Haematospermia

Haematospermia is the occurrence of blood in the ejaculate.

The accurate incidence of haematospermia remains unknown but is thought to be approximately 1 in 5000 of urology patients

The majority of cases are painless, benign and self-limiting although for the patients this might be a distressing and an alarming occurrence. Many cases are assumed to be the result of minor trauma in the genital tract. Another possible cause is prostatitis where there is also perineal pain.

Management in primary care if no identifiable cause (2):

• for men younger than 40 years of age who have had no more than three episodes of haematospermia within one month:
  • reassurance that a serious cause is extremely unlikely
  • the patient should be advised to return if more than three episodes of haematospermia occur or episodes of haematospermia continue for more than one month

Indications for urology referral: (2)

• Men ≥40 years of age
• Persistent or recurrent haematospermia
• Suspicious DRE findings
• Abnormal PSA results
• Suspicion of prostate, bladder, testicular or urethral malignancy on history, examination or investigations
• Concurrent haematuria
• Haematospermia despite treatment for suspected cause
  

Reference:

1. Kumar P, Kapoor S, Nargund V. Haematospermia - a systematic review. Ann R Coll Surg Engl. 2006;88(4):339-42
2. Dantanarayana N. Aust Fam Physician: Haematospermia. Volume 44, Issue 12, December 2015