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Hematospermia: Blood in Semen (Differential Diagnosis)

Blood in the semen (Hematospermia) is in the overwhelming majority harmless and disappears within a few weeks. In relapsing or persisting hematospermia, further investigations are necessary (see below), but rarely lead to the discovery of relevant diseases.

Differential Diagnosis of Hematospermia

45% unclear etiology
Infections (40%): prostatitis, urethritis, epididymitis
Trauma: prostate biopsy, surgery for hemorrhoids, autoerotic manipulations
Benign causes: stone in prostate or seminal vesicles, varicose veins of the prostate, anatomical abnormalities (cysts, diverticula, urethral stricture).
Tumors: condyloma acuminata of the urethra, prostate cancer, carcinoma of the seminal vesicles.
Systemic diseases: coagulation disorders, hypertension, liver disease, lymphoma.

Diagnostic Workup of Persisting Hematospermia

History: trauma? Micturition? sexual history? medication? disorders of coagulation?
Physical examination including blood pressure
Laboratory tests: PTT, PT, blood count, hepatic function panel, PSA
Urinalysis: urinary sediment and urine culture (two-glass test)
Semen analysis and semen culture
Cystoscopy
Imaging: transrectal ultrasound of the prostate and seminal vesicles, in case of abnormalities magnetic resonance imaging should be considered.

Gynecomastia

Index

Hematuria

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

References

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