hemospermia

Hemospermia is the presence of blood in semen, which may be visible to the eye or detectable only on laboratory analysis. In most cases it is benign and self-limited, resolving without intervention. The clinical significance depends on the patient’s age, accompanying symptoms, and how long the symptom lasts.

Common causes include infections or inflammation of the prostate, seminal vesicles, or urethra (such as prostatitis or epididymitis), recent sexual activity or trauma, and procedures involving the urinary tract. Less frequently, bleeding disorders, use of anticoagulant or antiplatelet medications, cysts or stones, or malignancies of the prostate, bladder, or seminal vesicles can be involved.

Red flags prompting urgent or thorough evaluation include persistent hemospermia for several weeks, recurrent episodes, associated fever or urinary symptoms, a new lump or significant abdominal or scrotal pain, weight loss, or age over 40 with abrupt onset.

Evaluation typically starts with a medical history and physical examination, including a digital rectal exam. Tests may include urinalysis, semen analysis, and targeted investigations for infection. Imaging such as transrectal ultrasound is used when the source inside the prostate or seminal vesicles is suspected, or if examination is unrevealing.

Most cases improve without treatment. Management aims to address identifiable causes: antibiotics for infection, prostatitis-specific therapies, and management of bleeding risk. If symptoms persist or recur, or if cancer is suspected, referral to a specialist is recommended. The prognosis is generally favorable.