HEMATOSPERMIA or HEMOSPERMIA

INTRODUCTION
The presence of blood in the ejaculate is called hematospermia or hemospermia.

Hematospermia is not uncommon and may affect men of any age after puberty, but its peak incidence is in men 30 to 40 years old. About 85 to 90 percent of all patients that have hematospermia will have repeated episodes.

CAUSES OF HEMATOSPERMIA

In about 50% of patients the cause of hematospermia is not clearly understood or known. Semen originates from multiple organs, including the testicles, epididymis, vas deferens, seminal vesicles and prostate. Most of the semen comes from the seminal vesicles and prostate and it is probably from these two organs that most hematospermia originates. Infections or inflammation of the organs listed above account for most of the other causes. Cancers are rarely causative and account for a very small percentage of hemospermic diagnoses. With the introduction of ultrasound-guided prostate biopsies, we are seeing a large number of patients will hemospermia after the biopsy. This occurence is expected in about a third of patients and is not cause for alarm.

PRIMARY HEMATOSPERMIA

Patients with hematospermia are usually categorized into two different groups. The first group, or 'primary hematospermia' is when blood in the ejaculate is the only symptom. That means no blood in the urine, either visually or under the microscope, is found, and the patient has no evidence of any urinary irritation or infection and physical exam is completely unremarkable. Patients who have this type of hematospermia with no other findings are almost always found to have no other problem. The condition is self-limited, that means it will go away in time without treatment. About 15% of patients will have one episode and never have another.

Primary hematospermia patients have been studied extensively in the past with x-rays and telescopic examination of the urinary tract. In every study no other associated problems were found. Consequently no treatment is felt to be needed for patients in whom hematospermia is the only complaint and the physical exam and urinanalysis are normal. We do encourage patients who have had hematospermia to return to our office if any change in their bleeding occurs or if they develop symptoms of infection or pain or they see blood in their urine.

TREATMENT OF PRIMARY HEMATOSPERMIA

In the past, physicians have used female hormones, such as stilbestrol or Premarin to treat primary hematospermia, believing the disease to be an inflammation of the seminal vesicles. Female hormone treatment often resulted in relief from the bleeding, but the side effects included breast swelling and tenderness, and lack of libido. For the most part its use has been discontinued. We recommend that no therapy be given for primary hematospermia.

SECONDARY HEMATOSPERMIA

The term 'secondary hematospermia' is used when a cause of bleeding is known or suspected, such as immediately after a prostate biopsy, or in the presence of a urinary or prostate infection or cancer. Unusual causes include tuberculosis, parasitic infections, and any diseases that affect blood clotting such as hemophilia and chronic liver disease.

Patients who have hematospermia associated with symptoms of urinary infection or visual or microscopic blood in the urine require a complete urologic evaluation. If blood is seen in the urine, an x-ray of the urinary tract, as well as a telescopic examination of the bladder and prostate is indicated. If the prostate or seminal vesicle is felt to have suspicious areas on rectal examination, or if the screening test for prostate cancer is suspicious (prostate specific antigen or PSA), ultrasonic examination and biopsy is indicated.

SUMMARY

In summary, hematospermia can be a very frightening occurrence to any male, but when all is said and done, most of these patients are found to have absolutely no abnormalities and require no therapy. Hematospermia is liable to continue on and off, but it is usually self-limited and carries with it no increased risk of any other disease, nor is the patient felt to be putting his sexual partner at risk.

To reiterate, malignant cancers of the testicle and prostate are very rarely associated with hematospermia.