Hematuria is the general term for blood being present in your urine. Microhematuria (sometimes called microscopic hematuria) is a subtype of hematuria. With microhematuria, the red blood cells in your urine are so small, they can’t be seen with the naked eye. The cells can be seen only with a microscope during urinalysis. 

So, with microhematuria, when you glance at the toilet, your urine won’t look much different from the way it always looks.

Most of the time, microhematuria isn’t a cause for alarm. But you don’t want to ignore it, either. Sometimes, it’s caused by a more serious health condition, such as kidney stones or bladder tumors. We’ll do some further testing to determine the cause. 

What causes blood in the urine? 

Microhematuria can be caused by a variety of conditions. Some are simple. For example, if you’ve worked out really hard (like running a marathon), you might have some blood in your urine. Hematuria can also be a side effect of medications. If that’s the case, we’ll review your prescriptions and see what can be adjusted. 

Other causes are more complicated. Some of the more common causes are: 

• Kidney or bladder stones
• Kidney infection
• Bladder, prostate, or kidney infections
• Urinary tract infection
• An enlarged prostate (also called benign prostatic hyperplasia or BPH)
• Bladder, prostate, or kidney cancer
• Sickle cell disease or other blood disorder
• Blood-clotting disorders (hemophilia) or blood thinner medications
• Polycystic kidney disease
• Sexually transmitted infections
• Trauma to the kidneys

Sometimes, the cause can’t be found, and hematuria clears up on its own. 

Finding out why there is blood in your urine. 

Once we’ve detected blood in your urine, we’ll do a full urological exam. If you’re a man, this might include a digital rectal exam. Women might have a pelvic exam. We’ll also ask you questions about your medical history and the medications you take. In addition, we’ll ask about your family’s medical history. Your answers to our questions will help us determine if you have any risk factors for bladder or kidney issues.

Based on your history and your symptoms, we’ll determine whether you are at low risk, intermediate risk, or high risk for certain urological conditions, like kidney stones or cancer. Then, we’ll talk together about next steps.

Low Risk

If you’re at low risk, we might have you come back in within 6 months for another urinalysis. We may also suggest the following two tests that can give us more information:

• Cystoscopy. This test allows us to see the inside of your bladder and urethra (the tube that urine passes through on its way out of your body) by using a cystoscope, a thin tube-shaped instrument. This test can be done here at the office, at an outpatient clinic, or in a hospital. It usually takes about 5 or 10 minutes, and you’ll likely be given local anesthesia or a numbing agent. 

If we notice any tissue abnormalities, a biopsy can be taken during the cystoscopy. That tissue will be examined with microscope. 

• Kidney ultrasound. This test uses sound waves to construct images of your kidneys. It’s also called a renal ultrasound. Further imaging tests, as described below, might be done at a later time.

We know that care decisions can be challenging. Be assured that we are here to answer all your questions!

If you decide not to have a cystoscopy or kidney ultrasound, and you still have blood in your urine after a subsequent urinalysis, you will probably fall into the intermediate risk category.

Intermediate Risk or High Risk

If you are at intermediate or high risk, we’ll recommend cystoscopy and a kidney ultrasound as described above. We’ll also talk to you about upper urinary tract imaging, which may include the following:

• CT scan. Computed tomography scans (often called “cat” scans) use X-rays to give us detailed images of your kidneys, bladder, and ureters (the two tubes that connect your kidneys and bladder). A CT scan can give us information about stones, infections, cysts, and tumors. 

• MR urography. MR stands for magnetic resonance. (You might be more familiar with the term magnetic resonance imaging or MRI.) If you are unable to have a CT scan, you might have MR urography, which provides images using radio waves.

• Retrograde pyelography. If you are unable to have a CT scan or MR urography, we might conduct a retrograde pyelography exam. This test uses X-rays along with a special dye injected into your ureters. This dye helps gives us a better view of your ureters and kidneys. Note: If you have a family history of kidney cancer or a genetic syndrome that increases your risk, we’ll most likely conduct imaging tests no matter what your risk level is.

Until we know more about your microhematuria, we encourage you to relax, though we know that can be easier said than done. And we understand that this is a lot of information to take in all at once. By all means, feel free to ask us any questions you have. We’ll take this process one step at a time. 

Resources

American Academy of Family Physicians

“Microscopic Hematuria”
(Last Updated: May 12, 2020)
https://familydoctor.org/condition/microscopic-hematuria/ 

American Urological Association

Barocas, D.A., et al.
“Microhematuria: AUA/SUFU Guideline”
(2020)
https://www.auanet.org/guidelines/microhematuria

Healthline

Sawyers, Tessa
“CT Scan vs. MRI”
(Updated: August 10, 2020)
https://www.healthline.com/health/ct-scan-vs-mri

Medscape

Babaian, Kara N., MD, FACS
“What is the role of upper urinary tract imaging in the diagnosis of bladder cancer?”
(Updated: December 30, 2020)
https://www.medscape.com/answers/438262-38704/what-is-the-role-of-upper-urinary-tract-imaging-in-the-diagnosis-of-bladder-cancer

National Institute of Diabetes and Digestive and Kidney Diseases

“Hematuria (Blood in the Urine)”
(July 2016)
https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine 

UpToDate.com

Feldman, Adam S., MD, MPH
“Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics)”
(Last updated: August 16, 2018)
https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics 

Urology Care Foundation 

“How Blood in the Urine is Tested and Treated”
(October 14, 2020)
https://www.urologyhealth.org/careblog/how-blood-in-the-urine-is-tested-and-treated 

“What is Cystoscopy?”
https://www.urologyhealth.org/urologic-conditions/cystoscopy 

“What is Hematuria?”
https://www.urologyhealth.org/urologic-conditions/hematuria

“What is Retrograde Pyelography?”
https://www.urologyhealth.org/urology-a-z/r/retrograde-pyelography

Male Birth Control: Present and Possible Future

Perhaps you and your partner are finished having children. Or you just know you don’t want children in the future and want to make sure no unplanned pregnancies happen. If this is the case, you might be looking for permanent methods of birth control.

Is a vasectomy the answer? For many men the answer is “yes.” Since vasectomy became common in the 1970’s it has provided men and families a safe, effective, minimally-invasive form of birth control with a fast recovery period. A vasectomy involves cutting two tubes called the vas deferens – the pathways that sperm travel through. The cut ends are then tied or sealed together with heat, blocking the path of sperm. (Note: A vasectomy doesn’t take effect immediately, as some sperm cells remain in the vas deferens and will need clear out. You and your partner will still need to use contraception until there are no more sperm cells in the pipeline.)

Vasectomies are usually considered permanent. A vasectomy reversal is an option if a man changes his mind, but the procedure can be expensive, and reversals are not effective 100% of the time. This may give some men reason to consider alternatives to vasectomy. Nowadays viable sperm can also be surgically retrieved for use with IVF (in vitro fertilization) procedures, even years after a vasectomy.

Vasectomy Alternatives

Are there alternatives? Yes.

Condoms

Male condoms can be an effective form of birth control – 98% effective, in fact – as long as you use them the right way. Condoms can reduce the risk of sexually transmitted infections (STIs), too – again, when used correctly. Many men unknowingly use condoms incorrectly, often because they learned how to use a condom informally or casually when they were younger and perhaps sexually inexperienced. (If you’re not sure you’re using condoms correctly, we can provide you with accurate educational material.)

Options for Women

Your partner has temporary contraceptive options, too. Female condoms, hormonal contraceptives, birth control pills, intrauterine devices (IUDs), and diaphragms are all possibilities for temporary birth control. Her gynecologist can help her choose which methods are best for her.

Women may also consider tubal ligation (sometimes called “getting your tubes tied”), a surgical procedure that cuts and seals the fallopian tubes, preventing sperm cells from reaching an egg. This method is permanent, however. It’s also more complex than a vasectomy, and it may have more complications, a longer recovery period, and a higher cost.

What about withdrawal?

Some men wonder whether withdrawal (coitus interruptus or “pulling out” before ejaculation) is a viable contraceptive method. This approach is not considered reliable, as sperm cells can be present in pre-ejaculate (precum) and find their way into the vagina before the man withdraws his penis. The method also requires determination and perfect timing on the part of the man, which can be hard to control in the midst of intercourse. (One more point to consider – withdrawal alone provides no protection against STIs.)

Male Birth Control Under Investigation

In the meantime, scientists are looking into other temporary, reversible male contraceptive options.

• Birth control pills. Scientists are studying hormonal oral contraceptives for men. While these pills have generally passed safety tests in humans, more research is needed to determine how effective they are.
• Hormonal gel. Scientists are also investigating a hormonal contraceptive gel that can be applied to the skin once a day.
• Reversible Inhibition of Sperm Under Guidance (RISUG). Like vasectomy, RISUG blocks the path of sperm cells. But instead of undergoing surgery, men receive an injection of a special gel that attaches to the walls of the vas deferens, forming a barrier that sperm cells can’t swim past. Clinical trials have shown RISUG to be effective, and the effects could last up to 10 years. It can also be reversed by injecting another substance that breaks down the gel and flushes it out.
• “Clean Sheets Pill.” How about a pill that allows men to feel the pleasure of orgasm without actually ejaculating? That’s the aim of the “clean sheets pill,” which men can take a few hours before sex. Much more research is needed, however, and some experts question whether men will be open to semen-free ejaculation.

Talk with Your Partner(s)

We encourage you and your partner to discuss your birth control options thoroughly. This is a decision you should make together, considering your feelings about family planning and your comfort with different contraceptive methods. If you’re single and/or having sex with multiple partners, we urge you to have the vital contraception/STI conversations with everyone you have sex with, including oral sex and anal sex.

Resources

Basic and Clinical Andrology
Khilwani, Barkha, et al.
“RISUG® as a male contraceptive: journey from bench to bedside”
(Published online: February 13, 2020)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017607/ 


BBC.com
Campo-Engelstein, Lisa
“Are we ready for men to take the pill?”
(October 22, 2019)
https://www.bbc.com/news/health-49879667

Birth Control Pharmacist
Gonzalez, Steven
“Updates In Male Contraceptive Agents”
(June 22, 2020)
https://birthcontrolpharmacist.com/2020/06/22/updates-in-male-contraceptive-agents/

Endocrine Society
“Dimethandrolone undecanoate shows promise as a male birth control pill”
(March 18, 2018)
https://www.endocrine.org/news-and-advocacy/news-room/2018/dimethandrolone-undecanoate-shows-promise-as-a-male-birth-control-pill

“Second potential male birth control pill passes human safety tests”
(March 25, 2019)
https://www.endocrine.org/news-and-advocacy/news-room/2019/endo-2019–second-potential-male-birth-control-pill-passes-human-safety-tests

LiveScience
Rettner, Rachael
“World’s First Injectable Male Birth Control May Soon Arrive in India”
(November 20, 2019)
https://www.livescience.com/male-birth-control-risug.html

Mayo Clinic
“Withdrawal method (coitus interruptus)”
(April 8, 2020)
https://www.mayoclinic.org/tests-procedures/withdrawal-method/about/pac-20395283

MedlinePlus.gov
“Tubal Ligation”
(Page last updated: August 10, 2020)
https://medlineplus.gov/tuballigation.html

National Health Service (UK)
“Condoms: Your Contraception Guide”
(Page last reviewed: September 19, 2017)
https://www.nhs.uk/conditions/contraception/male-condoms/

Urology Care Foundation
“Quick Snip: Should You Get a Vasectomy?”
(Fall 2014)
https://www.urologyhealth.org/patient-magazine/magazine-archives/2014/fall-2014/quick-snip-should-you-get-a-vasectomy

Vasectomy.com
Radcliffe, Shawn
“Birth Control for Men: ‘Clean Sheets’ Pill”
(November 28, 2018)
https://www.vasectomy.com/article/vasectomy/alternatives/birth-control-for-men-clean-sheets-pill

Verywellhealth.com
Stacey, Dawn, PhD, LMHC
“Male Birth Control Options”
(April 29, 2020)
https://www.verywellhealth.com/male-birth-control-injections-3970355

You’re getting older. You wake up needing to use the bathroom every few hours. And even after you pee, you feel like you still have to. You might need to strain to get any kind of flow going.

You can’t get a good night’s sleep. Your friends ask you to join them on a day-long hike in the mountains, but you decline because you’re not sure there will be bathrooms nearby. Your partner expresses some concerns about your overall health. You wonder what’s going on?

Prostate growth can squeeze the urethra and disrupt urine flow

To many men, especially over the age of 50, this scenario has a familiar ring. These are all signs of a common, treatable condition: Benign prostatic hyperplasia (BPH) otherwise known as an enlarged prostate. Most of the time, the prostate gets bigger as men age. About half of men between the ages of 51 and 60 have some degree of BPH, according to the American Urological Association (AUA). The rates increase as men get older.

For some men, BPH is no problem. For others, prostate growth squeezes the urethra and disrupts urine flow.

Fortunately, there are lots of ways to treat an enlarged prostate.

Choosing a BPH treatment can be a challenge. It’s normal to have lots of questions:

• Should I wait and see what happens?
• Should I try medication?
• Should I go with a minimally-invasive procedure? (And what does “minimally-invasive” really mean, anyway?)
• Should I have surgery?
• What are the risks of each treatment?
• What will my recovery be like?
• How long do the results last?

Treatment terminology can be confusing, too, with acronyms like TURP, TUIP, TULIP, HoLEP, HoLAP, TUMT and more. How can you determine which treatment options are right for you?

Your urologist can be both a trusted resource and a faithful advocate. Rely on your doctor’s training and experience as you weigh the pros and cons of your options. Don’t hesitate to ask questions.

Let’s look at some considerations doctors make when guiding BPH treatment decisions:

How severe are your symptoms?

Not all men have bothersome symptoms. Or their symptoms might happen just every once in a while. These men might decide on watchful waiting, holding off on any treatment and seeing if the symptoms worsen.

On the other hand, men whose symptoms affect their day-to-day life will probably choose a more active treatment path.

How large is your prostate?

On average, the prostate gland is about the size of a walnut and weighs about an ounce. Prostate growth varies from man to man.

If your prostate is growing modestly, your symptoms might not be severe. Typically, the larger your prostate, the more troublesome your symptoms will be. Some treatments are often recommended specifically for men with larger prostates. Your urologist will be able to discuss the treatment that is best suited for your particular condition.

How’s your overall health?

Are you generally healthy and fit, or do you have other medical conditions, like diabetes or heart disease, that complicate things?

For example, the AUA cautions about alpha blocker medications for men who need cataract surgery. This can be discussed and coordinated with your urologist and ophthalmologist. There are other minimally invasive treatments that can be used for men who can’t have surgery due to their overall health. Convective water vapor ablation (destroying excess prostate tissue with steam) might be a better option for men who don’t have success with BPH medications. Again, this and other treatment options should be discussed with your urologist to fit your particular needs.

Your treatment path may also depend on other urological issues you might be having, like bladder stones, bleeding from the prostate, blood in your urine, or difficulty emptying your bladder.

What’s your preference?

Some men are uncomfortable taking medications, or they might decide the side effects aren’t worth it. Others aren’t comfortable with having anesthesia or surgery. Still others might be reluctant to have procedures involving lasers, electric currents, or microwaves.

Other considerations: What are potential complications? What are the side effects? Will you have trouble with erections or ejaculation? Will there be significant pain? Does the treatment require a hospital stay? Will you have restrictions?

In some cases, your treatment decisions might be quite limited. In other situations, you might have a number of options to consider. You, your doctor, and your partner and family, if appropriate, can work together to come up with a BPH management plan that meets your needs.

Resources

UrologyHealth.org

“What is Benign Prostatic Hyperplasia (BPH)?”
(Updated: May 2019)
https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)

UpToDate.com

Cunningham, Glenn R., MD and Dov Kadmon, MD
“Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)
(Last updated: July 24, 2018 with literature review current through June 2020)
www.uptodate.com (by subscription)

Revised December 2022

Can COVID-19 be spread through sex?
It’s a good question—and an important one.

The COVID-19 pandemic is now in its fourth year. Since the beginning, scientists have been carefully studying the coronavirus, its transmission, and its long-term effects. They have been keeping up with numerous variants. And while great progress has been made, there’s still more to learn.

The effect of COVID-19 on sexuality has been one intense area of study. Scientists have investigated whether the virus can be transmitted during sexual activity. And the answer is yes.

How might COVID be transmitted through sex?

COVID-19 isn’t typically considered a sexually transmitted infection (STI), but the virus can still be passed during sex.

COVID-19 isn’t typically considered a sexually transmitted infection (STI), but the virus can still be passed during sex:

Respiratory droplets. The COVID-19 virus is spread through respiratory droplets. When a person exhales, tiny droplets containing water and other particles are expelled into the air. Even more droplets are released during talking, coughing, and sneezing. These droplets can contain the virus.

This means that sex, with its close contact and heavy breathing, can be risky. Droplets containing the virus can be inhaled by a partner, landing in their mouth or nose. If the virus gets mixed with saliva, it can be spread during kissing, too.

Touching surfaces. The droplets don’t just linger in the air. Droplets, along with the virus, can land on surfaces like clothes, skin, bed sheets, and sex toys. If a person touches these surfaces, then touches their eyes, nose, or mouth, it’s possible to get the virus.

Bodily fluids. The coronavirus can be spread through contact with feces, researchers say. So if sexual activity includes anal intercourse or any other fecal contact, there is a risk of transmission.

What about semen and vaginal fluids? Currently, scientists don’t think the virus is likely to spread through contact with these fluids, but it’s still possible.

“The detection of [the virus that causes COVID-19] in urine and semen is very rare; however, a possible risk of transmission through these bodily fluids has not yet been ruled out,” wrote the authors of an April 2022 study in Nature Reviews Urology.

Reducing COVID-19 risk during sex

Experts recommend following COVID-19 guidelines during intimacy.

Get vaccinated. COVID-19 vaccines and boosters are now widely available at clinics and pharmacies around the country. Vaccines reduce a person’s risk of getting COVID-19 in the first place, and if an infection does occur, vaccines lower the chances of serious illness or hospitalization. Sex partners should be vaccinated as well.

Wear masks during sex. It may not sound romantic, but wearing masks during sex can reduce the risk of COVID-19 transmission.

Don’t have sex if either partner has COVID-19 symptoms or has been exposed. It may be common sense to avoid sex if one partner is coughing or sneezing. But it’s important to remember that people can have COVID-19 without symptoms. (This is called being asymptomatic.) So a person can pass the virus to another even if they’re feeling well.

Test regularly. Before sex, get tested for COVID-19 at a clinic or with a home test. Be aware that a negative result doesn’t always mean a person is free of the virus. Some kits require a second test (usually within 24 to 48 hours) to confirm a negative result. Also remember that if a person tested negative for COVID-19 last week, they still could have picked up the infection since then and would need testing again.

In addition to COVID-specific guidelines, these safe sex practices are always a good idea:

Know a partner’s status. It’s critical to know whether a partner has a history of STIs or might have one at the time of a sexual encounter. People should also disclose if they have been exposed to COVID-19 (or if they think they have). Testing for both STIs and COVID-19 are effective ways to find out.

Always use a condom or dental dam during sex. That means every time. With every sex act. Not just every sexual encounter. So if couples have vaginal sex and oral sex in the same night, they need fresh protection for each event. What’s a dental dam? It’s a small layer of latex or polyurethane that serves as a barrier for oral sex. When properly placed over a person’s genitals or anus, it can protect both partners from infections. Dental dams are sold online or in drugstores. It’s also easy to make one: Snip the top and bottom off a condom with scissors and cut the condom lengthwise.

Limit the number of sexual partners. Casual sex and hookups can be risky, especially when partners don’t know each other well. Consider limiting sex with one committed, monogamous partner.

Wash up! People should wash their hands in soapy water before and after sex. Sex toys should also be thoroughly washed.

Having great sex

Enjoying sex during a pandemic takes some planning, but it also gives couples a chance to be creative. Here are some safe activities to think about:

Virtual sex. Couples can still share intimacy without physically being together. It might feel a little clumsy at first, but try to relax and give it a chance. Experiment by using a video-calling app, exchanging videos or photos, or sharing audio-only calls. Set the scene with some soft music or candlelight. Share fantasies. And who knows? After the pandemic is over, couples might have a new list of adventures to try in person!

Masturbation. Solo sex can be exciting, liberating, and fun. Relax and let the imagination take over. The sky’s the limit during fantasies. Making these connections in the brain can trigger deeply pleasurable physical and emotional satisfaction.

Resources

Centers for Disease Control and Prevention

“Dental Dam Use”
(Page last reviewed: June 2, 2021)
https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html

“How COVID-19 Spreads”
(Last updated: July 14, 2021)
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

Mayo Clinic

“Sex and COVID-19: Can you get COVID-19 from sexual activity?”
(March 30, 2022)
https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/sex-and-coronavirus/faq-20486572

Nature Reviews Urology

Ebner, Benedikt, et al.
“The COVID-19 pandemic — what have urologists learned?”
(Published: April 13, 2022)
https://www.nature.com/articles/s41585-022-00586-1

NYC Health
“Safer Sex and COVID-19”(October 13, 2021)
https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf

Scientific American

Barber, Carolyn
“When Is It Safe to Have Sex after COVID?”
(March 9, 2022)
https://www.scientificamerican.com/article/when-is-it-safe-to-have-sex-after-covid/