132 Hematospermia and Its Sexual Ramifications: A Systematic Review
Authors: Drury R , King B , Herzog B , Hellstrom WJ 
Published: April 2022

ABSTRACT

Introduction
Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare, usually benign condition associated with various etiologies and treatments. Though a source of great anxiety for patients, no comprehensive review exists on the sexual ramifications of HS.

Objective
To determine HS effects on sexual wellbeing, with emphasis on original research.

Methods
A systematic review of HS was performed via PubMed (Figure 1). The following search terminology was used: “(hemospermia OR hematospermia) AND (sexual OR libido OR anxiety OR infertility OR cryopreservation OR erectile dysfunction).” Articles were assessed for sexual health-related implications, such as emotional disturbances, changes in sexual activity, hindered sexual response cycles, pain associated with intercourse, altered fertility, and sexual infections.

Results
Thirty-eight articles met our inclusion criteria while 111 were excluded. The effect of HS on sexual health proved multifaceted. Anxiety is known to compromise sexual health. Two articles reported that anxiety following transrectal ultrasound (TRUS)-guided prostate biopsy had a positive correlation with duration of HS. Additionally, in both studies, 50% of patients reported decreased sexual activity due to HS. A similar study showed that patients with substantial prostatic calculi had greater HS after biopsy as well as significantly increased anxiety compared to those with no prostatic calcifications. Patients with underlying comorbidities experienced sexual complications from HS. One study described a man who developed HS due to hypertensive emergency. In response to his HS, sexual partners ostracized him and family members believed he was divinely cursed. Another article described 3 patients with congenital bleeding disorders (e.g., hemophilia A, prothrombin deficiency, von Willebrand disease) who required episodes of sexual abstinence due to HS. HS was associated with blood during parts of the sexual response cycle. Two studies showed urethrorrhagia occurred after sexual excitation in those with HS and urethral hemangiomas. Likewise, four articles revealed HS and post-coital hematuria, sometimes with severe bleeding after ejaculation, in patients with urethral hemangiomas, previous coital trauma, or seminal vesicle cysts (SVC.) Of note, another study demonstrated patients with SVC experienced HS and post-ejaculatory pain. In certain populations, HS indicated increased risk of sexual pathologies. One study illustrated patients with HS and chronic prostatitis had 4-fold increased risk of erectile dysfunction (ED) compared to those without HS. Sixteen articles showed that HS was associated with infertility (IF) in various circumstances, including anatomic genitourinary pathologies (e.g., SVC, prostatic cysts, Mullerian duct cysts, ejaculatory duct stones, vas deferens injuries, varicoceles), herpes simplex virus (HSV) infection with low seminal volume, hydroxyurea treatment of essential thrombocythemia, leukospermia, Zinner syndrome, and isolated follicle-stimulating hormone deficiency. Furthermore, two studies revealed HS was related to temporarily altered semen quality after shockwave lithotripsy. In 7 articles, patients with HS had infections that could be sexually transmitted, including HSV, Chlamydia, enterococcus, Ureaplasma, Schistosoma, and Zika virus.

Conclusions
Sexual effects of HS included increased anxiety, exacerbated comorbidities, bleeding during sexual response cycle, ED, IF, and increased risk of sexual infections. Further research is needed to better understand causality in addition to associations of HS on sexual wellbeing.

Disclosure
No