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.

Clinical features of haematospermia associated with seminal vesicle calculi versus posterior urethral haemangioma

“…The aetiology of haematospermia can be classified into inflammatory, infectious, lithiasis, cystic, obstructive, tumoral, vascular, traumatic, iatrogenic and systemic origin. (Suh et al., ). Evaluating the aetiology is the best method to the management of haematospermia.…”

Transurethral resection of ejaculatory duct combined with seminal vesiculoscopy for management of persistent or recurrent hemospermia in men with ejaculatory duct obstruction

“…Haemospermia, or haematospermia, is defined by the presence of blood in the semen [1,2]. Haemospermia has been considered as a benign and self-limiting symptom; however, it often invokes considerable anxiety and is frightening to the patient [3,4].…”

Voided urine cytology in a case of hematospermia

“…Although this rare disorder can be worrisome for patients, it is usually benign and selflimited. 3 The causes of hematospermia include the following: infections (bacterial, viral, and parasitic, eg, schistosomiasis); malignancy (prostate, bladder, testicular, seminal vesicles); iatrogenic (certain medications, prostatic massage, needle prostatic biopsy, and urological surgery); trauma (coital, perianal); ductal obstruction (cysts and/or calculi); systemic disorders (hypertension, amyloidosis, haemopathies, cirrhosis, hyperuricemia, among others); behavioral (excessive intercourse or masturbation, prolonged sexual abstinence); vascular (arteriovenous malformations, hemangioma); and idiopathic. 2 Precise incidences of hematospermia are difficult to identify, as examinations of the semen are not usually made by the affected individuals, and there are few follow-up medical consultations.…”

“…2 Precise incidences of hematospermia are difficult to identify, as examinations of the semen are not usually made by the affected individuals, and there are few follow-up medical consultations. 3 The causes of hematospermia include the following: infections (bacterial, viral, and parasitic, eg, schistosomiasis); malignancy (prostate, bladder, testicular, seminal vesicles); iatrogenic (certain medications, prostatic massage, needle prostatic biopsy, and urological surgery); trauma (coital, perianal); ductal obstruction (cysts and/or calculi); systemic disorders (hypertension, amyloidosis, haemopathies, cirrhosis, hyperuricemia, among others); behavioral (excessive intercourse or masturbation, prolonged sexual abstinence); vascular (arteriovenous malformations, hemangioma); and idiopathic. 4 An appropriate treatment should be directed at the diagnosed etiology (eg, antibiotics, adequate control of systemic disorders, for example, hypertension, urological surgery, etc.…”