Penis Blood

Penis Blood
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Dr Roger Henderson
Dr Roger Henderson is a Senior GP, national medical columnist and UK medical director for LIVA Healthcare
He appears regularly on television and radio and has written multiple books.

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The most common causes for blood in semen and urine and the danger signs to look out for.
Bleeding from the penis can occur for a number of reasons. If you experience blood coming out of your penis during intercourse or masturbation , it usually isn’t anything serious.
However, blood in your sperm (haematospermia) or urine (haematuria) should be investigated immediately, as it can be an indicator of an underlying medical condition.
We look at the symptoms and possible causes for bleeding from the penis, and when to see your doctor:
In most cases, these infections are spread through oral, vaginal or anal sex and blood or discharge from your penis can be a symptom of a sexually transmitted infection (STI) including gonorrhoea , genital herpes , and chlamydia .
If symptoms include painful or burning urination and unusual discharge from your penis, this can lead to serious health consequences, so make an appointment with your local sexual health clinic to get it checked out. Never ignore symptoms of a possible STI as if left untreated there can be potential long-term complications such as infertility or infection spreading to other body areas.
An injury to the penis can cause blood in the urine or semen. If you notice any bruising or unfamiliar marks on your penis caused by a sports injury, vigorous or rough sex or an accident, make an emergency appointment with your GP.
If you have recently had a surgical procedure and experience blood coming out of your penis, make an appointment with your surgeon or GP to get it checked out. In most cases this will settle with no treatment but should always be assessed.
Severe uncontrolled high blood pressure, bleeding disorders such as haemophilia , lymphoma , leukaemia, and chronic infections – for example, tuberculosis , schistosomiasis can cause blood in semen and urine.
If you are under 40 and don’t have any underlying medical conditions, blood in semen often disappears on its own so try not to panic. For men over 40, make an emergency appointment with your GP.
Blood in semen can be due to acute or chronic prostatitis , benign prostatic hyperplasia (BPH), prostatic calculi (stones), or abnormal prostatic blood vessels, and the prostate is a common reason for haemospermia or haematuria. As men get older, it is natural for the prostate gland to slowly increase in size (BPH) and experience symptoms from this – the usual ones are frequent urination, difficulty in urinating with a poor flow, dribbling of urine or stop-start urination – but there can also be blood in the urine as a result. This is often too small an amount to be seen with the naked eye but can be detected on a urine test.)
If your symptoms include swollen and painful testicles, it may be epididymitis , which is often caused by an infection and is easily treated with antibiotics, or orchitis . Epididymitis is inflammation of the epididymis which is the tube at the back of the testicles that carries sperm out of the testicles. Orchitis often feels similar to epididymitis but symptoms can include a raised temperature, nausea, painful swelling of one or both testicles and sometimes blood in the urine or semen. It often develops from a bacterial or viral infection and is usually treated with antibiotics if bacterial, and painkillers and rest if viral.
If you do not ejaculate for a prolonged amount of time, usually greater than three months, this could lead to blood in your semen. This is harmless and no specific treatment is required. Further ejaculations are usually clear of blood.
Certain urological cancers can cause blood in semen including prostate, bladder, urethral, testicular/epididymal and seminal vesicle cancers. Bladder cancer can cause intermittent bleeding, and at first this may be the only symptom but later on there may also be pain or difficulty on passing urine. Prostate cancer often develops with no symptoms initially before some develop such as blood in the urine or semen, erection problems, painful ejaculation and pain or burning when urinating.
If you experience blood in your semen and/or urine, if the symptoms include a burning sensation when you urinate and your pee smells strong or unfamiliar, it could be a urinary tract infection (UTI). This can occur anywhere in the urinary tract, including the urethra, ureters, bladder, and kidneys but is typically located in the bladder or urethra. Urine infections are less common in men than women and and it’s important that you always get it checked out by your GP. If confirmed then a short course of antibiotics is typically given to clear the infection away.
High impact exercise can cause blood in urine from an exercise-induced hematuria or dehydration. This can also be triggered by intensive cycling. with prolonged periods spent sitting on a hard saddle. It is usually temporary, lasting less than 2-3 days, but if symptoms persist, visit your GP.
Extreme sexual activity or rough sex can cause blood in urine. It usually goes away after a short while, but if symptoms persist get it checked out by a sexual health clinic .
An injury to the penis can cause blood in the urine. If you notice any bruising or unfamiliar marks on your penis caused by a sports injury, sex or an accident, make an emergency appointment with your GP.
Kidney cysts, tumours, cancer, nephritis and stones can all cause blood in urine with kidney stones usually being the most common of these. These are often tiny hard deposits of minerals that form in the kidneys and then travel down the tube between the kidneys and bladder (the ureters) where they can trigger extreme waves of pain. Other symptoms include pain in passing urine, and discoloured or reddish urine. If these symptoms arise make an emergency appointment with your GP.
Blood in urine can be a symptom of benign prostate enlargement, infection of the prostate (prostatitis) and prostate cancer. Classic prostate symptoms include a weak or slow urinary stream, frequently getting up in the night and difficulty starting to urinate.
This often presents with painless obvious bright red blood in the urine. However some patients with this type of cancer can also present like prostate disease, so always speak to your GP if you see blood in your urine.
Have you been snacking on raw beetroot or blood oranges? Red urine due to coloured foodstuffs is not that uncommon! Others include rhubarb and blackberries.
For patients on anticoagulation drugs such as warfarin or the newer oral anticoagulant drugs known as DOACs , passing blood can mean the drug levels are higher than they should be and the dose may need to be altered. Other medicines that can affect urine include overuse of anti-inflammatories such as ibuprofen and immunosuppressants.
Your doctor will carry out the following examinations:
If you experience blood in your semen your doctor will do a detailed history and examination which might be followed by an ultrasound and a blood test depending on the likely cause.
Blood in urine is more complicated than semen due to the large number of causes. If you experience blood in your urine your doctor will carry out a urine dipstick test initially and if confirmed then look for a underlying cause. For example, if it's a simple infection they will prescribe antibiotics. If you are in an older age group you will likely be referred for scanning and a cystoscopy to rule out cancer.

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The penile blood vessels arise from the internal pudendal artery.
Mohamed A Baky Fahmy MD, FRCS , in Complications in Male Circumcision , 2019
Penis has a specially designed network of blood supply that protects this special organ from the usual causes of ischaemia, which affect the peripheral organs. Almost all cases of penile ischaemia are iatrogenic, with many factors that could contribute to compromising penile blood supply:
Extensive combined infection, as in cases of Fournier gangrene,
Retained tight bandage after neonatal circumcision,
Direct thermal injury of the penile blood vessels by monopolar diathermy or improper use of bipolar diathermy,
Dorsal penile nerve block due to local anaesthesia infiltration with a vasoconstrictive agent.
Penile ischaemia may be manifested in a different spectrum:
Ischaemia secondary to severing the frenular artery, either by different clamps or by heavy suturing; this usually a mild form of ischaemia, but may leads to meatal stenosis ( Fig. 12.24 ).
Ischaemia of the glans penis spreads down to the coronal sulcus with a normal penile shaft blood supply; this should be differentiated from glans injury ( Fig. 12.7 ). In the former case, the glans contour is preserved with blackish discolouration. Glans ischaemia may affect the superficial layers only with a favourable outcome, or it may affect the deep tissues and result in glandular loss ( Fig. 12.25 ).
Whole penile shaft ischaemia and gangrene, which may lead to complete penile loss (aphallia) ( Fig. 12.26 ).
Chinyerum S. Opuwari , in Herbal Medicine in Andrology , 2021
Erectile dysfunction (ED) is a persistent or recurrent failure to achieve penile erection, leading to an unsatisfactory sexual performance [36] . It is the most common disorders of male sexual function and an underlying cause for infertility [36] . Administration of medicinal plants may bring about erection by inhibiting phosphodiesterase or stimulating the production and release of nitric oxide synthase [36] . Aphrodisiac agents cause the hypothalamus to release nitric oxide, which activates guanylate cyclase to convert nucleotide guanosine triphosphate (GTP) to cGMP, and in turn causes the relaxation of the smooth muscle cells in the penis leading to dilation of penile blood vessels with an increased blood influx into the corpora cavernosa and eventually to an erection. cGMP is then hydrolyzed by phosphodiesterase type-5 enzyme (PDE-5) to inactive GMP and thus terminate penile erection. Aphrodisiacs inhibit the hydrolysis of PDE-5, resulting in the accumulation of cGMP and maintaining erection thereof [37–39] .
Mowrey suggested that E. senticosus might increase sexual performance as it increases stamina in athletes [40] . E. senticosus was demonstrated to have aphrodisiac effects in animals and might have such invigorative and tonic effect in humans [41] . Another study demonstrated that phenols from E. senticosus have effects similar to a “Viagra effect,” by momentarily inhibiting nitric oxide by preventing transduction of cyclic GMP signal [42] .
Testosterone plays a role in sustaining the growth of cavernosal smooth muscle as well as functional integrity through the upregulation of phosphodiesterase type 5 inhibitor (PDE-5 inhibitor) [43, 44] . Studies have demonstrated that E. senticosus and A. membranaceus may be used to increase testosterone production [34, 45] .
Rebeccah L. Brown , Victor F. Garcia , in Pediatric Surgery (Sixth Edition) , 2006
The most common injury to the penis is iatrogenic injury during circumcision. 80 Complications of circumcision include penile amputation, urethral fistulization, laceration of the glans penis, and inaccurate removal of the foreskin resulting in phimosis degloving injury. Most of these injuries are avoidable with use of proper technique.
Penile injury resulting from blunt or penetrating trauma is rare in children. Urethral lacerations should be managed as described in the previous section. The findings of an expanding hematoma, palpable corporal defect, and excessive bleeding suggest cavernosal injuries. When possible, these injuries should be repaired primarily. 17 Urinary diversion with a suprapubic tube is occasionally necessary. 79 The preferred method of management of gunshot wounds with a limited extent of injury is debridement of superficial wounds, repair of the cavernosal defects, and primary repair of the urethral injury. 87
Penile erectile dysfunction (impotence) can occur after blunt pelvic and perineal trauma. 149 The dysfunction results from shearing of the penile blood vessels in the pelvis. Penile revascularization may restore potency. 119 Priapism may also occur after blunt trauma. For this disorder, selective angiography is helpful to diagnose the injury and to embolize the arteriovenous fistula causing the priapism. Doppler ultrasonography is also useful to characterize and localize the lesion. 138
Injury resulting from zipper entrapment of the penis can be addressed, in many cases, in the emergency department but may require a general anesthetic for release of the penis. 200 Penile strangulation injuries due to constricting bands are managed by removal of the constricting band in as atraumatic a manner as possible. In children, hair tourniquets are common sources of constriction and may be quite difficult to remove. Severe strangulation injuries may result in necrosis of the distal penile skin, glans, cavernosum, or urethra. Conservative debridement and urinary diversion may be required. 48
Scrotal injuries may result from penetrating trauma, blunt trauma, or both. High-resolution ultrasonography is very useful in the evaluation of these injuries. 10 Ultrasonography of penetrating injuries can identify testicular rupture and extratesticular soft tissue abnormalities as well as the presence and location of foreign bodies. 110 This technique is also useful in distinguishing less serious injuries, such as scrotal hematomas, hydroceles, and hematoceles, from surgical emergencies, such as testicular rupture and infarction. It should be noted that epididymal rupture is not as easily identified on ultrasonography. 155 Patients with hematoceles should be considered for exploration to evacuate the blood from the tunica vaginalis testis because this approach reduces morbidity and hastens recovery. Testicular disruption is managed by debridement and primary closure. 5
Sildenafil has become widely used. In dosages of 25, 50, or 100 mg (in most cases starting with 25 mg) and taken 1 hour prior to a sexual encounter, sildenafil will produce an erection, but only when the man is sexually stimulated. It is not an aphrodisiac but a “mechanical” means to facilitate intercourse. Nor does it substitute for intimacy; indeed, it may reveal strains in relationships. Sildenafil blocks the action of an enzyme, phosphodiesterase type 5, so that nitric oxide dilates the penile blood vessels . It also increases clitoral blood flow and some women report its usefulness; however, comprehensive studies have not verified this. Although there are currently no reliable measurements of female sexual response, efforts are under way to develop such instruments.
Sildenafil can cause hypotension when nitrates are used concurrently, so it is contraindicated in patients who take nitrates to relieve angina. A patient who has had an adverse heart event and has taken sildenafil that day should not be given a nitrate. Sildenafil can also cause headaches, upset stomach, bluish vision, and nasal congestion. Rarely, priaprism (4 hours of tumescence) occurs and must be treated to avoid damage to the penis.
Sildenafil has not been compared directly to other treatments for ED. 10 New oral drugs to treat ED are under study.
Other medications for ED include vasoactive compounds that are injected directly into the corpus cavernosum. Phentolamine, atropine, and prostaglandin E have been shown to be effective given individually or together. Prostaglandin E was the first prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat ED. Erection should occur within 5 to 10 minutes after injection, and the erection can last 30 minutes or more. Injection with these substances should not be done more than once every 24 hours and not more than three times per week. Possible problems with this therapy include priapism (4%), which can be reversed with epinephrine or ephedrine; mild to moderate pain at the site of injection; and some scarring. Contraindications include sickle-cell anemia, multiple myeloma, leukemia, anatomic deformities, and implants (discussed later). Treatment of men with ED with transurethral alprostadil (a synthetic compound identical to prostaglandin E1) is effective in nearly 70% of cases, regardless of age. A major advantage of this treatment is that the drug is delivered transurethrally via an applicator rather than through injection. 11
Some studies of the substance yohimbine, which comes from the bark of an African tree, have shown that it has a positive effect on erection, probably because it acts on neurotransmitters such as acetylcholine and dopamine that are involved in the sexual response. However, undesirable side effects have been noted.
Pierre Clement , François Giuliano , in Handbook of Clinical Neurology , 2015
The main component of the penis is constituted of three cylindrical spongy bodies containing erectile tissue: the paired corpora cavernosa on the dorsal side and the corpus spongiosum surrounding the distal segment of the urethra (penile urethra) on the ventral side of the penis ( Fig. 3.1 ). Proximally, the corpora cavernosa divide bilaterally to form the roots of the penis (penile crura) which attach to the perineum via the ischiopubic ramus. Distally, the corpus spongiosum expands and covers the distal part of the corpora cavernosa to form the penile glans. Corpora cavernosa and corpus spongiosum share common histologic features which consist of sinuses (trabeculae) lined by endothelium and separated by connective tissue septa deriving from the tunica albuginea. This organization explains the spongy appearance of erectile tissue. A multilayered structure of inner circular and outer longitudinal layers of connective tissue, namely the tunica albuginea, envelops the corpora cavernosa.
Fig. 3.1 . ( A, B ) Transverse section of the penis illustrating the anatomy, vascularization, and innervation of the organ.
The tunica albuginea with unique biomechanic properties is composed of fibrillar c
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