I am 27 years old male, I had sexual intercourse

Patient

Q: I am 27 years old male, I had sexual intercourse 3 days ago; it was 3 sessions of intensive sex in 40 minutes (because of premature ejaculation), now i am suffering from blood in semen, severe pain in the genitals area, but I am unable to determine the exact source of pain, the testicles and penis and perineum seems normal, its like hidden pain in the overall area, I also have difficulty in urination (10 seconds delay), burning sensation when urination (but very normal urine). My situation was very normal before the intercourse. I noticed the blood when ejaculating 24 hours after sex as I thought that the pain might be due to genitals' congestion. I don't think this is due to STD because i used protection and the symptoms showed in less than 1 day (pain after 1 hour, blood in semen after 24 hour as I noticed). What i am suffering from? What is the source of the blood and pain?and Will this pain be chronic? will I be able to get back to normal? Why blood showed in my semen and how can i can recover and get my life back?

Your help will help me recover, i am in desperate need for your consultation, I am a PhD student with no medical insurance, and cannot afford personal doctor visits, cannot purchase insurance as this will be considered as pre-existing condition and my state rejected the expansion of medicaid. I wish to receive accurate diagnosis. Thank you.

Symptoms:  Blood in semen (after intensive intercourse), genitals pain, burning sensation and difficulty in urination
Doctor

A:   Hello,
Thank you for your query at AskTheDoctor.com
I understand your concern.
This does not sound like any STD and it seems to be due to a pre-existing infection. Sometimes sub-clinical urinary tract infections persist, do not manifest any other symptoms apart from hematospermia. It could have been induced by the intensive sex sessions as you mentioned.

One more possibility that can be ruled out is prostatitis, but you need to get an ultrasound for that.

In most cases acute hematospermia resolves by itself in a weeks time. It is advised to avoid any kind of intercourse or manaturbation till then. The pain could also be vague in nature and indicates an infection. Idy a course of doxycycline should be taken twice daily for 7-10 days with a recommended adult dose of 100 mg for adults. This is available only on prescription.

Hope this was helpful,
Feel free to discuss further,
Regards.

Comments / Follow Ups

Patient: I understand that acute hematospermia resolves by itself in a weeks time.

1-But what about the pain?I cannot sleep because of this pain.... You say that this pain could indicate ''infection'', I did not have this pain before my intercourse, this pain started exactly 1 hour after intercourse till now, It seems like a pain in the organs, a fatigue. hows comes a silent ''pre-existing infection'' cause all this sudden severe pain! How can I get rid of this pain? I put Ice on my genitals area to reduce the pain.

You suggest that I have ''urinary tract infections'' that is causing the pain.
Doctor: The pain can be due to acute genital congestion. I think I mentioned that the infection got aggravated by the sexual activity. There is no other possibility or disease which can be triggered by intercourse and presents with acute pain after intercourse. There are urgencies like testicular torsion or from varicocele but can be confirmed on scrotal ultrasound.

I will suggest you chymotrypsin tablets 2-3 times daily depending on the severity of the pain. This has to be continued for 2 weeks. Such acute pain mostly arises from orchitis, this will respond to the medicine.

Regards.
Patient: I did a PSA (Prostate Specific Atigen) test, my result is: 2ng/ml, is this level normal for a 27 years old man?
Doctor: Yes, anything below 4 is normal at your age.

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