Etiology	Typical presentation
Behavioral*
Excessive sex or masturbation	Isolated hematospermia episode triggered by particular sexual behavior
Interrupted sex
Prolonged sexual abstinence
Infectious*
Echinococcus (rare)	Irritative genitourinary symptoms; urinalysis positive for inflammation; positive microbiology findings
Gram-positive and gram-negative uropathogens
Mycobacterium tuberculosis (rare)
Schistosoma (rare)
Sexually transmitted infections: Chlamydia trachomatis; Neisseria gonorrhoeae; herpes simplex virus types 1 and 2 urethritis; urethral human papillomavirus
Inflammatory
Chemical epididymitis	Irritative genitourinary symptoms; urinalysis positive for inflammation; negative microbiology findings
Interstitial, eosinophilic, proliferative cystitis
Prostatitis
Seminal vesiculitis
Neoplastic
Benign and malignant tumors of the bladder, urethra, prostate, seminal vesicles, spermatic cord, epididymis, and testes	Abnormal findings on examination or imaging
Structural
Ectopic prostatic tissue or prostatic polyps	Voiding problems
Intraprostatic Müllerian duct remnants
Prostatic stones, cysts, benign prostatic hyperplasia
Urethral stricture, fistula, diverticula
Systemic
Amyloidosis	Hematospermia associated with systemic disease without other explanations
Bleeding disorders
Chronic liver disease
Severe uncontrolled hypertension
Trauma (iatrogenic)*
Hemorrhoid injections	Temporary hematospermia related to trauma
Penile injections
Prostate biopsy, radiation therapy, brachytherapy, microwave therapy, transurethral resection of the prostate
Urethral instrumentation
Urethral stent migration
Vascular
Arteriovenous malformations	Isolated hematospermia episode, or hematospermia associated with hematuria
Bladder neck and prostatic varices, submucosal bleeding, hemangiomas, telangiectasias