
Have Soreness In Testicles. Noticed Blood After Sex. Would Blood In Urethra Cause Blood In Bladder?

If your bleeding is due to a ruptured blood vessel involving the prostate, Finasteride might help in reducing the congestion.
However, it needs to be taken on a fairly long term basis for it to show positive effects. On the other hand, if you are bleeding every time you are aroused, we cannot wait till the medicine takes effect, which can take up to and over 6 months.
MRI is not a bad idea, as it will show any disease involving the prostate and seminal vesicles, which can be tackled depending on the nature of the finding on the MRI. But you have to realize that there is a significant possibility of the MRI also turning out to be normal, in which a problem in the urethra also should be suspected.
This urethra is the passage which conducts urine and semen to the exterior, and any inflamed vessel could also be causing the problem you are facing. This can be ascertained by means of a test called retrograde urethrogram which might show up a more obvious lesion. On the other hand, it will almost certainly miss the more subtle ones, in which case further tests like angiogram / venogram of the pelvic vasculature might be required. The last step should be a cystoscopy and urethroscopy which should be able to tell us where the bleeding is coming from, and also provide us with an opportunity to treat the matter in the same sitting.
As your urologist seems have pointed out, we are handicapped by the fact that this is a very unusual picture, and therefore treatment cannot be guided only by one's own experience which is likely to be very limited.
Hope I have been able to help you.
Replied by Dr. V. Sasanka , Sun, 5 May 2013
This is how you answered my question I'm very impressed but would bleeding in my uretha cause blood in my bladder during sex sometimes it will come out the end of my penis but mostly in my bladder and it seems to happen while having sex not just ejaculation could it be coming from testicles I feel soreness above my testicles
Bleeding occurring at the onset of urination or towards the end of voiding urine usually suggests a problem in prostate / prostatic urethra / bladder neck.
Prostate congestion can typically cause a mild aching pain, discomfort, soreness in lower abdomen or perineum, i.e. adjacent to your testicles. This might be the discomfort what you are experiencing. This can be assessed by means of a test called trans-rectal ultrasound study which will reveal any local pathology in the prostate, seminal vesicles, ejaculatory ducts, and prostatic urethra, and also any local increase in vascularity suggestive of inflammation. It is an invasive technique (in the sense, it will involve the radiologist placing an ultrasound probe into your rectum) but I think there is a significant chance of picking up the cause of your trouble with this examination.
If this turns out to be not useful, you might require the other tests we discussed earlier, viz cystoscopy, MRI, etc.
Hope you get well soon, and please let me know the progress. I will be more than happy to clarify any further doubts.


Yes - what you did mention now looks like it could have caused the problem that you have at present.
The common area involved is what we call 'penoscrotal junction' but I would rather not hazard a more specific guess unless you get those tests done which I mentioned earlier. They will be able to localize the disease process much better, following which the actual treatment can be planned.


Oh ya it's a lot of blood when it ruptures but the wired thing is as soon as sex stops the bleeding stops and clears up leaving sore XXXXXXX
I am not surprised by what you have mentioned. Quite often urethral bleed ebbs back into the bladder and comes out along with urine.
At this point, I cannot say for certain that the pain that you experience behind the testicles is due to this present problem. I only wish the problem would resolve on its own, but if the vessel involved is large, or if there is an abnormal communication, it may need a urologist's intervention. Maybe you should see if you abstain from intercouse for some time and see if the condition settles down. But on occasions such a bleed could also be triggered by a simple erection alone, and that will be relatively more difficult to abolish.
As I said earlier, the bleeding is most likely from the urethra which is the normal passage for urine. The pathology in urethra shows up more clearly on a special X-ray called Retrograde urethrogram (RGU). If this is done soon after an episode of urethral bleed, the contrast medication might even extravasate into the bleeding vessels.
Cystoscopy is done usually as the last investigation, and usually the urologist would be prepared to tackle any bleeder if it comes into view so that a repeat procedure is not required.
Hope you get well soon.


Let me know what your urologist suggests, or if there is a problem.


I am afraid I am not familiar with the hospital to which you have been referred, but if your local doctor feels they will do a better job, by all means, please go ahead.
I would still advise you to desist from sexual relationships for the time being, so as to give the tear a chance to recover, which it will, unless there has been an anomalous connection which as been established with the urethra and what we call 'corporae' which are tubular blood filled structures which help maintain normal erection (The chance of this happening is quite rare, so please do not fret unnecessarily).
More likely the tear in urethra is getting split open whenever there is a stretch on the penis - As I said earlier, this is quite commonly seen when we do a procedure called urethrotomy for patients who have strictures - narrowings - of urethra. If this occurs in an area of urethra called penoscrotal junction or penile urethra, bleeding happens whenever the patient develops an erection. This is quite common, and during this period, we do give patients drugs to suppress erections. Some times bleeding can become quite severe, and then we do what we call perineal packing, and on occasions have had to take the patient back to the operation theatre to control the bleed.
I think we can try an analogy here - Imagine a cut in your skin in a limb near the elbow or knee. Even if the cut is deep and has not been sutured, the cut ends will eventually come together, but during this period of healing, the ends should not be separated. If the edges keep coming apart due to active mobility due to the area being close to a joint, the wound would bleed and take longer to heal. More vigorous the activity, higher would be the chances of the wound edges getting separated. So in your case, more vigorous the sexual activity or the longer it takes, more is the stress on the urethra, and promptly it bleeds. Either way, the best option would be to go to a center which as all the equipment in the armory to tackle this scenario.
Let me know what is the progress.


Yes - I still think the urethra is the culprit, unless there is anomalous connection which I mentioned earlier. Either way, without further investigations, there will no point in my speculating at this juncture. I suggest you also quite worrying about this right now, and take your time to visit the hospital which as been recommended by your local doctor. You can voice your apprehensions there, and you can also mention the feedback which you have received through these columns, and see what the urologist at UCSF have to suggest.


Thanks in advance
Good luck!!!

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