Dear Dr Ren,
I had oral sex not too long ago and found it difficult — and somewhat painful — to ejaculate. Afterward, my partner mentioned blood in my semen. I then noticed a big purple bruise on the head of my penis. Later I had to strain to pee. It burned a little and was a bit bloody. Do you know why this happened? Do I need to do anything about this? How can I prevent it happening again?
–Alarmed
Dear Alarmed,
Finding blood in semen, called hematospermia or hemospermia, can certainly make a man anxious. Fortunately, it generally doesn’t signal a major problem if you are under age 40, with no related symptoms and no other risk factors for underlying medical conditions. It will likely resolve itself and prove to be a singular event.
Actually, this situation may be more common than we suspect, as men generally don’t examine their semen for blood. It may be a fairly typical response to vigorous sex, as the male reproductive system contains copious amounts of tubing and the source of bleeding could be anywhere in the system. Still, thrombosed lymphatic vessels make a big show but rarely signal serious trouble.
But the news changes for men over 40, especially those who have repeated episodes of bloody semen, have experienced related symptoms while urinating or ejaculating, or are at risk for cancer, a bleeding or coagulation disorder, or other related conditions. In these situations, a medical assessment is advised.
Note: if the blood is red or pink, it likely originates in the urethra; if it is dark, it may come from the prostate or the seminal vesicles.
Because one of the most common causes is inflammation in the urethra or prostate gland due to an infection, it is sensible to check this out if you experience repeated episodes, regardless of your age.
As to the bruising on your penis, you’ll probably find a matching blue patch on the soft palate of your lover. Sounds like you probably got a bit carried away with the thrill of the moment and the increased pain-dulling endorphins from arousal overrode your pain receptors. You feel less pain when aroused. Had you not been having so much fun thrusting, you’d have felt the irritation. Not to worry; this bruise will likely fade like any other.
Injuries from sex are more common than you might think. A bruise can be caused by something as simple as donning too tight a cockring. We don’t realize the commonplace nature of such injuries because we aren’t comfortable talking about “those” matters. Many of the issues presented on a popular TV show about sex and the emergency room could be resolved easily if we could only eliminate sexual shame and misinformation.
The message, then, is twofold. First, understand how common, albeit alarming, minor sexual injuries are — and relax a bit. Second, be aware that repeated injuries may signal systemic issues that warrant a medical assessment.
In a very small percentage of men (approximately three percent), bruising can cause a heavy scar that makes the penile shaft bend or curve when erect. This is called Peyronie’s disease (it’s a condition, not a disease). Occasionally, this can become so severe and painful that sexual activity becomes impossible. Mind you, even Peyronie’s can be reversed in many cases, but this is one situation where prevention is definitely preferable.
If you want to minimize the opportunity for injury, consistently use lots of lubrication during sex. Most injuries that follow vigorous activity are caused by skin getting abused. Lube will prevent or minimize the chances for pulling and chafing.
And try to be a bit gentle with your sensitive bits. After all, you want them to last a lifetime.
Dr Pega Ren is Xtra’s queer- and kink-friendly sex therapist, specializing in relationship and sexual issues, including concerns of the aging population. To learn more about her and the work she does, or to book a session, visit her website at smartsextalk.com.
Have a question for Dr Ren? Send an email to asktheexpert@dailyxtra.com.
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