What is Hemospermia?

Hemospermia is the presence of blood in the semen. Its etiology may involve various causes. Although the symptom makes the patient worry, it rarely conceals any severe disease. It may occur at any age following puberty, but it is most frequent in men of 30-40 years old. In their majority, patients have no previous urinary tract symptom in their history.

What causes Hemospermia?

Many organs are involved in the process of semen formation: testes, epididymes, ejaculatory ducts, seminal vesicles and prostate. Blood in the semen may originate from any one of the above organs. In 50% of patients, the cause of hemospermia is not identified. The most common causes are: 

  • Inflammation in one of the above mentioned organs (making vessels brittle) 
  • Injury
  • Malignancy is a rare cause, but it should always be investigated in patients above 40 years old
  • Post-Urethral Resection of the Prostate (TURP)
  • Transrectal biopsy of the prostate is a common cause of hemospermia. It occurs in about 30% of patients and may persist for a long period of time, even up to 2-3 months after the biopsy. It should not worry the patient.

How is Hemospermia classified?

Hemospermia is divided in Primary and Secondary Hemospermia. In Primary Hemospermia, the patient's only symptom is the presence of blood in the semen. Before setting the diagnosis, the physician has to make sure that there is neither any microscopic/macroscopic hematurea nor any asymptomatic urinary tract infection. Primary hemospermia is a self-limiting condition -in 15% of patients it occurs as an individual episode. 

In Secondary Hemospermia, the cause is usually known; for example, prostate biopsy, prostate cancer or urinary tract infection, particularly prostatitis. However, there are some other more rare causes, such as:

  • Urolithiasis
  • Urinary Tuberculosis
  • Hematological diseases (causing blood coagulation problems)
  • Anticoagulants

What should I do if I am diagnosed with Hemospermia?

You should visit your doctor if any one of the following occurs:

  • If there are other additional symptoms, such as dysurea, painful ejaculation, fever, hematurea.
  • If there are risk factors, such as cancer history, hematological diseases or anticoagulant pharmacotherapy.
  • If there is an injury in genitalia.
  • If there is suspicion for a sexually transmitted disease.