blood in ejaculate

60 yr. old healthy male, recent psa 2.2, benigh nodule on somewhat enlarged prostrate (urologist exam. 3/30/04), ultrasound biopsy scheduled 5/04.  over past 3 to 4 weeks have increased sexual frequency to 1 to 2 X's day with 100mg Viagra and one time trial of Cialis, supplemented by 50mg of viagra per 2 days (approx 10 days ago)

yesterday experienced non-painful, bright red blood discharge with exaculation...subsequent, non-painful urination exhibited decreasing pink urine, resulting in visually clear after 3 urinations...

questions:

1. what is likely diagnosis?
2. what is likely causation?
3. is this a likely side effect of Viagra or Cialis?
4. is an immediate contat with urologist recommended?

[Kevin Pho, MD]

To answer your questions:
1) There are a variety of causes for hematospremia (blood in the ejaculate).  They include benign and malignant disorders of the prostate gland, seminal vesicles, spermatic cord, and ejaculatory duct system; urogenital infections; metastatic cancers; and vascular disorders. However, it is often impossible to know with certainty whether these conditions are the cause of hematospermia. The cause is idiopathic (i.e. without a clear cause) in a substantial proportion of patients, and the condition frequently resolves spontaneously.

2) see above

3) It is unlikely a side effect of those medications.

4) I would discuss this with your urologist.  Normal next step would be a transrectal ultrasound to evaluate the prostate - in your case, you are already having a biopsy.  You may want to consider moving up the procedure date.
Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Weiss et al.  Hematospermia.  UptoDate, 2004.