Haematospermia refers to the presence of blood in semen or ejaculatory fluid. It is a symptom that can cause great anxiety to patients despite commonly being of benign aetiology.
- urogenital infections including sexually transmitted disease
- commonest cause in < 40 years of age
- pelvic trauma
- scrotal injury
- prostate cancer
- ejaculatory duct obstruction
Although imaging is frequently requested in these patients no cause is identified in most cases.
Scrotal ultrasound is commonly requested imaging test in young patients. However, trans-rectal ultrasound is likely to be more helpful, particularly in patients with suspected prostate malignancy.
MRI with an endorectal coil can be used for the detailed assessment of the prostate and seminal vesicles. Pelvic angiography has been described to look for vascular anomalies in patient with persistent haematospermia without any other identifiable cause.
Treatment and prognosis
Most patients are young and have episodic symptoms that require no specific treatment.
Approach to haematospermia
The patient's age and persistence of symptoms guide the workup and subsequent treatment for haematospermia. The American College of Radiology has developed guidelines on the investigation of haematospermia to help ensure appropriate use of imaging.
Men < 40 years with episodic or transient symptoms and no signs of disease
- no imaging advised
- watchful waiting, reassurance, and followup
Men > 40 years with persistent symptoms or signs of disease
- PSA and digital rectal exam
- consider trans-rectal ultrasound or endorectal coil MRI
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