Ask Dr. H: This bleeding may not be serious

Question:

A few days ago, I noticed upon awakening a dried dark red/brown stain in the front of my underpants that looked like dried blood. I haven't had anything like a urine infection or kidney pain. This happened to me once before earlier in the year. I am too embarrassed to tell my wife or call my doctor. Is this something serious that I should see my doctor about?

Answer:

It's probably nothing to lose sleep over. Blood in semen may seem scary, but it's rarely serious. It's called hematospermia, and it usually is a result of some nonspecific irritation of the urethra (tube leading from the bladder to the tip of the penis), prostate, or the seminal vesicles (sac-like structures that secrete a supporting fluid into the semen).

Most men who experience hematospermia are 30 to 40 years old, but it can happen at any age. And while it can spontaneously disappear, a high percentage of men will have repeat episodes.

Since there's usually no solid evidence of infection or inflammation, the reason for any particular case often is never found. Ultrasound-guided needle biopsies of the prostate are a well-known cause of hematospermia, occurring in up to one-third of patients. That is no reason to worry.

Prostatitis or a urinary tract infection can cause what you describe, but usually with pain or discomfort. Cancer is a very uncommon cause of this sort of bleeding.

I suggest you see your doctor to at least be checked for an infection. If the physical examination and urinalysis are normal and no obvious infection is found, no specific treatment is needed. As you've discovered, it goes away on its own.

If it fails to resolve, or returns frequently, I'd suggest you see a urologist.