Definition: Presence of blood in the semen known as haemato-spermia. It is often a frightening finding for patients. The incidence of hemato-spermia is difficult to quantify because most men do not observe their semen
Most Important to Note: It is normally a Benign and Self Limiting condition.
- Hemato-spermia is commonly benign and self-limited, especially in men younger than 40 years without risk factors and in men with no associated symptoms.
- These patients need minimal investigation, and they can be reassured if workup findings are negative, or treated if indicated.
In Whom should there be a detailed assessment for haemato-spermia ?
- Patients with risk factors or associated symptoms.
- Patients 40 years and older
- Persistent or recurrent haemato-spermia
Etiology ?
- Most Common
Prolonged sexual abstinence / Excessive masturbation
Rigorous sexual intercourse
- Others
Infectious ( 40%)
Neoplastic (e.g., prostate cancer, testicular cancer),
Iatrogenic (e.g., prostate biopsy (most common]), prostate surgery, urologic instrumentation, radiation therapy, hemorrhoid injections)
Structural
Systemic
Vascular causes
Assessment and Management Rules
- History physical examination with emphasis on genital and digital rectal examination.
- Rule out – hematuria / sex partner as source of blood.
- First / Self Limiting Episodes: Rule out infection, including STI
- Age <40: Rule Out Testicular Cancer
- Age > 40: Rule out Prostate cancer
Other points to be taken in to consideration are
constitutional symptoms / urinary symptoms and pain
. In presence of these further imaging is warranted. An
initial course of two weeks antibiotics may be given if infection suspected
along with something to massage the prostate from within.