Q: After my husband and I have sex, the next two or three times he urinates, he passes blood clots and has very bloody urine. He has seen a urologist three times, but they can’t find anything wrong. His PSA was good, the cystoscopy found nothing, and they even checked his kidneys and did a full-body scan with dye—still no answers! There is no pain associated with the passing of this blood. I know it has something to do with his erection because it will happen if he has a wet dream, or even if he just becomes aroused and we don’t have sex. It is worst after full sexual intercourse. Why is this happening, and what should we do?
Possible Cause: Pressure in the Penile Blood Vessels
A: I understand how worrying and frustrating this can be, especially when every test seems normal. Based on your description, it’s quite possible that the bleeding is linked to the physical process of erection. The penis is a highly vascular organ—meaning it’s full of tiny blood vessels. During erection, internal pressure in these vessels can reach two to three times higher than anywhere else in the body. Such elevated pressure may cause small ruptures in the urethra or prostate, resulting in visible blood or clots during urination after sex.
In a few rare cases, I’ve seen men with similar symptoms where the bleeding site couldn’t be located during routine testing. To investigate further, doctors can simulate an erection by injecting a medication into the penis and then performing a flexible cystoscopy. This minimally invasive procedure allows specialists to visually identify where the bleeding originates—either in the prostate or the penile urethra.
Treatment and Medical Options
Once the bleeding site is located, it can often be cauterized to stop the recurrence. For men over 50, when the bleeding arises from fragile blood vessels in the prostate, one effective medication is finasteride (brand name Proscar). This drug reduces prostate size and decreases blood vessel growth within it. Such treatment is particularly helpful in men with mild to moderate prostate enlargement or related urinary symptoms. For further reading, see Fighting More Advanced Prostate Problems for more on prostate therapies and prevention strategies.
When to Seek Additional Evaluation
Although your husband’s PSA and scans were normal, ongoing visible blood should always be evaluated, especially if symptoms change. If bleeding worsens or he develops discomfort, urinary retention, or erectile changes, a second urological opinion may help. Additional imaging or targeted prostate evaluation may reveal issues not apparent on initial tests. Erectile health also plays a role here—see Correcting Diabetes-Related Erection Problems to understand how vascular health and blood flow can influence both erections and urinary issues.
Expert Resource
For authoritative information about causes of blood in urine (hematuria) and related conditions, visit the Mayo Clinic’s Blood in Urine (Hematuria) overview.
Bottom Line
- Bleeding after sexual activity is usually caused by pressure-related rupture of small blood vessels in the urethra or prostate.
- Even with normal test results, further investigation during erection (diagnostic cystoscopy) can help identify the exact source.
- Medications like finasteride or minor cauterization procedures often resolve the issue.
- Persistent bleeding warrants follow-up with a urologist experienced in vascular or prostate disorders.