Q. When I ejaculate, sometimes the color is a pale yellow, sometimes dark brown, and sometimes red. There is no pain associated with ejaculation. I have been to a urologist, and he said that there was no sign of infection or anything else that he thought could cause it. He did say he thought it could be a burst blood vessel. I notice that when I am on a exercise regimen, it slowly returns to a “normal” color. What might be causing this, and how would I find out for sure?

A. Your symptoms are suggestive of hematospermia — that is, the presence of blood in the seminal fluid. It most commonly results from nonspecific inflammation of the urethra, prostate and/or seminal vesicles. Most men with hematospermia are young (average age 37). Hematospermia typically resolves spontaneously, usually within several weeks. Most urologists feel that if you are in this age group and the hematospermia goes away on its own within three to four weeks, a full evaluation is not necessary.

However, if the symptoms persist, you will need a complete evaluation. This should include a blood pressure measurement, a genital and rectal exam, a serum PSA test, urine culture, urine cytology and a transrectal ultrasound of the prostate. If everything checks out OK and problem still persists, your doctor may perform a cystoscopy. This procedure involves inserting a small viewing device into the urethra.

Hematospermia may be associated with infections like tuberculosis, cytomegalovirus and schistosomiasis. It may also be a sign of calculi (stones) in the prostate, cysts of the prostate and/or seminal vesicles, and — rarely — a malignancy like bladder or prostate cancer. Your doctor will know more about your risk for these problems. Let me emphasize, though, that hematospermia almost always resolves on its own and is rarely associated with any significant disease.

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