infection of prostate (prostatitis), urethra (urethritis), sexually transmitted disease, viral infection like herpes simplex etc. Rarely testicular tumor may be the cause. Many times no cause is found.
Above 40 years age cause mostly again infection of prostate and urethra, dilated veins over enlarged prostate. Prostate cancer has to be ruled out by blood tests and imaging modalities. Blood in semen also may appear after prostate biopsy for prostate cancer, following radiotherapy after prostate and bladder cancer.
Patient experiencing blood in semen should not neglect his symptoms and should see a urologist. After detailed history the specialist will do physical examination of testis, epididymis, prostate and seminal vesicles. Thereafter routine investigations are carried out to find out the cause.
Urine and semen culture are done to rule out infection. Whole abdomen and transrectal ultrasound helps us to find out any disease of prostate seminal vesicles. Blood tests like serum PSA helps us to rule out prostate cancer. Usually disease is self limiting. If infection then antibiotics usually control or lessen the symptoms.
In case of recurrent hematospermia the doctor may advise to get pelvic MRI (with or without MR angiography) & cystoscopy. In cystoscopy under anesthesia the urethra, prostate and bladder may be visualized by passing a telescope through patient’s urethra. Treatment advised depends on underlying cause. Many times no cause is found and patients are simply reassured. And most of the time disease is self limiting & benign and no cause for worry.