tough stuff

[kafka]

Question: For about 2 years, on and off, I have felt a strange discomfort in my penis – and sometimes in my testicles. This all began after protected sexual intercourse with a woman(only once in June 2001) and several times of unprotected oral genital contact for both of us – that was the last time I had any sexual contact. I had all the tests and everything came back normal – yet the symptoms persisted. Twice I went to the emergency room of the hospital because the pain in my testicles was above my threshold. This last and more recent trip to emergency was in late December of 2003 – though everything came back fine. For this same two years I also have a tingly sensation in the backs of my thighs, which is quite disconcerting. Anyway, last week things turned for the worse: after masturbation there was blood in my semen. Then one week later there was blood and what looks like gelatinous globules, some like little caviar eggs – some larger and elongated. The first problem sounds like hematospermia, which according to the research I’ve done is not necessarily serious – though should be checked. The second problem, I have had a very hard time finding relevant information anywhere, except for one urology forum where many people speak of this phenomenon, yet there is no satisfactory answer. Along with this is the very frequent feeling that I must urinate (sometimes with very little results), though it hasn’t yet woken me up out of my sleep. Today I visited my urologist – and he was somewhat dismissive of the gelatinous globs – and said that they won’t go away.  He said my testicles seem fine, my prostate seems fine, and everything else looks normal. He’s sending me for urine and blood tests, though, which I will have to wait more than a week to find anything out. Anyhow, tonight – pain in my testicles and penis and all - for experimental purposes, I tried masturbating again. This time there was a bunch of the stuff – bloody semen and globules – that came out prior to orgasm, and then even more bloody semen and globules upon ejaculation. And at this very moment, after ejaculating, I have much pain in my urethra. Took a hot shower, but that did very little good. Anyway, first I would really appreciate it if you could explain what the globules are, why they appeared now, at 29 years old, and whether they will go away (maybe when and if the blood goes away?). Whether ejaculation will be painful from now on? I should mention, I take two medications – wellbutrin for depression 250mg a day, and seroquel 500mg and soon to be 600mg a day (an antipsychotic). Finally – I have been patient, over two years patient – no sexual contact at all -  waiting to see if things would ever return to normal so that perhaps I might look for a partner again. Now all this starts. I feel like I will never be intimate with a woman again - and much of this is because what is happening is just plain disgusting.

[Kevin Pho, MD]

Even though the prostate exam was negative, this is still highly suspicious.  Blood in the semen, urinary hesitancy, testicular pain, a sensation on the back of your thighs all suggest a prostate disorder.  

You are correct in saying that in most cases hematospermia often goes away on its own.  However, any type of prostate disorder often causes this (i.e. infection).  If the prostate exam was negative, I would suggest further imaging to evaluate the prostate.  A transrectal ultrasound can identify structural abnormalities of the prostate gland, seminal vesicles, and spermatic cord, and guide biopsies if any suspicious abnormalities are identified in those organs.

In addition, I would also suggest a scrotal ultrasound to evaluate the pain in the testicles.  Tests for STDs such as gonorrhea or chlamydia should also be obtained if not already.  

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.

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