Differential diagnosis	Diagnostic studies	Initial management
First episode of hematospermia*
Excessive sex or masturbation; interrupted sex; prolonged sexual abstinence	Urinalysis	Patient reassurance, education
STI	STI testing based on risk stratification	Treat as indicated, patient education
Urinary tract infection	Urinalysis and culture	Treat as indicated, patient education
Benign prostate hyperplasia†	American Urological Association symptom index, postvoid residual	Monitoring versus pharmacologic treatment
Prostate cancer†	Prostate-specific antigen	Urology referral for prostate biopsy
Persistent, recurrent, or high-volume hematospermia
Vascular (prostate or urethral varices, hemangioma)	Urinalysis	Urology referral for fulguration
Tumors (bladder, urethra, prostate, seminal vesicles, spermatic cord, epididymis, testes)	Urinalysis, urine cytology	Urology referral
Bleeding diathesis	Prothrombin time, partial thromboplastin time, complete blood count	Treat as indicated