Hemospermia (synonyms: Hematospermia; blood in semen; blood in ejaculate; ICD-10-GM R86.9: Abnormal findings in examination materials from male genital organs: Unspecified abnormal finding) refers to the presence of blood in semen. The semen then turns pink to dark red or even brownish. Hemospermia is often not noticed.
Hemospermia can occur once, sporadically or chronically.
Hemospermia can be a symptom of many diseases (see under “Differential diagnoses”). In 50-70% of cases, it is idiopathic hemospermia, i.e., no cause can be found.
Frequency peak: the symptom occurs predominantly between the 3rd and 4th decade of life.
The prevalence (disease incidence) is estimated to be approximately 1:5,000 of all urological patients.
Course and prognosis: The course and prognosis depend on the cause of the disease. When hemospermia occurs for the first time, the patient’s medical history and physical examination, including blood pressure measurement, and a urinalysis (urine status, including bacteriology and urine cytology) are required. If necessary, a macroscopic and microscopic examination of the ejaculatory fluid is also performed.In the case of recurrent (recurring) hemospermia and patients older than 40 years, as well as in patients with a positive family history for prostate carcinoma (prostate cancer), additional laboratory tests, imaging procedures and, if necessary, interventional examinations are required. Painless hemospermia without evidence of inflammation, infection, or malignancy (e.g., prostate and bladder carcinoma) regresses spontaneously: recurrence-free rate of 96.6% after three months, 89% after one year, 84.8% after five years, and 78.2% after ten years. Causes of hemospermia were bleeding of the vesicular glands (42.3%) and prostatic cysts (29.1%).
