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Barry D Weiss, MD
Jerome P Richie, MD, FACS
Section Editor
Michael P O'Leary, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


Hematospermia, the presence of grossly bloody or blood-tinged penile (seminal) ejaculate, is an uncommon condition. While it is usually alarming to patients, the cause is almost always benign. Only a few case series have been published, nearly all of which are from urology specialty practices.

Because of the paucity of research literature, there is little evidence on which clinicians can base their evaluation of patients with hematospermia. Searching for the rare causes that have been identified in case reports is not likely to be productive [1], and the relative frequencies of causes reported in case series from urology specialty practices may not apply to primary care practice. The most important lesson from the literature is that hematospermia is almost never a sign of cancer in younger patients.


The most common cause of hematospermia is prostate biopsy. Hematospermia occurs in more than 80 percent of men undergoing prostate biopsy and lasts for an average of three to four weeks [2,3]. Hematospermia is also common after radiation treatment for prostate cancer, both external beam radiation and brachytherapy. In addition, vasectomy can cause hematospermia for a week or more. Because the cause of hematospermia is obvious in these instances, the remainder of this review will focus on other causes of hematospermia.

A variety of conditions other than prostate biopsy have been reported in patients with hematospermia (table 1) [4-43]. They include benign and malignant disorders of the prostate gland, seminal vesicles, spermatic cord, and ejaculatory duct system; urogenital infections including sexually transmitted infections (eg, chlamydia, herpes simplex virus, gonorrhea, trichomonas); metastatic cancers; vascular malformations; congenital and drug-induced bleeding disorders; and even frequent daily ejaculation over a period of several weeks. However, it is often impossible to know with certainty whether these conditions are the cause of hematospermia. The cause is idiopathic in a substantial proportion of patients, and the condition frequently resolves spontaneously.

It is also difficult to know the true relative frequency of the causes of hematospermia (table 1) because of publication bias that tends to favor reporting of new or unusual causes of hematospermia. In addition, as noted previously, there are no data on the relative prevalence of the causes of hematospermia among patients seen in primary care practice.

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Literature review current through: Nov 2017. | This topic last updated: Mar 18, 2016.
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  1. Ahmad I, Krishna NS. Hemospermia. J Urol 2007; 177:1613.
  2. Raaijmakers R, Kirkels WJ, Roobol MJ, et al. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology 2002; 60:826.
  3. Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis 2007; 10:283.
  4. Leary FJ. Hematospermia. J Fam Pract 1975; 2:185.
  5. Jinza S, Noguchi K, Hosaka M. [Retrospective study of 107 patients with hematospermia]. Hinyokika Kiyo 1997; 43:103.
  6. Furuya S, Ogura H, Saitoh N, et al. Hematospermia: an investigation of the bleeding site and underlying lesions. Int J Urol 1999; 6:539.
  7. Worischeck JH, Parra RO. Chronic hematospermia: assessment by transrectal ultrasound. Urology 1994; 43:515.
  8. Kochakarn W, Leenanupunth C, Ratana-Olarn K, Viseshsindh V. Hemospermia: review of the management with 5 years follow-up. J Med Assoc Thai 2001; 84:1518.
  9. Schwartz E, Pick N, Shazberg G, Potasman I. Hematospermia due to schistosome infection in travelers: diagnostic and treatment challenges. Clin Infect Dis 2002; 35:1420.
  10. Torresi J, Sheori H, Ryan N, Yung A. Usefulness of Semen Microscopy in the Diagnosis of a Difficult Case of Schistosoma haematobium Infection in a Returned Traveler. J Travel Med 1997; 4:46.
  11. Miyata Y, Sakai H, Kanetake H, Saito Y. [Clinical study of serum antibodies specific to Chlamydia trachomatis in patients with chronic nonbacterial prostatitis and prostatodynia]. Hinyokika Kiyo 1996; 42:651.
  12. Hasegawa N, Miki K, Kato N, et al. [Magnetic resonance images of hematospermia]. Nihon Hinyokika Gakkai Zasshi 1998; 89:956.
  13. Koment RW, Poor PM. Infection by human cytomegalovirus associated with chronic hematospermia. Urology 1983; 22:617.
  14. Walton HC. Trichomonas and haematospermia. Br Med J 1969; 2:514.
  15. Abdel Razic MM, el-Morsy FE. Genitourinary mycobacteria in infertile Egyptian men. Fertil Steril 1990; 54:713.
  16. Dumas JP, Poumier-Chabanier C, Dupuis JL, et al. [Cancer of the prostate revealed by hemospermia in a young man]. Ann Urol (Paris) 1985; 19:207.
  17. Gaudin PB, Rosai J, Epstein JI. Sarcomas and related proliferative lesions of specialized prostatic stroma: a clinicopathologic study of 22 cases. Am J Surg Pathol 1998; 22:148.
  18. Maheshkumar P, Otite U, Gordon S, et al. Testicular tumor presenting as hematospermia. J Urol 2001; 165:188.
  19. Meng MV, Werboff LH. Hematospermia as the presenting symptom of metastatic malignant melanoma of unknown primary origin. Urology 2000; 56:330.
  20. Yamamoto S, Mamiya Y, Noda K, et al. [A case of metastasis to the seminal vesicle of renal cell carcinoma]. Nihon Hinyokika Gakkai Zasshi 1998; 89:563.
  21. Lemesh RA. Case report: recurrent hematuria and hematospermia due to prostatic telangiectasia in classic von Willebrand's disease. Am J Med Sci 1993; 306:35.
  22. Furuya S, Ogura H, Tanaka Y, et al. Hemangioma of the prostatic urethra: hematospermia and massive postejaculation hematuria with clot retention. Int J Urol 1997; 4:524.
  23. Furuya S, Ogura H, Shimamura S, et al. [Clinical manifestations of 25 patients with prostatic-type polyps in the prostatic urethra]. Hinyokika Kiyo 2002; 48:337.
  24. Ishigooka M, Hashimoto T, Kodama C, et al. Polyps of the prostatic urethra. Report of four cases. Urol Int 1993; 50:57.
  25. Coppens L, Bonnet P, Andrianne R, de Leval J. Adult müllerian duct or utricle cyst: clinical significance and therapeutic management of 65 cases. J Urol 2002; 167:1740.
  26. Fujisawa M, Ishigami J, Kamidono S, Yamanaka N. Adenomyosis of the seminal vesicle with hematospermia. Hinyokika Kiyo 1993; 39:73.
  27. Botash RJ, Poster RB, Abraham JL, Makhuli ZM. Senile seminal vesicle amyloidosis associated with hematospermia: demonstration by endorectal MRI. J Comput Assist Tomogr 1997; 21:748.
  28. Yanagisawa N, Saegusa M, Yoshida T, Okayasu I. Squamous cell carcinoma arising from a seminal vesicular cyst: possible relationship between chronic inflammation and tumor development. Pathol Int 2002; 52:249.
  29. Wang TM, Chuang CK, Lai MK. Seminal vesicle cyst: an unusual cause of hematospermia--a case report. Changgeng Yi Xue Za Zhi 1993; 16:275.
  30. Mayersak JS, Viviano CJ. Unilateral seminal vesicle cyst presenting as hematospermia; diagnosis established by transrectal prostatic ultrasound. Wis Med J 1992; 91:629.
  31. Fan K, Schaefer RF, Venable M. Urethral verumontanal polyp: evidence of prostatic origin. Urology 1984; 24:499.
  32. Harada M, Tokuda N, Tsubaki H, et al. [Cavernous hemangioma of the spermatic cord: a case report]. Hinyokika Kiyo 1992; 38:591.
  33. Furuya S, Ogura H, Shimamura S, et al. [Transurethral endoscopic treatment for chronic hematospermia caused by müllerian duct cyst and ejaculatory duct obstruction]. Hinyokika Kiyo 2001; 47:839.
  34. Ameur A, Touiti D, Jira H, et al. [Hemospermia: diagnosis and therapeutic aspects. Seven case reports]. Ann Urol (Paris) 2002; 36:74.
  35. Leifert S, Lurie A, Kellner J. Ectopic prostatic tissue in urethra. Urology 1985; 26:509.
  36. Navío Niño S, Jiménez Cruz JF, González R, et al. [Hemospermia caused by proliferative papillary urethritis]. Actas Urol Esp 1981; 5:331.
  37. Redman JF, Young JW 3rd. Massive post-ejaculation hematuria. Urology 1987; 30:73.
  38. Bhaduri S, Riley VC. Haematospermia associated with malignant hypertension. Sex Transm Infect 1999; 75:200.
  39. Hamburger S, Styczynski M, O'Hearne J, German G. Hemospermia and hypertension two case reports. J Kans Med Soc 1980; 81:459.
  40. Correa-Pérez JR. Occurrence of nonpersistent hematospermia after a prolonged period of daily ejaculatory intensity longer than 3 weeks. J Assist Reprod Genet 2004; 21:341.
  41. Najafi L, Noohi AH. Recurrent hematospermia due to aspirin. Indian J Med Sci 2009; 63:259.
  42. Girolami A, Scarparo P, Candeo N, et al. Hemospermia in patients with congenital coagulation disorders: a study of three cases. Acta Haematol 2009; 121:42.
  43. Kurkar A, Elderwy AA, Awad SM, et al. Hyperuricemia: a possible cause of hemospermia. Urology 2014; 84:609.
  44. Zhao H, Luo J, Wang D, et al. The value of transrectal ultrasound in the diagnosis of hematospermia in a large cohort of patients. J Androl 2012; 33:897.
  45. Han M, Brannigan RE, Antenor JA, et al. Association of hemospermia with prostate cancer. J Urol 2004; 172:2189.
  46. Han, M, 2004, personal communication.
  47. Corachan M, Valls ME, Gascon J, et al. Hematospermia: a new etiology of clinical interest. Am J Trop Med Hyg 1994; 50:580.
  48. van Delft F, Visser L, Polderman A, van Lieshout L. Cough and alterations in semen after a tropical swim. Neth J Med 2007; 65:304.
  49. Bamberger E, Madeb R, Steinberg J, et al. Detection of sexually transmitted pathogens in patients with hematospermia. Isr Med Assoc J 2005; 7:224.
  50. Smith GW, Griffith DP, Pranke DW. Melanospermia: an unusual presentation of malignant melanoma. J Urol 1973; 110:314.
  51. Anonymous. Hematospermia (Bloody Semen). In: Reinsurance Notes, Vol 1, No.9, Harvard Medical School, Boston 1998.
  52. Torigian DA, Ramchandani P. Hematospermia: imaging findings. Abdom Imaging 2007; 32:29.