Rigi10™ Malleable Penile Prosthesis
Also Known As
Hemospermia, bloody ejaculate, blood in semen
Definition
Hematospermia is defined as the presence of blood in the semen (ejaculate).1 It is characterized by the macroscopic presence of blood in the seminal fluid, which may appear as fresh or old blood.2 Hematospermia is a relatively frequent, distressing, and frightening symptom for many men, though it is usually a benign, self-limiting disorder.3 The condition can occur as a single episode, multiple episodes, or persist chronically, and may be caused by inflammation, infection, tumors, blockage, injury, vascular abnormalities, or systemic diseases affecting any region within the male reproductive organs.4
Clinical Context
Hematospermia is most commonly encountered in men younger than 40 years of age, where infection of the urogenital tract is the most common etiology.1 In this age group, without risk factors (e.g., history of cancer, known urogenital malformation, bleeding disorders) and with no associated symptoms, hematospermia is often self-limited and requires no further evaluation or treatment other than patient reassurance.3
In patients 40 years or older, or those with persistent or recurrent conditions or associated symptoms, it is necessary to exclude urogenital malignant disorders.1 In men 40 years and older, iatrogenic hematospermia from urogenital instrumentation or prostate biopsy is the most common cause of blood in the semen.3
Clinical assessment should include medical history taking, physical examination including temperature and blood pressure assessment, digital rectal palpation, and laboratory blood, urine, and semen tests.1 If the diagnosis is still unclear, further investigations involve transrectal ultrasonography, magnetic resonance imaging, urethrocystoscopy, and histological confirmation by biopsy.1
Treatment for hematospermia depends on the underlying pathological lesions, but often involves only minimal examinations and simple reassurance in most cases.1 Hematospermia caused by genitourinary infections is effectively treated with appropriate antiviral, antibiotic, or antiparasitic agents.1 Hematospermia due to malignant disorders including prostate, testis, and seminal vesicle cancers resolves with definitive treatment of the primary lesions.1