Hematospermia Presence of blood in the sperm

The presence of blood in the sperm is almost always a benign and self-limited situation, although, understandably, it motivates anxiety and substantial worry; in most cases, a direct cause is not identified.

The unknown cause, classified as “idiopathic”, is often attributed to a probable non-specific inflammation of the prostate and seminal vesicles that resolves spontaneously. In patients where a cause is identified, it may be due to inflammatory and infectious diseases (such as prostatitis, orchid epididymitis and sexually transmitted diseases), urinary calculi ("stones") of the seminal vesicles, trauma and, rarely, neoplasms (tumors of the prostate, testis, seminal vesicles, urethra or bladder). In men over 40 years of age, it often happens after a prostate biopsy is performed. Other rare causes include utricle, seminal, or Müllerian cysts, genitourinary tuberculosis and schistosomiasis. Diseases or medications that affect blood clotting and platelet aggregation and others, such as hypertension, can increase the risk of hematospermia.

In isolated episodes, and in patients without risk factors, additional evaluation is generally not necessary.

In recurrent cases and in patients with risk factors, it may be necessary to investigate the cause. The investigation depends on other elements of the clinical history, but may include: urine and blood tests, urethroscystoscopy, prostate and seminal vesicles ultrasound, bladder ultrasound and pelvic MRI.