Savage Love: Bloody Business

Q: I am a 60-year-old heterosexual man, and I am being told that I’m normal. I have been to several urologists, and they say I have no medical issues. But I’m having a hard time buying it, because for the last six months, my ejaculate has been extremely bloody. This is embarrassing, especially since oral sex—giving and receiving—has always been my favorite. The urologists’ explanation is that as you get older, there are blood vessels within the penis that can break during an erection. They gave me some pills to ensure there was no infection, but then they told me that I’ll probably have to use condoms for the rest of my life. My partner doesn’t need contraceptives, so we haven’t used condoms for decades. If I were bleeding out of any other orifice, there would be a team of doctors helping me. Is there really no hope?

—Tell Me It Ain’t So

A: “Hematospermia—blood in the ejaculate—is usually not considered a big deal, in the sense that the vast majority of the time it’s not a sign of cancer,” said Dr. Ashley Winter, a board-certified urologist, the cohost of The Full Release podcast, and my go-to expert on all blood-in-spunk-related matters. “I’d want to know how much he’s actually bleeding and what they’ve done to check him out. But that said, sometimes a guy with a large prostate will bleed with orgasm.”

For everyone out there panicking because they saw blood in their semen one time a decade ago, Dr. Winter says a one-off bloody load isn’t something to worry about. But if you saw blood in your semen that one time and you have health insurance and you’re a hypochondriac like me, Dr. Winter recommends a visit to a doc for a short consultation and a quick physical exam.

“But in a case like TMIAS’s, where the issue is ongoing and the subject is over 55,” said Dr. Winter, “a typical evaluation would include a PSA blood test (a prostate cancer screening test), as well as testing for STIs (such as gonorrhea, chlamydia, and herpes), along with a urinalysis to check for blood in the urine and urinary infections. If those tests were not revealing, I would consider doing an ultrasound or MRI of the prostate and surrounding organs, as well as putting a camera up the urethra (called cystoscopy) to check out the plumbing.”

Assuming you’ve had all those tests, and your prostate was present on photo day, and the doctors found no sign of cancer or infection, TMIAS, then what the hell is going on?

“Typically, the cause would be something such as dilated blood vessels along the ejaculate exit route,” aka the urethra. Quickly: The urethra is a tube that connects the outside world (and all those piss bottoms) to your bladder; it’s the tube we all piss through. In males, the urethra pulls double duty, men also ejaculate through it (and some women do, too!)—it runs through the prostate gland, a gland that produces about a third of the seminal fluid. An enlarged prostate squeezes the urethra, which can make urination difficult and uncomfortable, and can also result in—you guessed it—blood in the semen.

One possible “fix” for an enlarged prostate is a transurethral resection of the prostate (TURP), which basically amounts to “a ‘roto-rootering’ of the prostate,” as Dr. Winter so vividly put it. A doctor shoves something called a resectoscope up your urethra and slices away chunks of prostate tissue.

“The problem with these procedures is that they can cause a person to stop ejaculating at all,” said Dr. Winter. “So if TMIAS has already had a fairly robust evaluation, then either using condoms or just having his sex partner adapt to the presence of blood may be the best solution. And in the absence of an infection, shooting a bloody load into your partner is not dangerous. Couples have intercourse during menstruation without harm, and plenty of F-F couples have sex during menstruation as well.”

But hold on and back up and wait just a goddamned minute: Didn’t your doctors say everything looked normal? Doesn’t that mean your prostate isn’t enlarged?

“A ‘normal’ prostate generally means that it is not cancerous and normal in size for your age,” said Dr. Winter. “As you get older, your prostate gets bigger. So it’s highly probable that what TMIAS has is a big-ass-but-normal-for-his-age prostate. And bigger prostates tend to have larger blood vessels lining the urethra and are therefore more likely to bleed when he experiences those lovely contractions associated with orgasm. When TMIAS was told that ‘there are blood vessels within the penis that can break,’ I suspect his doc was referring to this and was trying to simplify the explanation.”

And while the presence of blood in your ejaculate may not be normal or ideal, TMIAS, it’s likely your normal, and there’s nothing your doctor—or a team of them—can do about it.

“Sometimes a lack of a ‘fix’ is not dismissiveness, it’s just an admittance that a lot of things medical folks do/offer aren’t perfect,” said Dr. Winter.

Follow Dr. Ashley Winter on Twitter @AshleyGWinter, and check out The Full Release podcast, which she cohosts with comedian Mo Mandel, at thefullreleasepod.com.

Q: I’m a woman with a dating profile on OkCupid that states I’m nonmonogamous and only looking for the same. Recently, I had two great dates with a guy who described himself as monogamous on his profile. However, after our first date and a lot of messaging, I intuited that he hadn’t actually read the fine print on my profile. Usually guys bring that up when they’ve read it, and he hadn’t mentioned it once. So I brought it up at the end of our second date when we were having post-dinner drinks at a bar. In retrospect, I should have set up a time to seriously discuss this, not spring it on him while we were drinking, but I felt like the longer it went unsaid, the more “betrayed” he might feel. And boy, did he have a reaction. He went from “This is not a deal breaker” to “Oh my god, I can’t do this, I should just go” in 20 minutes, and then rushed out of the bar. We cleared the air the next day, and he apologized for being a jerk and bailing. But clearly we’re not going to be dating going forward. Maybe this was always how a guy like him was going to react, but when is the right time to bring nonmonogamy up if you meet someone in real life first? Or if it’s clear someone didn’t read the damn fine print on your profile before jumping straight to infatuation? He claimed his meltdown was an emotional response to the conflict he was feeling between (a) the expectation that serious relationships need to lead to monogamy and (b) the great time he was having with someone who turned out to be (gasp) nonmonogamous. Was there a better way to have shared this information? A time sooner or later? We were really clicking, so his freak-out was a huge surprise.

—Read The Fine Print

A: Dude should have read the fine print on your profile. He should have done his screw diligence—but you should have done yours, too. Or followed through with yours. You read the fine print on his profile, RTFP, you knew he described himself as monogamous, but you went on a date with him anyway—you went on two dates and swapped a lot of messages—without stopping to ask him the dreaded direct question (DDQ): “My profile says I’m nonmonogamous and only looking for the same, and yours says you’re monogamous. Are you making an exception for me because I’m amazing or did you not read my whole profile?” You should have asked this guy the DDQ not to spare him the horror of your company and avoid wasting his time, RTFP, but to spare yourself that stupid scene in the bar and avoid wasting your time.

This article appears in December 31, 2019.