From the Guidelines
Hematospermia is typically a benign and self-resolving condition, and for most men under 40 without risk factors, reassurance and watchful waiting is recommended. This approach is supported by the American College of Radiology Appropriateness Criteria, which suggests that imaging does not play a role in young men with transient or episodic hematospermia without other signs or symptoms of disease 1. The condition is often idiopathic in nature, but when a cause can be identified, infections of the urogenital tract are the most common.
Key Considerations
- Men over 40 years of age should undergo clinical screening for prostate cancer, as recommended by the American College of Radiology Appropriateness Criteria 1.
- Persistent or refractory hematospermia, or hematospermia accompanied by other symptoms or signs, may require noninvasive imaging, such as transrectal ultrasound (TRUS) or MRI, to identify underlying causes like obstruction, stricture, calcifications, or cysts.
- TRUS is considered the first-line imaging modality, with MRI used when TRUS is inconclusive or negative 1.
Underlying Causes and Treatment
- Hematospermia can occur due to rupture of blood vessels in the seminal vesicles, prostate, or ejaculatory ducts, often caused by inflammation, infection, trauma, or rarely, tumors.
- Treatment focuses on addressing any underlying cause, which may include antibiotics for infection, anti-inflammatory medications for inflammation, or treatment of urinary tract conditions.
- The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for specific clinical conditions, including hematospermia, and recommend a thorough evaluation for men over 40 or those with risk factors like abnormal rectal exam findings, elevated PSA, or history of genitourinary procedures 1.
From the Research
Definition and Prevalence of Hematospermia
- Hematospermia is a symptom characterized by the presence of blood in the ejaculate, often causing distress and anxiety in affected individuals 2, 3, 4, 5, 6.
- The prevalence of hematospermia is not well-established, but it is most common in men under 40 years old 5.
Etiology of Hematospermia
- The causes of hematospermia can be benign or malignant, and may include:
- Iatrogenic trauma, such as transrectal ultrasound-guided prostate biopsy 5.
- Urogenital infections, such as sexually transmitted infections 2, 3, 4.
- Pathological changes of the prostate, such as prostate cancer 2, 3, 4, 5.
- Systemic causes, such as arterial hypertension or hematologic disorders 5.
- Inflammatory and infective pathologies, such as ejaculatory obstruction or vascular malformations 3, 4.
Diagnostic Evaluation of Hematospermia
- A diagnostic algorithm for hematospermia includes:
- Precise history-taking and physical examination, including blood pressure measurement and urinalysis 5.
- Laboratory tests, such as prostate-specific antigen testing and semen analysis 2, 4.
- Imaging studies, such as transrectal ultrasonography and magnetic resonance imaging 3, 4, 6.
- Interventional diagnostic procedures, such as urethrocystoscopy and biopsy 4.