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Urology/blood in urine and when i ejaculate


when i urinate i pee out blood and this time when i ejaculated blood came out i dont know   if it was mixed with sperm what can causes this i only aw blood

Peter, bleeding related to ejaculation usually comes from the prostate gland. It is generally due to a tear in one of the fragile veins of the prostate gland or an inflammation of the prostate (prostatitis).   Bleeding may occur during sexual excitation, ejaculation, from straining with bowel movements, or during urination.  The prostate is the organ that produces the majority of the seminal fluid in response to sexual stimulation. When the prostate contracts at the time of ejaculation, a vein may tear and blood mixes with the semen (hematospermia).  Red blood indicates new and dark (brownish) discoloration indicates previous bleeding. 

In addition, prostatic bleeding frequently is associated with gross blood during urination.  This typically will occur with initiation or at the end of urination (as opposed to being throughout the entire stream). With the latter, it is often manifest as spots of blood on the underwear, pajamas or bed sheets.  Irritation of the gland (prostatitis) can also cause it to become inflamed and predisposed to bleed.  An inflamed or congested prostate gland, especially one with varices, can start bleeding if ones strains during a bowel movement.  This occurs because hard stool can actually push on the adjacent gland precipitating bleeding or straining in itself may cause the varices to rupture.  Some factors leading to inflammation include too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, excessive alcohol or spicy foods, prolonged sitting or bike riding, etc. The prostate may then become secondarily infected and require antibiotic therapy for cure. Sometimes as the prostate gradually enlarges with age, friable veins called varices develop on its surface.   These are also prone to tearing.  In such cases, Proscar or Avodart is sometimes prescribed to shrink both the prostate and the veins.  These are not generally recommended in men less than 40-50 years of age.  Although hematospermia is not a typical sign of prostate cancer, its presence may indicate an increased risk of prostate cancer.  Therefore, it is advisable to seek consultation with a urologist to evaluate this condition.  

That being said, I am not sure from the way you phrased you note if you also have experienced blood in the urine (hematuria) unrelated to ejaculation.  There are many possible causes for blood in the urine .  The origin of the bleeding can come from the upper (kidneys or ureters) or lower (bladder, prostate, urethra) urinary tract.  Blood seen only under the microscope (microscopic hematuria) is usually of a benign nature whereas gross hematuria is potentially more serious. With gross hematuria, it is important to note the relationship of the bleeding to the urinary stream.  If at the beginning of urination (initial hematuria), the source of the blood is almost always in the urinary canal (urethra).  If at the end of urination (terminal hematuria), the source is usually the prostate gland in men or the bladder neck in men and women.  Bleeding throughout the entire stream (total hematuria) is due to bleeding that is initiated in the urinary bladder or upper urinary tract (kidneys and/or ureters).  

Some of the common causes of hematuria include infection, tumors, stones, and trauma (injury).  In order to look for the cause, it is necessary to consult a urologist.  A history, physical examination, urine cytology, and other laboratory tests are done.  In recent years, the FISH assay of the urine has been used in lieu of or in place of the urinary cytology.  This test has proven to be much more sensitive and specific in detecting bladder cancer in voided urine specimens or bladder washings. Visualization of the kidneys by imaging studies (ie IVP, ultrasound, CT or MRI) and examination of the lower urinary tract with a cystoscope are usually required.  

In summary, consultation with a urologist is needed to determine the cause and seriousness of the hematuria.  Good luck!


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Arthur Goldstein, M.D.


Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.


I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

American Medical Association, American Urological Association, American College of Surgeons

College degree - BS Medical degree - MD Master of Science - MS

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