Haemospermia - blood in the sperm

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Definition of Haemospermia: the presence of blood in the semen.
Usually intermittent, benign, self-limiting and no cause identified.

Causes:
Age <40 years: usually inflammatory (e.g. prostatitis, epididymo-orchitis, urethritis, urethral warts) or idiopathic (though to an extent this reflects the limited investigation that is usually carried out in this age group). Rarely testicular tumour; perineal or testicular trauma.

Age >40 years: as for men aged <40 prostate cancer; bladder cancer; BPH; dilated veins in the prostatic urethra; prostatic or seminal vesicle calculi; hypertension; carcinoma of the seminal vesicles.
Rare causes at any age: bleeding diathesis; utricular cysts; Mallerian cysts; TB; schistosomiasis; amyloid of prostate or seminal vesicles; post-injection of haemorrhoids.

Examination: Examine the testes, epididymis, prostate, and seminal vesicles. Measure blood pressure.
Investigation: Send urine for culture. If the haemospermia resolves, an argument can be made for doing nothing else. If it recurs or persists, arrange a transrectal ultrasound (TRUS), flexible cystoscopy, and renal ultrasound. If haematuria coexists, investigate this as described above.

Treatment: This is directed at the underlying abnormality, if found.

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