title: Hematospermia-a Symptom With Many Possible Causes.
abstract: BACKGROUND
  Hematospermia, or blood in the ejaculate, is a symptom with many possible causes that often gives rise to worry. Precise figures on its prevalence are unavailable. It is most common in men under 40, and its cause is usually benign; nonetheless, even a single episode of hematospermia calls for a basic diagnostic evaluation.
  
  
  METHODS
  This review is based on pertinent articles re trieved by a search in PubMed with the key words "hemato spermia," "hemospermia," "ejaculation," "male semen," and "transrectal ultrasound."
  
  
  RESULTS
  A diagnostic algorithm for hematospermia is described. The most common cause is iatrogenic trauma, in particular transrectal ultrasound-guided prostate biopsy to rule out prostate cancer. Urogenital infections are the second most common cause. Pathological changes of the prostate should be considered along with systemic causes, e.g., arterial hypertension or various hematologic disorders. A single event in men under 40 should be evaluated by precise history-taking, a meticulous physical examination including blood-pressure measurement, and urinalysis. Repeated episodes, or hematospermia in men over 40, calls for additional evaluation with further laboratory tests, imaging studies, and, in some cases, interventional diagnostic procedures.
  
  
  CONCLUSIONS
  Further tests, preferably imaging studies, seem a reasonable way to detect or exclude potential causes of hematospermia, especially malignant ones. The treatment is directed at the underlying cause.
authors.affiliation: Joint Urological Practice Remscheid, PandaMED, Cooperative Practice of the Department of Urology and Pediatric Urology, Helios Hospital Group Wuppertal, University of Witten/Herdecke; Department of Urology and Pediatric Urology, Wuppertal Hospital, Helios Hospital Group Wuppertal, University of Witten/Herdecke; Department of Urology, Maria Hilf Hospital Group, Mönchengladbach.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mathers
authors.forename: Stefan
authors.initials: S
authors.lastname: Degener
authors.forename: Herbert
authors.initials: H
authors.lastname: Sperling
authors.forename: Stephan
authors.initials: S
authors.lastname: Roth
mesh_terms: D051516:Hemospermia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011471:Prostatic Neoplasms; D012189:Retrospective Studies; D014463:Ultrasonography