Etiologic classification, evaluation, and management of hematospermia

Abstract

Hematospermia is defined by the presence of blood in the semen typically occurring in men younger than 40 years of age. Symptoms can occur due to a multitude of reasons, but are usually benign and self-limiting, requiring no additional treatment or evaluation. Despite this, the condition often impairs quality of life due to associated anxiety and must be taken seriously by the patient and the physician, particularly if recurrent, refractory, and painful. The etiology of hematospermia can be classified into inflammatory, infectious, lithiasis, cystic, obstructive, tumoral, vascular, traumatic, iatrogenic, and systemic origin. Alternatively, it can also be divided into subcategories based on anatomical origins such as prostate, bladder, spermatic cord, seminal vesicles, or epididymis. A complete history and physician examination, laboratory testing, and a variety of invasive and non-invasive imaging and instrumentation modalities can help to identify and treat the underlying pathology promptly.

Keywords: Hematospermia; accessory sex glands; ejaculatory dysfunction; genital diseases; hemospermia; semen.

Figure 1

Hematospermia evaluation algorithm. MRI, magnetic resonance imaging; CT, computed tomography; TRUS, transrectal ultrasonography; STI, sexually transmitted infection; CBC, complete blood count; CMP, comprehensive metabolic panel; MSU, midstream specimen of urine; M/C/S, microscopy, culture, and sensitivity; PSA, prostate specific antigen; PPD, purified protein derivative; TB, tuberculosis; TURED, transurethral resection of ejaculatory ducts.