Hematospermia or hemospermia is a clinical condition, which describes the presence of blood in the ejaculate. Although this rare disorder can be worrisome for patients, it is usually benign and selflimited. 1 That said, some patients may require further evaluation by a specialist when considered alongside other factors such as the patient's age (>40 years), recurrent episodes or persistent bleeding, prostate cancer risk or presence of constitutional symptoms. 2 Precise incidences of hematospermia are difficult to identify, as examinations of the semen are not usually made by the affected individuals, and there are few follow-up medical consultations. 3 The causes of hematospermia include the following: infections (bacterial, viral, and parasitic, eg, schistosomiasis); malignancy (prostate, bladder, testicular, seminal vesicles); iatrogenic (certain medications, prostatic massage, needle prostatic biopsy, and urological surgery); trauma (coital, perianal); ductal obstruction (cysts and/or calculi); systemic disorders (hypertension, amyloidosis, haemopathies, cirrhosis, hyperuricemia, among others); behavioral (excessive intercourse or masturbation, prolonged sexual abstinence); vascular (arteriovenous malformations, hemangioma); and idiopathic. 4 An appropriate treatment should be directed at the diagnosed etiology (eg, antibiotics, adequate control of systemic disorders, for example, hypertension, urological surgery, etc.). It is also important to rule out so-called pseudohematospermia in cases of haematuria or a partner's sexual bleeding (condom use can help rule out this possibility in such cases). 5 Hematospermia should also be distinguished from melanospermia, a very uncommon condition that occurs because of metastatic melanoma lesions in certain organs such as the prostate and seminal vesicles. 6 Nevertheless, although it is also a very rare clinical entity, the metastasis in seminal vesicles from a melanoma can also be the cause of hematospermia. 7 Herein, we report the case of a healthy 42-year-old male who presented two episodes of hematospermia in the last month. Among the clinical records, we can highlight hypertension, hyperuricemia, and vasectomy performed 3 years ago. A digital rectal examination was normal. Blood analysis, voided urine cytology, urine sediment, fluid seminal analysis, urine and seminal cultures were carried out. A blood analysis was unremarkable (including prostate-specific antigen [PSA] levels) except for the existence of hyperuricemia (7.9 mg/dL). The rest of the exams of the urine sediment, fluid seminal analysis, cultures for bacteria (included mycobacteria), chlamydia, trichomonas, and fungi were normal. Only in the urine cytology, the presence of two cellular groups of discohesive cells showing enlargement of nuclear size, anisokaryosis, hyperchromasia, and poorly defined scant cytoplasms with a high N/C ratio (Figure 1) were F I G U R E 1 Voided urine cytology showing seminal vesicle cells. Marked atypia, intracytoplasmic lipofuscin pigment, and some spermatozoa are visible (...
