Hemosperm refers to blood in the semen that is visible to the naked eye, i.e., semen mixed with blood. Normal semen is milky white or off-white. The color of semen with blood can be light red, bright red or dark red, and some patients may also present with blood clots in the semen. Hemospermia is more common in young and middle-aged men, with the average age of onset reported in the literature to be 37 years. Most of the diseases causing hematospermia are benign lesions, and most of the symptoms of hematospermia are self-limiting. However, if the symptoms of hematospermia are recurrent and persistent, further investigations are needed, especially to exclude tumorigenic lesions. Causes There are many diseases that cause hematospermia, and any male genital, lower urinary tract and systemic blood disorders may lead to hematospermia. Target organs that can cause hematospermia include the prostate, seminal vesicles, ejaculatory ducts, vas deferens, bladder, urethra, epididymis and testes. The most common causes of hematospermia are inflammation and infection, with the most common sites of infection being the prostate and seminal vesicles, followed by the posterior urethra and bladder neck. Secondly, cysts and obstruction of the genital ducts are also a common cause of hematospermia, including ejaculatory duct obstruction, Mullerian duct cysts, dilated seminal vesicles, seminal cysts and prostate cysts. In addition, tumors of the male reproductive system can also manifest as hematospermia. Benign tumors or proliferative lesions such as: posterior urethral adenoma, proliferative urethritis, and posterior urethral mucosal heterogeneity in the prostate. Malignant lesions such as: prostate cancer and seminal vesicle cancer, and a few testicular cancers can also cause hematospermia. Vascular abnormalities in the posterior urethra, prostate and seminal vesicle glands can also lead to hematospermia. Finally, systemic diseases such as hypertension, malignant lymphoma and hemorrhagic qualities can also lead to hematospermia. Hemospermia can occur in patients with hemophilia and severe liver disease. Improper use of certain medications, such as aspirin, warfarin and antithrombotic drugs, can also induce hematospermia. Diagnosis Hemosperm can occur only once or twice, or multiple times over a period of time; it can occur intermittently or with each ejaculation; the color can be bright red, light red or dark red. The clinical causes of hematemesis are particularly numerous, so it is still difficult to make an accurate diagnosis of the cause of hematemesis. More than a decade ago, more than 70% of patients with hematospermia had unknown etiology and were diagnosed as idiopathic hematospermia. In recent years, with the advancement of diagnostic techniques, especially the development of seminoscopy, MRI, and transrectal ultrasound technology, the proportion of idiopathic hematospermia has been significantly reduced. Conservative treatment or oral medication for hematospermia that still persists or recurs is called persistent hematospermia. In any patient with hematospermia, it is important to first understand the amount and color of hematospermia, the length of the disease, and the number of times hematospermia has occurred, and whether there are other concomitant symptoms, such as hematuria, lower urinary tract symptoms (urinary frequency, urgency, painful urination, difficulty in urination, etc.), abnormal bowel movements, weight loss, pain in the lower abdomen and/or perineal area, and bone pain. Patients with hematospermia should undergo a comprehensive and systematic examination, including a detailed physical examination and necessary ancillary tests. Ancillary tests that are clinically helpful in the diagnosis of hematospermia include: routine urine/prostate fluid/semen, blood biochemistry, coagulation, prostate tumor markers (PSA), urological ultrasound, transrectal ultrasound, pelvic CT, and MRI. Treatment Some patients with hematospermia only need proper abstinence for 2-4 weeks and the symptoms of hematospermia may disappear. However, there are still a significant number of patients whose hematospermia symptoms persist or recur after the above methods, and further diagnosis and treatment are required. For hematospermia caused by infectious diseases, effective antibiotics can be used for treatment according to the type of pathogen, and some patients can obtain better results. However, the concentration of antibiotics in the prostate and seminal vesicles may not reach an effective concentration during treatment, requiring the selection of appropriate antibiotics as well as a longer treatment period, currently considered to take at least 4 weeks. In patients who do not respond to antibiotic therapy, attention should be paid to the possibility of ejaculatory duct obstruction, seminal vesicle stones, and other diseases, and if necessary, vesiculoscopy should be performed. For patients with hematospermia due to prostate, seminal vesicle and ejaculatory duct cysts, puncture aspiration under ultrasound or CT guidance is possible, or transurethral cyst electrosurgical debulking may be an option. Patients with hematospermia caused by posterior urethral adenoma, varicose veins and ectopic prostate tissue can choose to undergo transurethral electrodesiccation or electrocautery, and most patients can have their hematospermia cured or relieved. For hematospermia caused by seminal vesicle cancer and prostate cancer, appropriate treatment (surgery, endocrine therapy, radiotherapy or chemotherapy, etc.) should be chosen according to the stage of the tumor. The literature reports that finasteride (Polyclonal) is effective for hematospermia caused by posterior urethral adenoma and ectopic prostate tissue and can be used selectively. In recent years, with the development of endoscopic techniques, seminal vesiculoscopy has become an effective method for the diagnosis and treatment of intractable hematospermia. Vesiculoscopy is applicable to almost all patients with recurrent or recalcitrant hematospermia. It can detect under direct vision whether the opening of the seminal vesicle and the ejaculatory duct are narrowed, and whether there are bleeding, stones and tumors in the mucosa of the seminal vesicle gland. It can also dilate narrow ejaculatory ducts, flush and drain inflammation in the seminal vesicles, remove stones in the seminal vesicles after laser fracturing or directly remove them, and biopsy lesions suspected of being tumors.