Last revised by Dr Daniel J Bell on 03 Jul 2020

Hematospermia (less commonly hemospermia) refers to the presence of blood in semen or ejaculatory fluid. It is a symptom that can cause great anxiety in patients despite usually being of benign etiology.

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, transrectal 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 used to look for vascular anomalies in a patient with persistent hematospermia without any other identifiable cause.

Most patients are young and have episodic symptoms that require no specific treatment. 

The patient's age and persistence of symptoms guide the workup and subsequent treatment for hematospermia. The American College of Radiology has developed guidelines on the investigation of hematospermia 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 follow-up

Men >40 years with persistent symptoms or signs of disease

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