Hematospermia (Blood in semen)

•Presence of gross or microscopic blood in seminal fluid.

•It may occur only once or may be sporadic and chronic.

•The exact etiology is unknown in upto 20% of cases even after extensive workup.

•Causes include – prostate infection, STDs, prostate cancer, urethral stricture, seminal vesicle infections and cancer, Genitourinary tuberculosis, testes cancer, deviant sexual practices, after prostate biopsy etc.

•Diagnosis is made after comprehensive evaluation with medical history, clinical examination, semen culture and analysis, urine culture, urethral swab, blood tests including PSA, imaging with TRUS and ultrasound scrotum and MRI pelvis and rarely cystoscopy.

Mostly it is self limiting; treatment is based on the cause found and may include antibiotics, surgery or just reassurance if no identifiable cause found.

•Men with recurrent hematospermia and age >40 years need exhaustive workup in search for its cause and to rule out prostate malignancy. Those with single episode and age <40 years need basic workup.

Published by Dr Varinder Attri

MS MCh (PGI Chandigarh), Urologist and Andrologist

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