Hematospermia is the presence of blood in the semen. The semen is composed of secretions from the testes, epididymis, urethral glands, prostate gland, and seminal vesicles. The clear secretion from the urethral glands account for 0.1-0.2 ml, the milky white prostate gland secretions account for 0.5 ml, and the viscous secretions from the seminal vesicles for 1.5-2.0 ml.
Hematospermia is not uncommonly encountered in men and usually results from prostate or seminal vesicle inflammation. It is almost always benign and self-limited, resolving in several weeks. IT IS RARELY INDICATIVE OF ANY SERIOUS UNDERLYING DISORDER, AS FRIGHTENING AS IT IS TO SEE THE PRESENCE OF BLOOD IN THE EJACULATE! In a very small minority of individuals, hematospermia may become recurrent or chronic, causing great concern and anxiety.
Hematospermia may cause blood in the initial, middle, or terminal portion of the ejaculate. Typically, blood arising from the prostate occurs in the initial portion, whereas blood arising from the seminal vesicles occurs later. The color of the semen can vary from bright red, indicative of recent or active bleeding, to a rust or brown color, indicative of old bleeding.
Evaluation for hematospermia involves a digital rectal examination of the prostate to check the size and consistency, a urinalysis to check for urinary infection and blood in the urine, and a PSA (prostate specific antigen) blood test.
Hematospermia is managed with oral antibiotics. Only if the bloody ejaculations fail to respond is further workup required. This may involve prostate sonography with possible prostate biopsy and cystoscopy. Prostate sonography, done be the trans-rectal route, will commonly show dilated seminal vesicles, ejaculatory duct cysts, and ejaculatory duct or seminal vesicle stones. Cystoscopy, a visual inspection of the lower urinary tract with a small-caliber, flexible instrument will enable inspection of the inner aspect of the prostate and urinary bladder.
Andrew L. Siegel, M.D.
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