What Is Hematospermia?

Hematospermia is a common disease in andrology and urology and refers to the presence of blood in semen. According to the amount of blood, it can be manifested as naked blood sperm, blood clots in the semen, or a small amount of red blood cells under the microscope. Strictly speaking, hematospermia is a clinical manifestation, not a disease. Hematospermia can occur at any age after development. Generally, it is more common in young adults who are 30 to 40 years old during the period of vigorous sexual activity, and 80% to 90% are intermittent. Hematospermia is mostly a benign self-limiting disease that requires only conservative treatment. However, some patients with severe refractory hematospermia may have the potential for other serious pathological changes and need further treatment.

Basic Information

English name: hemospermia syndrome
Visiting department: Urology

Multiple groups: 30 to 40 years old
Common causes: "Reproductive system infection
Common symptoms: Blood in semen during ejaculation

Causes of Hematospermia

Hematospermia can be caused by various parts of the semen delivery route and tissue lesions, but mainly from the seminal vesicles, prostate and posterior urethra. Blood essence can be divided into functional and organic. Functional blood ejaculation is the relaxation of men after orgasm contraction and relaxation after ejaculation, which causes the pressure of seminal vesicle glands to change rapidly. Capillaries on the cyst wall are damaged and bleeding or capillary permeability changes and oozing . Organic blood sperm is caused by certain diseases, and common causes include:

Inflammation

Reproductive system infections are the most common cause of blood sperm. Infectious pathogens include viruses, bacteria, tuberculosis, and parasite infections. They can also be the result of trauma, foreign bodies in the urethra, or chemicals. Common are seminal vesiculitis, prostatitis, posterior urethritis, seminal vesicle tuberculosis, epididymal testicular inflammation and so on. Stones from the prostate, seminal vesicles, or vas deferens can also cause blood sperm.

2. Obstruction or cyst

Ejaculatory duct obstruction can cause the proximal duct of the obstruction to expand and expand, leading to rupture and bleeding of mucosal blood vessels. There are seminal cysts, ejaculatory duct cysts, seminal vesicle diverticula, noon ductal cysts, and prostate cysts.

3. tumor

A variety of benign tumors of the urogenital tract can cause blood spermatozoa, such as posterior urethral adenoma, leiomyoma, fibroma, adenoma-like polyps, and benign prostatic hyperplasia. Malignant tumors of the bladder, prostate, testes, and seminal vesicles can also cause blood sperm.

4. Vascular abnormalities

Varicose veins in the seminal vesicles, prostate urethra, and bladder neck are the causes of blood sperm. In addition, abnormal blood vessels in the reproductive system can lead to blood sperm, including pelvic arteriovenous malformations, prostate hemangiomas, seminal vesicles, and seminiferous hemangiomas.

5. damage

Most of them are iatrogenic causes, which are commonly found in prostate biopsy, intraprostatic drug injection, prostate cancer radiotherapy, seminal vesicle damage caused by transurethral device operation or pelvic surgery, and vasectomy, distal ureteral stones, extracorporeal shock wave lithotripsy, and hemorrhoid injection Wait after treatment. In addition, it is also seen in perineal trauma, gonadal trauma, pelvic fracture and so on.

6. Systemic factors

Hypertension, hematological diseases (lymphoma, thrombocytopenia, leukemia, hemophilia), and abnormalities of anticoagulation secondary to liver diseases can cause blood sperm.

Hematospermia clinical manifestations

Hematospermia is characterized by blood in the semen during ejaculation, which can be accompanied by ejaculation pain, decreased libido, premature ejaculation, perineal discomfort, initial or terminal hematuria after ejaculation, and bladder irritation. Functional blood ejaculation is characterized by: in the case of no ejaculation for a long time, blood ejaculation is easy to occur once ejaculation, without other symptoms, short duration, and easy to relapse.

Due to different bleeding causes, locations, amounts, and length of bleeding, the appearance of blood sperm is also different: the blood sperm is mixed evenly due to inflammation and injury; when it comes from urethral mucosal bleeding, it appears as bright red blood in the semen. Mix with semen; if the seminal vesicles are stored for a long time, it is usually brown; if it is fresh, it is pink. The majority of patients with hemospermia have less bleeding and can be initial, terminal, or full course.

Hematospermia test

Laboratory inspection

Including urine analysis, urine bacterial culture and drug sensitivity tests and detection of chlamydia. Routine semen or prostate fluid examination showed a significant increase in red blood cell and white blood cell counts. If necessary, semen bacterial culture and drug sensitivity tests can be performed. PCR technology can be used to determine the diagnosis of tuberculosis. People over 40 should also check for serum prostate-specific antigen (PSA). In addition, check blood routine, liver function, kidney function, clotting time and electrolytes to exclude blood sperm caused by chronic diseases and hemorrhagic quality.

2. Imaging examination

(1) Transrectal ultrasonography is the preferred method for checking blood sperm, and it can be used to guide the aspiration of seminal vesicles, biopsy or biopsy of the prostate to further clarify the cause of bleeding.

(2) The biggest advantage of magnetic resonance (MRI) examination is the ability to directly display seminal vesicles or prostate bleeding. Three-dimensional imaging of MRI is considered to be the "gold standard" for imaging imaging of the body's gonads, accessory gonads, and catheters.

(3) Endoscopy When a urethral, bladder, ejaculation, or seminal vesicle is suspected to cause blood sperm, a cystourethroscopy, ureteroscopy, or seminal cystoscopy may be performed.

Previously used plain radiographs, excretory urography, vasectomy, or seminal vesicle angiography provide limited information, but they are rarely used in the diagnosis of blood sperm. Compared with transrectal ultrasound and MRI, CT has no superiority.

Hematospermia diagnosis

Hematospermia is diagnosed based on medical history, systemic examination, urinary and reproductive system examinations. Care should be taken to exclude the possibility of bleeding from sexual partners during diagnosis. Differentiate from extremely rare melanoma. The latter is a malignant melanoma that occurs in the prostate, seminal vesicles, or genitourinary tract, and is characterized by dark brown semen or dark brown spots in the semen.

Hematospermia Treatment

For functional blood sperm, idiopathic blood sperm and iatrogenic blood sperm are mainly symptomatic treatments such as hemostasis, suspension of sexual intercourse, and prevention of infection. Some patients can often heal themselves. If it is caused by infection, available drugs and symptomatic treatment, combined with antibiotics and finasteride treatment is an effective method for the treatment of infectious hematospermia. A small number of patients with tuberculosis may be treated with surgery when necessary. Refractory recurrent blood spermatozoa can be washed with transurethral ureteroscopy or seminal vesicles, and perineal or abdominal seminal vesicle puncture under ultrasound guidance. Hematospermia caused by urethral diseases such as posterior urethral polyps, adenomas, and vascular lesions can be cured by transurethral resection or electrocautery, while patients with bladder cancer, prostate cancer, and seminal vesicle cancer need surgery.

Hematospermia Prognosis

In most cases, the blood sperm is mild and can heal itself. If it is a benign lesion, the prognosis is good, but it may still recur. If it is a malignant disease, the prognosis is related to the clinical and pathological stage of the primary disease.

Hematospermia Prevention

Moderate sexual life, should not be too frequent and intense, and should not be abstinent for too long. It is forbidden to drink alcohol and spicy and irritating food. Don't ride a long distance to avoid repeated illness. Those who have given birth can take a warm bath with water at a temperature of 41 ° C to 42 ° C once a day for 15 to 20 minutes each time. For those who have not given birth, avoid sitting baths, as high temperature will affect sperm quality.