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, with a peak incidence between the ages of 30 and 40. In around half of cases no cause is found (idiopathic). Importantly, the patient is often far more frightened than the symptom warrants – commonly fearing cancer or a sexually transmitted infection (STI) – so 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, and 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, whereas 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, and immediate reassurance is usually all that is required. |
Source: NICE NG12 · BAUS
🔒 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.