DEAR DR. DONOHUE: My sister died suddenly at age 72 from a ruptured aortic aneurysm. She was unaware she had it. Please tell me all about aortic aneurysms. What causes them? My sister never smoked, but her husband of 54 years was and is a heavy smoker. Could secondhand smoking have caused hers? – M.H.

Aneurysms are weak spots in an artery wall. The rush of blood through the artery causes the weak spot to balloon outward. The aorta – the body’s largest artery – is a frequent site of an aneurysm bulge. The aorta runs from the top of the heart to the bottom of the abdomen. The abdominal portion of the aorta is the place where aneurysms most often develop.

Typically, people don’t realize that they have an aneurysm. It rarely causes pain until it is very large or until it breaks apart. Sometimes doctors can feel an aneurysm as a pulsating mass when they put their hands on a person’s abdomen. X-rays and scans also pick them up.

Cigarette smoking increases the chances of developing an aneurysm. I haven’t seen secondhand smoke implicated, but I imagine it could be. Aging is a definite factor, as are high blood pressure and high blood cholesterol. Artery hardening – something that happens with age – is the greatest risk.

Quite often, the story is similar to your sister’s story. Pain occurs only when the emergency occurs – the weak spot ruptures, and there is a massive hemorrhage. Emergency surgery can sometimes save a life, but even with surgery, the mortality rate is high.

Early detection can save life. When the diameter of the aneurysm reaches 5.5 cm (2.2 inches), surgery to replace the weakened section with a graft is usually done, or grafts can be inserted into the artery through a surface artery, much like stents are put in heart arteries.

DEAR DR. DONOHUE: I am a 76-year-old woman in good health. I recently had surgery for Paget’s disease of the vulva. An extensive area of skin was removed, and it was a painful experience. Why isn’t this type of cancer made more public so women can become aware of it? – B.H.

Paget’s disease of the vulva is a rare cancer found mostly in older women. The vulva are the external female genitals. Itching and tenderness are its two most prominent symptoms. The involved skin is thickened and tends to be scaly. It’s often mistaken for other conditions, so it can take years before the correct diagnosis is made. Almost routinely, a biopsy has to be taken to arrive at the diagnosis. Treatment is the treatment you received – surgical removal of the involved skin.

Dr. James Paget was a British doctor with other illnesses named after him – Paget’s bone disease and Paget’s breast cancer. He died at the end of the 19th century.

DEAR DR. DONOHUE: I am a 52-year-old man. In the past six to eight weeks, I have noticed bright-red blood in my semen. What could be causing it? – C.F.

That’s called hematospermia – blood in the seminal fluid. It’s something that scares the wits out of all men who have it. Usually it comes from a breakage of small blood vessels in the path sperm take in exiting the body. Men with it invariably think it’s a cancer sign.

You should mention this to your doctor, who can test for the very rare serious causes. Cancer is a possible but highly unlikely cause.

Hematospermia is common after a prostate biopsy. Infections and polyps of the urethra – the tube that drains the bladder of urine – are other possible causes.

For most men, however, no serious condition is found and the bleeding clears on its own.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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