Expert: Arthur Goldstein, M.D. - 3/2/2007

Question
Hi
I have been experiencing blood in my urine and semen only after sex for about 6 months. It seems as if my penis is bleeding when i get an erection then the blood is pushed out via urine or semen which ever comes first. If i masturbate quickly there is no blood but if i have a prolonged erection i will have huge blood clots which are difficult to pass. I am a normal healthy 38yo male with no other symptoms or pain and had a normal sex life. Can you give me any idea what is wrong.
Regards
Chris
Northern Ireland

Answer
Chris, this type of bleeding usually comes from the prostate gland. It is due to a tear in one of the fragile veins of the prostate.  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.  Prostatic bleeding often 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.  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 is sometimes prescribed to shrink both the prostate and the veins.   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.  Good luck.