Blood in the urethra in women. Manifestation and methods of treatment of female urethritis

Blood flows from the urethra various reasons, but in any case you should be wary. Most often, this symptom indicates pathology. Discharge of blood from the urethra in women is normal only during menstruation, and if this phenomenon is not associated with menstruation, you should consult a doctor. The fact is that the pelvic organs are responsible for childbirth. In most cases, the presence of blood in urine indicates problems with the genitourinary system. The main thing is to contact a specialist in a timely manner; he will prescribe tests, based on which it will be possible to identify the cause of the disease.

Anatomy of the female urinary organs

Let's consider physiological characteristics female body. Urine is formed in the kidneys, after which it enters the ureter and accumulates in the bladder. When urinating, the sphincter relaxes, allowing urine to flow freely through the urethra. The abdominal muscles are responsible for bowel movement bladder: When they contract, the bladder is put under pressure. Women have a wide, rather short urethra, and unlike men, they are more prone to infectious diseases. The infection can quickly spread to the kidneys and ureter. Blood clots can be seen directly in the urine and have an orange-red hue. Diseases associated with the genitourinary system must be prevented early stages. If you find out, be sure to come to an appointment with a gynecologist. The doctor will identify the cause of the disease and prescribe therapy.

Etiology of the problem

Try to provide prevention all kinds of diseases. Following simple rules will help you avoid relapses. specific disease. The genitourinary system should be kept warm and should not be subjected to hypothermia. It is necessary to exclude fatty and spicy food. It is important to maintain genital hygiene and take measures to strengthen the immune system. If the body is healthy, it shouldn’t be. If you observe drops of blood in your urine, this indicates that the body is undergoing pathological changes. It is important to note that a woman may feel abdominal pain. A symptom of the pathology is also purulent discharge.

If at least one of the alarming symptoms You should contact a urologist or gynecologist. If blood clots are present in the urine, we can talk about gross hematuria. Macrohematuria is a phenomenon in which large quantities of blood are present in the urine. Microhematuria has a different nature: urine may have normal color, but red blood cells are detected after detailed diagnosis. Bleeding from the urethra can occur due to cystitis, urolithiasis, endometritis. In a woman, the symptom may appear due to the disease cervicitis.

Sometimes the cause of blood in the urine is scarlet fever or hemophilia, but such ailments are rare in women. During pregnancy, the uterus increases in size and puts pressure on the bladder, which leads to bleeding microtraumas. If you observe blood clots in your urine during pregnancy, you should urgently go to the gynecologist. The symptom may indicate ectopic pregnancy or other pathology.

Remember that the treatment will pass successfully if you consult a doctor in time. Diagnostics allows you to analyze in detail clinical picture illness To confirm the diagnosis, the doctor will prescribe blood and urine tests. More reliable diagnostic methods are ultrasound and computed tomography bladder. The doctor will examine the test results and determine the cause of the blood and prescribe treatment.

Male urethritis

In men, the cause of bleeding from the urethra is urethritis. The disease can occur due to the fact that a man wears tight, uncomfortable underwear. Sometimes urethritis occurs due to injury to the genital organs. Urethritis is manifested by bleeding from the penis. In most cases, the disease occurs due to hypothermia. In the cold season, you need to wear insulated underwear, not synthetic ones. Urethritis is caused by an infection in the urethra. The disease can develop in men who engage in heavy physical labor. Promiscuous sexual intercourse also leads to urethritis. For the purpose of prevention, you need to eat nutritiously, lead a moderate sex life, refuse bad habits, limit the consumption of salty, fatty, pickled foods. Men and women should promptly treat chronic ailments, because they can lead to genitourinary diseases.

With urethritis in men, the urethra begins to turn red, pain and itching appear in this area. In especially severe cases, the urethra sticks together (this is where urgent medical intervention is necessary). The symptom of urethritis is severe itching in the genital area. Complications of the disease may affect the bladder, prostate gland, a man may develop cystitis and prostatitis. Urethritis is dangerous due to complications, so if suspicious symptoms are detected, you should contact a urologist. Diagnostics is aimed at identifying the causes of the disease. Diagnostic measures include a bladder examination, prostate gland and other organs. After this, the doctor prescribes therapy. Treatment involves eliminating the infection and restoring the functions of the urethra.

Voluntary discharge of blood from the urethra is a marker of genitourinary pathologies in acute stage. Urethral bleeding indicates degenerative pathological processes in the kidneys and urinary tract; presence of venereal viral infection. To determine the disease, you need to use many methods due to the difference in the structure of men and women urinary system. Regardless of the gender of the patient, ailments associated with urethral bleeding have a similar symptomatic range:

pain when emptying the bladder;
burning sensation at the final stage of urination or after urination;
change in urine color;
increased frequency of trips to the toilet, while the amount of urine excreted at a time is less than with healthy genitourinary organs;
weakened immunity, decreased overall tone.

Below we will describe the pathologies that cause blood to flow through the urethra.

Bleeding from the urethra is a sign of a number of diseases.

Cystitis

This pathology can occur due to hypothermia or infection in the urinary tract. Beneficial factors for the occurrence of cystitis are: stagnation of urine in the bladder, vitamin deficiency, surgical treatment cervix.

The symptomatic range of the disease has the following manifestations:

regular urge to urinate;
blood in urine;
burning in the perineum;
spotting after completion of the act of urination;

Blood from the urethra during cystitis appears in advanced stages of the disease, when extensive damage to the genital organs occurs. In particular, blood is characteristic of cystitis at the gangrenous stage, when degenerative changes are already irreversible.

Urethritis

When the described pathology is localized, drops of blood may be released from the urethra. Risk factors for urethritis:

presence of urolithiasis;
lack of diet;
promiscuous sex life;
prolonged hypothermia.

In addition to blood from the urethra, urethritis is characterized by: redness of the genital organs, accompanied by permanent itching of the area; discharge of pus from the vagina.

WITH most likely a woman becomes infected with urethritis if she does not protect herself during sexual intercourse, since the disease is caused by the penetration of chlamydia into the vagina. Treatment of urethritis is carried out with the help of antihistamines and the introduction of a dietary diet. A woman must exclude spicy and salty foods from her diet.

Bleeding from the urethra in women occurs not only due to acquired pathologies: these can be harmless short-term hemorrhages during menstrual cycle, postpartum complications, consequences surgical intervention in the treatment of the uterus.

Women can treat the pathologies described above folk remedies, taking herbal baths, applying compresses, drinking diuretic herbal teas.

Blood from the urethra in men

The presence of urethral bleeding in men is caused by the presence of cystitis, urolithiasis, trauma to the penis, sexually transmitted diseases, and infections of the excretory tract. Blood from the urethra in men is a sign of prostate cancer. Also, spotting can serve as a marker of advanced prostatitis.

In the absence of prostate problems and compliance intimate hygiene, the most common cause of blood from the urethra is urolithiasis. If the patient feels a regular urge to empty the bladder, acute colic in the lumbar region, pain with a sudden change in body position, change in the color of urine and the presence in it blood clots, then he has urolithiasis.

Pathology occurs due to physical inactivity, lack of diet, sudden change climatic environment. violations functional state thyroid gland. Blood from the urethra in case of urolithiasis is released in the cystine type of pathology, when associated inflammation of the genital organs occurs and urinary tract.

At venereal diseases, blood from the urethra in men is not released so often. Common: change in urine color, persistent unpleasant odor with urination. Blood from the urethra in boys and men is often associated with injuries to the genital organ. They occur especially often during “debut” sexual intercourse, when a young man injures soft fabrics, skin foreskin and the walls of the urinary canal.

With any pathology, the discharge of blood from the urethra has accompanying symptoms: an increase in the duration of the act of urination while simultaneously reducing the amount of urine released; burning for a long time after emptying the bladder.

The appearance of blood in the urine (hematuria) is pathological phenomenon which indicates damage to the mucous membrane of the urethra or internal organs, which are responsible for the excretion of urine.

If a woman’s urine contains blood, the cause of the symptom may be diseases of the genitourinary system or physiological phenomena(eg menstruation). Treatment of conditions that may lead to hematuria may require the use of medications(antibiotics, cytostatics, etc.) and surgical intervention.

Symptoms

Hematuria may be accompanied by pain during urine output, increased body temperature, burning, aching pain in the lower back and other symptoms.

Most often observed in female diseases painful urination which accompanies inflammation of the urinary tract. The high incidence of this pathology is due to the anatomy of the female genitourinary system (short and wide urethra, through which infection easily penetrates).

No pain

Painless discharge of blood during urination can occur against the background of swelling, hypertension or hypotension, an increase in the volume of daily urine, weight loss, bleeding gums, frequent bruising on the skin, swelling lumbar area and other symptoms.

No pain and accompanying symptoms may indicate false hematuria - staining of urine when consuming foods and medications containing red pigments (beets, phenolphthalein compounds, etc.).

The clinical picture of hematuria, laboratory and instrumental studies allow for differentiated diagnosis.

With pain

Painful urination accompanied by hematuria occurs when the lower urinary tract is inflamed or damaged. Pathological processes may be accompanied by an increase in the patient’s body temperature, burning in the urethra, frequent urges to urination, heaviness in the pelvic area and other symptoms.

Pain can be observed not only during urine output, but also outside the toilet. The appearance of blood after urination in women with pain in the lower back or lower abdomen may indicate injury, oncological diseases and inflammation of the glomerular system of the kidneys.

Why is there blood?

The cause of blood in the urine of women can be infectious inflammation, kidney stones, autoimmune processes, gynecological diseases, taking anticoagulants, hormone therapy etc.

Excretion of blood along with urine is observed mainly during inflammation lower sections urinary system. It is caused by microdamages of the inflamed mucous membrane of the bladder and urethra.

With a small amount of blood, urine remains normal in color, and hematuria is detected only when laboratory research. This phenomenon is called microhematuria.

With infectious inflammation at the end of urination, women experience cutting or aching pain. Trips to the toilet become more frequent and are accompanied by a burning sensation in the urethra. The patient may see cloudy urine and small spots of blood.

Inflammation of the urinary tract can be caused by chronic or acute infections sexually transmitted diseases. In this case, hematuria may be accompanied by pain in the pelvic area and pathological discharge, the color and consistency of which depend on the type of pathogen.

Cystitis

Cystitis is an inflammatory process in the bladder, which is provoked mainly by bacterial flora. Because of anatomical features the urethra is typical for women high risk the occurrence of bacterial inflammation.

However, infections are not the only etiological factor cystitis. Its development can be provoked by abnormalities of the urinary tract, chemotherapy, radiation, the presence foreign body in the bladder tumor processes, decreased organ tone and other factors.

Cystitis, which is accompanied by visible bleeding during urination (macrohematuria), is called hemorrhagic. It is characterized by deep damage to the mucous membrane and walls of the bladder, as well as damage to its vessels.

The disease manifests itself as fever, pain syndrome in the suprapubic zone, frequent urination and anemia. A woman can write in small doses (up to a few drops). Urine has a foul odor and pathological color(pink, scarlet or brown).

Urolithiasis

Urolithiasis is one of the most common reasons appearance of bloody urine. Hard concretions (stones) have sharp protrusions that damage the walls of the ureter and provoke bleeding. Blood discharge occurs mainly when a calculus enters the bladder and urethra.

The process of passing a stone through the canal is accompanied by sharp pain, the intensity of which increases during the release of urine. The localization of the source of pain depends on the position of the stone: at the beginning of the path (at upper third ureter), the pain is localized above the navel, and finally in the projection of the bladder. Hematuria may occur during or immediately after urination.

Urethritis

Inflammation of the urethra (urethritis) is provoked by sexually transmitted infections, penetration pathogenic microorganisms into the damaged mucous membrane of the canal or complications of inflammation of other urinary organs (pyelonephritis, cystitis).

Irritation of the urethral mucosa may develop after endoscopic studies and catheterization. When a tool penetrates, mechanical damage the walls of the canal, as a result of which the patient there's blood coming out with urine.

Symptoms of the disease are burning, pain during urine discharge, discomfort when the urethra rubs against underwear, hyperemia of the urethra, etc.

Oncology

Hematuria can also be caused by tumor processes. Malignant tumors grow into the walls of the kidneys, bladder and ureter, damaging vascular network these organs and causing bleeding.

Characteristic features cancerous tumors are blood clots in the urine and painless hematuria.

In the zone greatest risk Oncology patients are middle-aged. If pain and blood during urination in young girls most often indicates cystitis and urethritis, then painless hematuria in patients 30-50 years old with high probability is a symptom of cancer.

Glomerulonephritis

Glomerulonephritis is an inflammatory process in the glomerular (filtering) system of the kidneys, which is autoimmune in nature. This disease can develop after vaccination, viral and bacterial infections, rheumatic lesions, alcohol abuse and hypothermia of the lower back.

Most characteristic features pathology is swelling, increased pressure and the presence of red blood cells (erythrocytes) in urine. Drops of blood in a woman’s urine are visible to the naked eye and color the discharge a dirty scarlet color (“meat slop”).

Injuries

Kidney injuries cause damage vascular system urinary tract. The blood released may be excreted unchanged in the urine or form small clots. Urination is painful and with blood.

In addition to painful urination, with kidney injuries, edema (swelling) of the lower back on the side of the damaged organ, pain in the back or abdomen, and symptoms of anemia (pallor, tachycardia, weakness) are observed.

If you receive a kidney injury, you should immediately consult a doctor, because the accumulation large quantity blood clots can completely block the urinary canal. In this case, the patient cannot relieve herself and experiences nagging pain lower abdomen.

Pregnancy

The appearance of blood from the urethra in women during pregnancy can be caused by damage to the mucous membranes urinary canal at instrumental studies, inflammation of the urinary tract and oncological processes.

Development risk infectious inflammation during pregnancy the child increases significantly. This is due to the occurrence of stagnation of urine due to compression of the ureter by the growing uterus and physiological decline immunity of the expectant mother.

The cause of hematuria can be: in this case, part of the blood entering the vagina comes out along with urine. The discharge of blood, including outside the act of urination, means that the problem is gynecological in nature.

Taking hormonal medications

Wrong choice or dosage violation hormonal drugs may cause urinary stagnation. This significantly increases the risk of developing inflammation of the genitourinary system, which leads to hematuria.

During the period of getting used to oral contraceptives spotting and spotting may be observed, which completely disappear after 1-2 months of taking the pills. Abundant pathological discharge blood, the intensity of which increases, may be mistaken for bleeding from the bladder. Their occurrence is a reason to contact a gynecologist again.

Endometriosis

Cell entry uterine endometrium microdamage in the walls of the urinary organs (endometriosis) provokes the occurrence of small ulcers and bleeding. Proliferation of the endometrium under the influence pituitary hormones causes deep damage to the walls and vessels of the bladder and other urinary organs.

The first sign of illness is constant pain lower abdomen or discomfort during urine discharge, which occurs during menstruation. Subsequently, hematuria, urinary incontinence, edema and other signs appear. A sick woman's urine may be cloudy, with whitish flakes, or bloody (sometimes with blood clots).

Taking anticoagulants

Anticoagulants (Warfarin, Aspirin) improve rheological properties blood, preventing thrombosis and reducing platelet adhesion. In the background long-term use these drugs may cause internal bleeding, which stain intestinal and kidney secretions.

A characteristic sign of taking anticoagulants is bleeding gums and frequent occurrence bruises. The reason for the decrease in blood clotting can be not only the intake special drugs, but also pathologies hematopoietic system(hemophilia, porphyria, oncology bone marrow etc.).

The presence of blood in the urine means that bleeding has occurred in one of the internal organs, caused by insufficient healing of the damage.

What to do

Frequent urination with blood or hematuria, not accompanied by other symptoms, is an important reason to consult a doctor. A patient with such a symptom may need to consult a gynecologist, urologist, oncologist, endocrinologist and nephrologist.

Diagnostics

To diagnose the causes of blood discharge from the urethra, the following methods are used:

general analysis of urine and blood;
24-hour urine analysis;
ELISA and PCR test for sexually transmitted infections;
cystoscopy;
cystography;
Ultrasound of the urinary system and pelvis;
analyzes of sex hormone concentrations;
MRI and CT of the genitourinary system;
biopsy and histological analysis tissues of the urinary system.

Urine tests are prohibited during menstruation, because during this period, traces of blood in the urine of women may be due to the release of the endometrium from the uterus.

Treatment

Bleeding during urination should be treated according to the diagnosis. IN medication course may include the following medications:

antibiotics (fluoroquinolones, macrolides, penicillins);
glucocorticoids;
herbal uroseptics;
cytostatics;
hemostatic agents;
hormonal drugs;
vitamin and mineral complexes with iron, etc.

If hematuria is accompanied by pain, the medication course is supplemented with antispasmodics (Spazmalgon, Papaverine) and NSAIDs (Ketanov, Nimesil).

Prevention

To prevent bleeding from the urethra in women, it is necessary to limit the consumption of salt, spices, meat and offal, and observe drinking regime and rules of personal hygiene, promptly eliminate foci of infection in the body and avoid hypothermia of the lumbar area.

When blood begins to flow from the penis, but this process does not have physiological signs, there is a possibility of manifestation of a disease called urethrorrhagia, it may be accompanied in parallel heavy discharge blood with sperm.

It should be noted that urethrorrhagia is one of the widespread diseases, characterized by injuries to the urethra, manifested in the presence of tumors, inflammation various kinds, other diseases. Whatever the symptoms of this disease, you must immediately seek advice from specialists.

If there are bleeding from the urethra and you experience pain, this may be an alarming symptom

Factors causing the disease:

Hypothermia
Trauma to the penis

Signs of illness

Blood can also be released from the urethra as a result, during which stones coming out of the urethra damage the walls of the organ.

If there is blood from the urethra outside of urination, then this fact often indicates significant problems in the urinary system in front of the canal walls during external trauma or under the influence of intervention with instruments.

Bleeding happens absolutely different types: starting with a couple of drops, up to heavy bleeding, threatening life. Even if the patient did not notice minor bleeding, only the remains of dried blood outside the hole will indicate it.

The very degree of the disease is sometimes completely dependent on damage indicators: during complete break channel bleeding manifests itself unnoticed, with partial bleeding - profusely.

Blood from the urinary tract

Sometimes urethrorrhagia is a sign various processes tumor formation (, cancer cells or angioma), very rarely characterizes the appearance chronic urethritis, in which the entire mucous membrane of the canal begins to bleed and has a loose structure.

The disease should not be confused with initial, in which bloody discharge appears only with the first urine output, indicating the presence of kidney disease. It appears as a result of enormous abdominal loads. abdominal area, enough sharp turns torso, lifting heavy objects. It is in such cases that the kidney “moves out” from its so-called “own” place.

To identify suspicions of bladder damage by actually combining gross hematuria with clearly identified dysuria, constant desire“go to the toilet,” during which only bloody discharge or small portions of urine come out.

Factors causing the disease:

Hypothermia
Trauma to the penis
Urolithiasis - sand and stones, when passing through the urethra, damage it, causing the formation of urethritis
Constant physical activity
Fickle intimate life, a huge number of sexual partners

Diagnostics

To identify the disease, urine and blood tests are used; they are the most basic in laboratory examination. Additionally, an examination of the bladder and an ultrasound of the kidneys may be prescribed.

Under various circumstances, blood discharge from the penis in men can be a symptom of a number of diseases. This is really serious reason think about your health. Therefore, in this article we will look at everything possible reasons such an anomaly and the degree of danger they pose to a man.

Circumstances of bleeding

One of the main signs that helps determine the direction of diagnosis is when the discharge occurs:

During or after sexual intercourse;
When urinating along with urine;
During ejaculation, coloring the sperm;
When exerting yourself, for example during defecation;
No visible prerequisites.

It is important to analyze these circumstances and inform your doctor. Further, when considering the causes of the anomaly, such factors will be indicated. The amount of discharge from the penis also plays an important role.

Fact! Bleeding outside the process of urination is called urethrorrhagia, and with it hematuria.

Why is there blood coming from my penis?

There are 4 main reasons for red discharge from the urethral opening:

Injury to the penis, scrotum, or internal pelvic organs.
Inflammatory processes of the genitourinary system.
Venereal infections and others.
Benign and cancerous tumors, cysts, polyps.

Let's analyze each situation in more detail.

Damage to the penis often occurs during sexual intercourse, so bleeding will accompany sex or appear after. The reasons are:

Insufficiently long and elastic frenulum of the penis;
Sudden movements during intercourse;
Anatomical curvature of the penis;
Bad pose.

In addition to bleeding, a man necessarily feels pain from mechanical actions. The intensity of the discharge depends on the degree of injury. Blood, which is detected already in the process on the surface of the head, is most likely the result of damage to the frenulum. If discharge comes out of the urethra after sexual intercourse, this may indicate an injury to the scrotum or the penis itself.

It happens that the cause of damage is chemical burn from using any aggressive drugs to treat the head. Alcohol-containing liquids for wounds lead to such consequences. Thermal burn also causes bleeding. Discharge can appear as a result of injuries to the internal organs of the genitourinary system due to a blow, fall, or accident.

Expert opinion

Olga Yurievna Kovalchuk

Doctor, expert

Among athletes, situations often arise when lifting weights, heavy loads and sudden movements lead to displacement of the kidneys, which is expressed by bleeding at the beginning of urination.

Injuries to the frenulum and glans can be detected independently when examining the penis. If cracks are visualized, then you should avoid sex until they are completely healed, maintain personal hygiene and treat with water-based antiseptics.

Inflammation

The corresponding process, localized in the pelvic organs, causes damage to the mucous membranes and bleeding. Pathologies of the seminal ducts, testicles, prostate gland, bladder, kidneys, urethra:

Urethritis;
Cystitis;
Prostatitis;
Epididymitis;
Kidney tuberculosis;
Urolithiasis;
Pyelonephritis and others.

Inflammation is manifested not only by blood discharge from the penis, but also by other symptoms:

Pain during urination, ejaculation;
Increased body temperature;
Itching, tingling, burning;
Discomfort in the lumbar region and lower abdomen;
Swelling of the scrotum;
Frequent desire to go to the toilet “in a small way”;
General malaise up to symptoms of intoxication;
The pain radiates to anus during defecation.

The inflammatory process is easily detected by general analyzes blood and urine, then an ultrasound is needed to determine the localization of the process.

Attention! Similar diseases The treatment is long-term and complex, so contacting a doctor is mandatory.

As a rule, inflammatory processes manifested by hematuria, that is, bleeding from the penis together with urination. The amount of discharge is insignificant, just a few drops.

Infections

Some STDs cause a small amount of blood from the penis during sexual intercourse. This is explained by damage to ulcers and other rashes, as well as special condition mucous membrane under the influence pathogenic flora when it is easily damaged. What should make you think about venereal and other infectious diseases, including candidiasis, genital herpes and others:

The presence of discharge of unusual consistency and color - foamy, thick, very liquid, green, yellow, white cheesy. These are all symptoms of various infections;
Unpleasant odor;
Itching and burning;
Rashes - blisters, pimples, sores, etc.;
Redness and swelling of the head of the penis.

Attention! It often happens that infections do not manifest themselves in any way, so in the absence of visible damage and pathologies of internal organs, it is necessary to be tested for STD pathogens.

The presence of cysts, polyps, cancer and benign formations leads to bleeding from the man's penis. This happens due to damage to the tumors themselves, their growth and compression of surrounding organs, vessels, and ducts. Such processes are one of the most dangerous reasons urethrorrhagia and hematuria. Even seemingly harmless urethral polyps can turn into cancer. And the cysts burst, leading to peritonitis and sepsis. Therefore, it is necessary to carefully examine genitourinary system for the presence of neoplasms. Diagnostics use ultrasound, MRI, CT, as well as blood tests for tumor markers. When a tumor is detected, histology is done to determine what cells it consists of.

Associated symptoms of cancer:

Enlarged inguinal lymph nodes;
Rapid weight loss;
Redness in the form of lines on the skin near the scrotum;
Weakness;
Nausea and vomiting.

Hematospermia

Sometimes the appearance of blood is associated only with the process of ejaculation, then the sperm turns pink and red. First of all, you need to exclude the possibility that this could be a woman’s discharge. To do this, the following sexual acts are carried out using a condom. If the situation has not changed, you should consult a doctor.

False hematospermia is a consequence of the release of blood with sperm that appeared due to injury. By appearance these are thread-like inclusions. True pathology is manifested by drops of rich or dark red color. In addition, concomitant hematuria cannot be excluded.

The causes of true hematospermia are inflammatory diseases kidneys, prostate, testicles, bladder, seminal ducts, as well as tumors in them. Vesiculitis and colliculitis can manifest as bloody discharge.

Attention! Blood is found on underwear in the morning if there was an erection at night.

Diagnostics

The doctor determines the direction based on his assumptions after a survey and examination of the patient. The list of studies includes:

General blood and urine tests;
Urethral canal swab;
Ultrasound of the pelvic organs;
Urethroscopy and cystoscopy;
Blood for tumor markers;
Tests for pathogens of STDs and other infections;
Three-glass urine test;
Sperm examination;
If necessary, MRI, CT, X-ray.