How to Diagnose and Treat Hemospermia : A Review and Case Series

Disorders of breeding stallions have severe ramifications for not only the economics of the equine industry but also the welfare of affected animals. Hemospermia in particular is challenging to diagnose and manage, as there are many etiologies and treatment options. Importantly, one of the mainstays of treatment for all cases is sexual rest, which has severe economic consequences on the stallion’s reproductive performance. Because hemospermia is associated with heavy breeding or collection schedules, the disease is often diagnosed in the beginning or height of the breeding season. Therefore, timely identification of the disorder, diagnosis of the pathophysiology, and implementation of a treatment protocol will provide the best opportunity to return the stallion to breeding function, albeit most often for the following season. Some causes of hemospermia are life-threatening, such as squamous cell carcinoma, and early diagnosis and treatment may improve survival rates. Often, the first indication of hemospermia, especially in live-cover breeding operations, is infertility. Presence of erythrocytes within the ejaculate may dramatically reduce pregnancy rates as the result of effects of an unknown factor of the erythrocytes on spermatozoa. Alternatively, blood may be noted at the mare’s vulva or stallion’s penis on dismount. Stallions that are collected by means of an artificial vagina may be identified by blood-contaminated ejaculates. External lesions may be observed during washing before collection. Stallions may demonstrate normal libido but pain on erection, dilation of the glans, or ejaculation. Pain may also be observed in association with masturbation behavior or urination. The objectives of this paper are 1) to provide an overview of the diagnostic evaluation of stallions that present for hemospermia; 2) to review the major causes of hemospermia and their treatment options; 3) to present a case series of stallions with hemospermia that represent cases that veterinarians commonly see in practice.