Hematospermia, or blood in the semen, can be quite alarming to many patients. It can be caused by many conditions of the male genitourinary system, but it is most commonly benign and resolves without treatment. 

The most common cause is prostate biopsy, although the list of other possible offenders is lengthy. It may be the result of benign or malignant tumors of the prostate, bladder, testes, or seminal vesicles, as well as sexually transmitted infections, inflammatory conditions of the prostate, epididymis, or urethra. 

Hematospermia also could result from stones in the seminal vesicles or prostate, urethral polyps, ejaculatory duct obstruction, or other abnormalities in the seminal vesicles.

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The diagnostic workup most commonly includes urinalysis, cultures for sexually transmitted infection, imaging studies such as ultrasound or magnetic resonance imaging, and semen analysis in certain situations. Treatment is directed towards the underlying cause, if found. 

One quarter of hematospermia patients have prostatitis and they may benefit from antibiotic treatment. 

For most patients, however, hematospermia is not associated with any obvious cause. No treatment is given in those cases, and it typically resolves on its own.