Question: There is blood in my semen. Should I be worried?
Answer: No, almost all blood in the semen is a benign finding. Sometimes it can be caused by an infection of the prostate or the seminal vesicles (SV). The SV are paired, sac-like organs which sit just behind the prostate, making and storing 90% of the semen. They are quite vascular, and laced with a network of tiny blood vessels. Commonly, one of these tiny blood vessels can rupture, and bleed a little bit into the semen. It is neither painful nor dangerous. It may take several days or weeks to clear up. Very rarely, instances of blood in the semen (hematospermia) are related to a cancer. Follow up with a urologist is recommended.
Question: My erection is curved. What is going on?
Answer: You probably have a common condition known as Peyronie’s Disease. The penis contains paired erectile bodies (corpus cavernous, or CC) that have a thick, fibrous coating. As they fill up with blood, the CCs expand, stretch out in length, and become rigid. Sometimes a thickening or “plaque” can occur on the coating of the CC, leading to an area that will not stretch out as the penis fills with blood. Instead, the “plaque” will force the penis to expand around it, leaving the “plaque” at the inside of the curve. While the “plaque” may typically be found on the top of the shaft of the penis, forcing an upward curvature, it can also occur to the right, left or underneath the penis, too. Peyronie’s Disease can be treated with a number of procedures. A new device known as RestoreX has been shown in a recent Mayo Clinic study, to both correct curvature and to add length to the penis. Collagenase (Xiaflex injection), an enzyme which helps to dissolve collagen, can be injected into the plaque to reduce curvature. Topical and oral Vitamin E may have some efficacy in reducing curvature. Finally, surgical correction of the curvature can be successful in a single procedure. Sometimes a lump on the penis is the result of a sexually transmitted disease or a cancer. For treatment of Peyronie’s Disease, and any abnormalities you find on your penis, please consult a urologist.
Question: I am having trouble staying hard during sex. What should I do?
Answer: An rigid erection occurs when a signal from the brain (the limbic or “feel good” system found in the thalamus) travels down the spinal cord, through the pelvic nerves, and stimulates the tissues of the paired erectile bodies, or corpora cavernosa. The limbic system is also responsible for mediating the release of hormones, importantly testosterone, which aids in forming an erection.
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