Hemospermia

HEMOSPERMIA (from Greek haima—blood and sperma—seed), a pathological condition characterized by the admixture of blood to semen. True (haemospermia vera) and false hemospermia (h. spuria) are distinguished. In true hemospermia, blood is mixed into the semen in one of the organs involved in the composition of normal semen: 1) in the testicles with their efferent ducts, 2) in the prostate gland, 3) in the seminal vesicles. In false hemospermia, blood is mixed in from the posterior or anterior part of the urethra (during inflammatory or neoplastic processes in it). False hemospermia is easily distinguishable by the characteristic color of fresh blood that has not had time to mix thoroughly with the ejaculate. True hemospermia is not a pathognomonic symptom of any single ailment. It is a frequent symptom of inflammation of one of the male sex glands, as common (Janet) as nosebleeds are in diseases of the accessory sinuses. The most frequent causes of hemospermia are acute and subacute gonorrheal epididymitis, prostatitis, and vesiculitis. In the latter, the blood, due to its prolonged stay in the seminal vesicles, changes in color, and the ejaculated semen has a rusty color, reaching chocolate, or resembles currant jelly (Kholtsov). On linen, such semen leaves stains with a grayish center surrounded by a yellow or yellowish-brown ring. Upon microscopic examination of such semen, spermatozoa are completely absent or are found rarely and are immobile. How such altered secretion of the prostate gland vesicles impairs the viability of spermatozoa is unknown; there is no doubt, however, that this involves changes of a chemical nature (necro-spermia) (Finger, Saenger). It has been noted that the first sexual act after recovering from epididymitis is almost always accompanied by bloody ejaculation. The connection of hemospermia with tuberculosis of the genitourinary system is currently disputed. Sometimes hemospermia can serve as an initial symptom of prostate cancer (Janet). In a number of histological studies, Finger discovered that the anatomical substrate for hemospermia consists of hemorrhages forming in the alveoli of the prostate gland and seminal vesicles that are dilated during catarrh. Hemospermia is probably encountered more often than it is diagnosed by physicians. The reason for this lies in the fact that special diligence is required in the patient's self-observation to notice hemospermia. In the clinical picture, hemospermia, when combined with seminal colic, disturbance of orgasm, etc., can be a symptom that aids in differential diagnosis. The prognosis for hemospermia depends on the underlying ailment and is generally favorable. As is evident from the above, hemospermia does not require special treatment; treatment should be directed at the process causing the hemospermia after careful topical identification of the latter. Lit.: Kholtsov B. N., Private Urology, issue 3, Leningrad, 1927; Finger E. u. Saenger M., Pathology and Therapy of Male and Female Infertility, St. Petersburg, 1895; Janet J., "L'hemospermie," Journal d'urologie, v. XXII, No. 6, 1926.