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. They 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, what should we do?

A. I realize how frustrating and scary it can be to see blood without knowing the cause. As far as I can guess without examining your husband in person, I believe your hunch is right — the blood is a result of his erection. The penis is a very vascular organ, meaning it has many blood vessels. When erect, it is full of blood under high pressure. In fact, the pressures in the penis during intercourse are two to three times higher than anywhere in the body. Such high pressure can cause blood vessels in the prostate or urethra (urine tube) to rupture, causing profuse bleeding.

I have had several patients with visible blood in the urine in whom we were unable to find the site of the bleeding. So, we simulated an erection by injecting a medication into the penis to produce an erection. During the erection, we performed a flexible cystoscopy, a procedure that involves passing a narrow tube with a viewing device into the penis. In two patients, the bleeding was obviously coming from the penile urethra during the erection. In a third patient, after the penis was no longer erect, blood was seen coming from the prostate.

Such bleeding can be cauterized. Another treatment for bleeding prostates in men over 50 is a medication called Proscar (finasteride). This medication works by blocking the growth of blood vessels in the prostate. In addition, it shrinks the prostate, which tends to enlarge with age.

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