GPAtlas🧭 When to suspect
Haematospermia is the presence of blood in the ejaculate (semen).
• It is usually a painless, isolated, benign and self-limiting symptom.
• Peak incidence is between the ages of 30 and 40.
• In around half of cases no cause is found (idiopathic).
• The patient is often far more frightened than the symptom warrants, commonly fearing cancer or a sexually transmitted infection (STI).
• Calm, structured assessment and clear reassurance are central to good care.
There are two clinical tasks:
• Identify and treat the minority with a treatable or serious cause.
• Reassure the majority robustly.
Risk is driven by age and persistence:
• A man under 40 with a single painless episode and a normal examination is very low risk.
• New-onset haematospermia over 40, or persistent or recurrent symptoms at any age, carries a higher chance of underlying pathology – most importantly prostate cancer.
| Cause category | Examples |
|---|---|
| Idiopathic | • No cause found in around half of men, especially younger patients • Benign and self-limiting |
| Iatrogenic | • Recent prostate biopsy (very common and expected for weeks) • Also catheterisation and post-vasectomy |
| Infection/inflammation | • Prostatitis, urethritis, epididymo-orchitis • STIs (chlamydia, gonorrhoea) • Urinary tract infection (UTI) • The commonest identifiable cause under 40 |
| Trauma | Perineal or testicular injury, vigorous cycling, instrumentation. |
| Obstruction/cysts/stones | Seminal-vesicle or prostatic cysts, calculi, ejaculatory-duct obstruction – typically cause persistent or recurrent bleeding. |
| Vascular/systemic | • Severe uncontrolled hypertension • Bleeding disorders • Anticoagulant or antiplatelet drugs |
| Neoplastic (uncommon) | • Prostate cancer (mainly over 40) • Rarely seminal-vesicle, testicular, bladder or urethral tumours • Benign prostatic hyperplasia (BPH) |
|
🧠 Clinical pearl • Recent prostate biopsy is one of the most common causes of all. • Haematospermia is expected for up to several weeks after transrectal (TRUS) or transperineal prostate biopsy, and after some other urological procedures. • Ask about recent procedures before embarking on any work-up – it spares the patient unnecessary investigation. • Immediate reassurance is usually all that is required. |
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.