No Results

No Results


Hematospermia is defined as blood in the semen. While often perceived as having little significance, blood in the ejaculate can cause great concern to the men who experience it. The condition is common, with many episodes going unnoticed; therefore, the prevalence of hematospermia remains unknown.

Hematospermia is most commonly secondary to infectious or inflammatory etiology and follows a benign and self-limited course. [1]  As such, no further diagnostic workup is generally needed; however, in some patients, hematospermia may be the first indicator of other urologic diseases or systemic disorders (see DDx/Diagnostic Considerations).

The advent of newer imaging modalities, especially transrectal ultrasonography, has altered both the diagnosis and the treatment of hematospermia. In 2009, Aslam et al developed an algorithm to guide the management of these patients. [2]

Hematospermia has been written about for centuries. Hippocrates, Galen, Pare, Morgagni, and Fournier all commented on this condition. The first American report appeared in 1894, and Fletcher, [3] Leary, [4] Marshall, [5] and Ganabathi [6] have  published excellent contemporary reviews on the subject.


For an understanding of the causes of hematospermia, a working knowledge of the relevant anatomy of the ejaculatory complex is useful.

The seminal vesicles are androgen-dependent accessory organs that produce and store seminal fluid, which is essential to male fertility. The seminal vesicles are best studied ultrasonographically. Normal seminal vesicles are flat paired structures that lie cephalad to the prostate behind the bladder and have a bow-tie appearance on transverse imaging. They are symmetric, well-defined, saccular, elongated organs.

In its normal collapsed state, the center of the seminal vesicle is homogeneous, with areas of increased echogenicity corresponding to the folds of secretory epithelium. In the distended state, the wall is visibly composed of 2 distinct layers. 

The dimensions of the seminal vesicles vary with age, but not with the ejaculatory state. Upon transrectal ultrasonography (TRUS), the dimensions are estimated to be 30 ± 5 mm in length, 15 ± 4 mm in width, and 13.7 ± 3.7 mL in mean volume. The age of the patient and degree of prostate enlargement have been shown to cause variation in the size of the seminal vesicles.

The vasa deferentia act as conduits, carrying sperm between the epididymis and the ejaculatory ducts via the vasal ampullae. The vasal ampullae pass medially to the seminal vesicles and are best seen using transaxial TRUS views.

The seminal vesicles and vasal ampullae join together to form the ejaculatory duct. The ejaculatory duct travels through the prostate and enters the urethra at the level of the verumontanum. The junction between the seminal vesicle and the ejaculatory duct lies within the prostate and is difficult to see in a healthy unobstructed system. Small echodensities are frequently seen at the junction of the ejaculatory ducts and the verumontanum in the urethra. These areas provide useful landmarks and are thought to represent concretions within the periurethral glands surrounding the verumontanum.

United States

The true prevalence of hematospermia is unknown. It is likely that many cases escape the patient’s notice, and remain unrecognized and unreported.

Data collected after TRUS-guided biopsy of the prostate suggest that up to 36.3% of men undergoing removal of 6-15 cores develop postprocedure hematospermia. Increasing the number of cores did not significantly increase the frequency of hematospermia. [7] Other studies have found rates of hematospermia following TRUS-guided biopsy to be as high as 84%. [8]

Hematospermia can occur in males of any age. In younger men (<40 y), hematospermia is uniformly benign. Even in older men, it is rarely associated with malignancy.

Leocádio DE, Stein BS. Hematospermia: etiological and management considerations. International Urology and Nephrology. 06/19/2008. 41:77-83. [Medline]. [Full Text].

Aslam MI, Cheetham P, Miller MA. A management algorithm for hematospermia. Nat Rev Urol. 2009 Jul. 6(7):398-402. [Medline].

Fletcher MS, Herzberg Z, Pryor JP. The aetiology and investigation of haemospermia. Br J Urol. 1981 Dec. 53(6):669-71. [Medline].

Leary FJ, Aguilo JJ. Clinical significance of hematospermia. Mayo Clin Proc. 1974 Nov. 49(11):815-7. [Medline].

Ahmad I, Krishna NS. Hemospermia. J Urol. 2007 May. 177(5):1613-8. [Medline].

Ganabathi K, Chadwick D, Feneley RC, et al. Haemospermia. Br J Urol. 1992 Mar. 69(3):225-30. [Medline].

Berger AP, Gozzi C, Steiner H, et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol. 2004 Apr. 171(4):1478-80; discussion 1480-1. [Medline].

Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer and Prostatic Diseases. 2/20/2007. 10:283-287. [Medline]. [Full Text].

Ambakederemo TE, Dodiyi-Manuel ST, Ebuenyi ID. Bloody semen, severe hypertension and a worried man. Pan Afr Med J. 2015. 20:326. [Medline].

Han M, Brannigan RE, Antenor JA, et al. Association of hemospermia with prostate cancer. J Urol. 2004 12. 172(6, Part 1 of 2):2189-2192. [Medline].

Prando A. Endorectal magnetic resonance imaging in persistent hemospermia. Int Braz J Urol. 2008 Mar-Apr. 34(2):171-7; discussion 177-9. [Medline].

Ng YH, Seeley JP, Smith G. Haematospermia as a presenting symptom: outcomes of investigation in 300 men. Surgeon. 2013 Feb. 11(1):35-8. [Medline].

Etherington RJ, Clements R, Griffiths GJ, et al. Transrectal ultrasound in the investigation of haemospermia. Clin Radiol. 1990 Mar. 41(3):175-7. [Medline].

Furuya S, Kato H. A clinical entity of cystic dilatation of the utricle associated with hemospermia. J Urol. 2005 Sep. 174(3):1039-42. [Medline].

Abdelkhalek MA, Abdelshafy M, Elhelaly HA, El Nasr MK. Hemospermia after transrectal ultrasound (TRUS)-guided prostatic biopsy: a prospective study. J Egypt Soc Parasitol. 2012 Apr. 42(1):63-70. [Medline].

Finney G, Haynes AM, Cross P, et al. Cross-sectional analysis of sexual function after prostate brachytherapy. Urology. 2005 Aug. 66(2):377-81. [Medline].

Walsh IK, Keane PF, Herron B. Benign urethral polyps. Br J Urol. 1993 Dec. 72(6):937-8. [Medline].

Furuya S, Masumori N, Furuya R, et al. Characterization of localized seminal vesicle amyloidosis causing hemospermia: an analysis using immunohistochemistry and magnetic resonance imaging. J Urol. 2005 Apr. 173(4):1273-7. [Medline].

Koment RW, Poor PM. Infection by human cytomegalovirus associated with chronic hematospermia. Urology. 1983 Dec. 22(6):617-21. [Medline].

Yu HH, Wong KK, Lim TK, et al. Clinical study of hemospermia. Urology. 1977 Dec. 10(6):562-3. [Medline].

Bamberger E, Madeb R, Steinberg J, et al. Detection of sexually transmitted pathogens in patients with hematospermia. Isr Med Assoc J. 2005 Apr. 7(4):224-7. [Medline].

Shebel HM, Elsayes KM, Abou El Atta HM, Elguindy YM, El-Diasty TA. Genitourinary schistosomiasis: life cycle and radiologic-pathologic findings. Radiographics. 2012 Jul-Aug. 32 (4):1031-46. [Medline].

Downs JA, de Dood CJ, Dee HE, McGeehan M, Khan H, Marenga A, et al. Schistosomiasis and Human Immunodeficiency Virus in Men in Tanzania. Am J Trop Med Hyg. 2017 Apr. 96 (4):856-862. [Medline].

Whyman MR, Morris DL. Retrovesical hydatid causing haemospermia. Br J Urol. 1991 Jul. 68(1):100-1. [Medline].

Radfar MH, Simforoosh N, Sotoudeh M, Ramezani MH, Mollakoochakian MJ, Nikravesh M, et al. What is the impact of extracorporeal shock wave lithotripsy on semen parameters? A systematic review and meta-analysis. Urologia. 2017 Feb 3. 84 (1):28-34. [Medline].

Lemesh RA. Case report: recurrent hematuria and hematospermia due to prostatic telangiectasia in classic von Willebrand’s disease. Am J Med Sci. 1993 Jul. 306(1):35-6. [Medline].

Minardi D, Scortechini AR, Milanese G, Leoni P, Muzzonigro G. Spontaneous recurrent hematuria and hematospermia: Unique manifestations of von Willebrand disease type I. Case report. Arch Ital Urol Androl. 2016 Mar 31. 88 (1):62-3. [Medline].

Close CF, Yeo WW, Ramsay LE. The association between haemospermia and severe hypertension. Postgrad Med J. 1991 Feb. 67(784):157-8. [Medline].

Kurkar A, Elderwy AA, Awad SM, Abulsorour S, Aboul-Ella HA, Altaher A. Hyperuricemia: a possible cause of hemospermia. Urology. 2014 Sep. 84(3):609-12. [Medline].

[Guideline] Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012 Dec. 188 (6 Suppl):2473-81. [Medline]. [Full Text].

Smith GW, Griffith DP, Pranke DW. Melanospermia: an unusual presentation of malignant melanoma. J Urol. 1973 Sep. 110(3):314-6. [Medline].

Xing C, Zhou X, Xin L, Hu H, Li L, Fang J, et al. Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia. Int J Urol. 2012 May. 19(5):437-42. [Medline].

Worischeck JH, Parra RO. Chronic hematospermia: assessment by transrectal ultrasound. Urology. 1994 Apr. 43(4):515-20. [Medline].

Raviv G, Laufer M, Miki H. Hematospermia–the added value of transrectal ultrasound to clinical evaluation: is transrectal ultrasound necessary for evaluation of hematospermia?. Clin Imaging. 2013 Sep-Oct. 37(5):913-6. [Medline].

Maeda H, Toyooka N, Kinukawa T, et al. Magnetic resonance images of hematospermia. Urology. 1993 May. 41(5):499-504. [Medline].

Yang SC, Rha KH, Byon SK, et al. Transutricular seminal vesiculoscopy. J Endourol. 2002 Aug. 16(6):343-5. [Medline].

Oh TH, Seo IY. Endoscopic Treatment for Persistent Hematospermia: A Novel Technique Using a Holmium Laser. Scand J Surg. 2015 Oct 22. 16:270-1. [Medline].

Fuse H, Sumiya H, Ishii H, et al. Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography. J Urol. 1988 Nov. 140(5):991-2. [Medline].

Li L, Jiang C, Song C, et al. Transurethral endoscopy technique with a ureteroscope for diagnosis and management of seminal tracts disorders: a new approach. J Endourol. 2008 Apr. 22(4):719-24. [Medline].

Li YF, Liang PH, Sun ZY, Zhang Y, Bi G, Zhou B, et al. Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia. J Androl. 2012 Sep. 33(5):906-16. [Medline].

Shen BY, Chang PL, Lee SH, Chen CL, Tsui KH. Complications following combined transrectal ultrasound-guided prostate needle biopsies and transurethral resection of the prostate. Arch Androl. 2006 Mar-Apr. 52(2):123-7. [Medline].

Collins GN, Lloyd SN, Hehir M, et al. Multiple transrectal ultrasound-guided prostatic biopsies–true morbidity and patient acceptance. Br J Urol. 1993 Apr. 71(4):460-3. [Medline].

Craig SR. 3-in-1′ nerve block complicated by haemospermia. Br J Clin Pract. 1992 Summer. 46(2):80. [Medline].

Geoghegan JG, Bonavia I. Haemospermia as a presenting symptom of lymphoma. Br J Urol. 1990 Dec. 66(6):658. [Medline].

Gustafsson O, Norming U, Nyman CR, et al. Complications following combined transrectal aspiration and core biopsy of the prostate. Scand J Urol Nephrol. 1990. 24(4):249-51. [Medline].

Kawahara M, Matsuhashi M, Tajima M, et al. Primary carcinoma of seminal vesicle. Diagnosis assisted by sonography. Urology. 1988 Sep. 32(3):269-72. [Medline].

Stein AJ, Prioleau PG, Catalona WJ. Adenomatous polyps of the prostatic urethra: a cause of hematospermia. J Urol. 1980 Aug. 124(2):298-9. [Medline].

Weidner W, Jantos C, Schumacher F, et al. Recurrent haemospermia–underlying urogenital anomalies and efficacy of imaging procedures. Br J Urol. 1991 Mar. 67(3):317-23. [Medline].

Benson, RC Jr., Clark WR, Farrow GM. Carcinoma of the Seminal Vesicle. Journal of Urology. September 1984. 123 (3):483-485. [Medline]. [Full Text].

Alexander D Tapper, MD Resident Physician, Department of Urology, William Beaumont Hospital

Alexander D Tapper, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Michigan State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Avadel.

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

John P Mulhall, MD Director, Sexual and Reproductive Medicine Program, Memorial Sloan-Kettering Cancer Center

John P Mulhall, MD is a member of the following medical societies: American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for Basic Urologic Research, Society of University Urologists

Disclosure: Nothing to disclose.

Jonathan D Schiff, MD Assistant Clinical Professor of Urology, Department of Urology, Mount Sinai Medical Center; Adjunct Assistant Clinical Professor of Urology, Weill-Cornell School of Medicine

Jonathan D Schiff, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.


Research & References of Hematospermia|A&C Accounting And Tax Services