Hematospermia - Causes, Symptoms, Diagnosis, Treatment, and Complications

Introduction:

Hematospermia is a distressing symptom that causes sexually active male patients great worry. Inflammation, infection, ductal blockage or cysts, neoplasms, vascular abnormalities, and systemic or iatrogenic causes can all cause hematospermia. Treatment for hematospermia varies depending on the underlying clinical diseases. However, in most cases, it consists of merely a few quick examinations and reassurance.

What Are the Causes of Hematospermia?

Hematospermia can occur due to various factors such as inflammatory conditions, obstructive disorders, vascular problems, and traumatic and iatrogenic origin.

Here are a few examples:

• Epididymitis (inflammation of the epididymis).

• Epididymo-orchitis (a condition that involves inflammation of the epididymis and testes).

• Urethritis (inflammation of the urethra).

• Prostatitis (prostate gland inflammation).

• Seminal vesiculitis (inflammation of the vesicular gland).

• Injuries due to excessive sexual intercourse or masturbation.

• Direct trauma.

• Placement of ureteral stents.

• Viral infections such as human immunodeficiency virus, cytomegalovirus, genitourinary tuberculosis, etc.

• Sexually transmitted diseases (gonorrhea, syphilis, and Zika virus).

• Presence of calculi (stones) in the seminal vesicles, ejaculatory duct, urethra, bladder, ureter, or prostate.

• Presence of cysts such as median raphe cyst, prostatic cyst, and seminal vesicle cyst.

• Obstruction due to the presence of urethral stricture.

• Carcinomas, both benign and malignant, can give rise to hematospermia.

• Vasectomy - Hematospermia has been linked to a vaso-venous fistula that develops following a vasectomy.

• Hypertension - Patients with uncontrolled hypertension are linked with hematospermia, although the exact mechanism is unknown.

• Prothrombin deficiency.

• External beam radiation.

• Foley catheterization (treatment used to manage urine issues).

• High-frequency ultrasound.

• Hemophilia (blood disorder).

• Von Willebrand disease (bleeding disorder).

• Zinner's syndrome (congenital disease of the urogenital tract).

• Purpura (leakage of blood under the skin).

What Symptoms Are Related to Hematospermia?

Hematospermia is more often a sign rather than a condition. A few other signs that can coexist with hematospermia are:

• Fever.

• Cloudy urine after sexual intercourse.

• Painful urination.

• Pain during intercourse.

• Pain during masturbation.

• Bleeding during intercourse or urination.

• Unusual penile discharge.

• Abdominal pain.

• Swelling in the penile region.

• Testes are tender on touch.

When Should Hematospermia Be Treated by a Doctor or Healthcare Provider?

Hematospermia can be benign (non-cancerous) or be the precursor of the underlying pathology.

It is important to see the doctor if the blood in semen is:

• Persistent.

• The quantity of blood in semen is increasing.

• Associated with severe genital pain.

• Associated with severe abdominal pain.

Is It Possible for Hematospermia to Be Harmful to a Sexual Partner?

If hematospermia is caused by a sexually transmitted infection like gonorrhea, syphilis, or chlamydia, it might have serious consequences for the sexual partner. Sexual partners of males with hematospermia are advised to get tested for STDs (sexually transmitted diseases).

How Is Hematospermia Diagnosed?

Complete Medical History and Physical Examination - The goal of the physical examination is to rule out any local or systemic pathology. The patient's abdomen is thoroughly inspected to rule out liver or spleen enlargement and the presence of pelvic tumors. Skin lesions, urethral meatus, testes, and spermatic cord are also examined. After a rectal examination, the urethral meatus is re-examined for the presence of bloody discharge.

• Blood Investigations - In patients with hematospermia, a blood cell count, serum coagulation profile, and prostate-specific antigen are all-important laboratory examinations. In addition, individuals with persistent hematospermia should have coagulation tests done because this condition is linked to coagulation problems.

• Bacterial Culture and Urinalysis - Urine analysis and bacterial culture will help to confirm whether or not a urinary infection is associated with hematuria. Urine culture is indicated for all cases of hematospermia since a positive result indicates a cause.

• Semen Culture and Analysis - The presence of white blood cells in the ejaculate may indicate the existence of an infectious illness, necessitating additional investigation. A urethral swab is performed to check for sexually transmitted diseases.

• CT-Guided Aspiration - Hematospermia due to cystic lesions can be diagnosed by aspiration.

• bA transperineal ultrasound (TRUS) or magnetic resonance imaging (MRI) may be required to assess the genital glands and associated ductal drainage systems in patients who have lost their rectum undergoing abdominoperineal resection.

• Condom Test - A condom test is a diagnostic test for hematospermia, in which the patient is requested to collect the semen in the condom, which is then tested for blood.

Is Blood in Semen a Common Condition?

Blood in semen is not a common condition. Sometimes, it can be a sign of underlying medical conditions, such as infections in the prostate or urethra, inflammation of the prostate and urethra, injury to the reproductive organs, blockage or cyst in the reproductive tract, vascular abnormalities in the reproductive organs, and blood clotting disorders. In many cases, the condition resolves on its own without any treatment, especially if it occurs infrequently and without other symptoms. However, a medical evaluation is necessary to rule out serious medical conditions.

What Is the Algorithm Followed to Treat Hematospermia?

Hematospermia in men under the age of forty is usually self-limiting, as the most common cause is a urogenital tract infection. Therefore, it is crucial to exclude urogenital malignant illnesses in individuals forty years or older or those with persistent or recurring hematuria or concomitant symptoms involving hematuria. The mode of treatment includes:

Medicine or Drug Therapy - Medicine to treat the underlying cause is given to alleviate the symptoms.

• Antibiotics are administered to treat sexually transmitted infections if present.

• Hormonal preparations are given to control hematospermia in patients with prostate cancer.

• Antifibrinolytic drugs are also proven to be useful in hematospermia cases.

TRUS (Transperineal Ultrasound) - Transperineal ultrasound-guided drug delivery can be done in obstructive lesions leading to hematospermia.

Surgical Therapy - If conservative therapy fails to resolve the patient's hematospermia, surgical therapy serves as the last resort.

• Transurethral Unroofing - This is the treatment of choice in cystic lesions; access is guided using CT (computed tomography) or TRUS (Transperineal ultrasound).

• Transurethral Incision - A transurethral incision approach can treat duct obstruction.

• Laparoscopic Vesiculectomy - This is a minimally invasive approach to treat hematospermia.

• Seminal Vesicle Puncture - Stopping hematospermia with bilateral seminal vesicle puncture and medication injection under ultrasound guidance.

• Transurethral Vesiculoscopy - Endoscopic technique used to access and treat the vesicle calculi (stones).

What Are the Complications of Hematospermia?

Blood in the sperm is a common occurrence that is usually self-limiting but can be concerning if it persists. For both patients and their sexual partners, blood in the semen can be extremely upsetting. In addition, hematospermia in young people may signal or exacerbate the underlying illness, leading to infertility or sexual dysfunction. Hematospermia in older people, on the other hand, could be a sign of underlying malignancy.

Conclusion:

Hematospermia is a disturbing symptom that causes sexually active male patients great worry. Inflammation, infection, ductal blockage or cysts, neoplasms, vascular abnormalities, and systemic or iatrogenic causes can all cause hematospermia. Therefore, most instances are addressed expectantly unless the particular etiology is unknown. An individual experiencing symptoms, such as blood in the semen, painful urination, and pain during intercourse, should consult with a healthcare provider for early diagnosis and treatment.