Haematospermia: in the context of a genitourinary medicine setting

Haematospermia should be taken more seriously. Although it is usually benign and self-limiting, it provokes great anxiety in patients. Malignancy is generally rare, but it should particularly be considered in older patients (40 years old or above). Recent investigative modalities, especially non-invasive, have made diagnosis feasible in most cases. What will constitute a reasonable approach to the problem of haematospermia in the context of a genitourinary medicine setting? A detailed history and physical examination, including genital and rectal examination, would be necessary. Initial investigations could include screening for STIs, urine examination and full blood count. Few patients will need further investigations, which will depend on the findings in patients' history and examination as well as the nature of the bleeding. Patients should be given a detailed explanation of their condition, and a plan of management and follow up should be made clear to them. Treatment depends on the underlying cause but often simply involves reassurance. Referral to a urologist may include patients with recurrent or persistent haematospermia, those with associated symptoms and patients who are 40 years old or above.