The presence of blood in the ejaculate is called hematospermia. Hematospermia is not always visible to the naked eye, so it is difficult to estimate the frequency of the condition. The presence of blood in the semen can be caused by many conditions affecting the male genitourinary system. Areas affected may include the bladder, urethra, testicles, seminal vesicles, epididymis, and prostate gland. Hematospermia most often results from a biopsy of the prostate gland. The majority of men who undergo a prostate biopsy may have a small amount of blood in their semen. It is normal to be observed for about three to 4 weeks after the procedure. Similarly, a vasectomy can cause a small amount of blood to appear in the semen for about a week after the procedure. In men with hematospermia who have not had a recent prostate biopsy or vasectomy, there are a number of conditions that lead to the appearance of blood in the semen. Benign or malignant tumors of the prostate, bladder, testicles or seminal vesicles; Infections, including chlamydia, herpes, cytomegalovirus and trichomoniasis; Inflammation of the prostate (prostatitis), epididymitis or urethritis (inflammation of the urethra); Stones in the seminal vesicles or prostate (similar to those in the kidneys); Presence of polyps in the urethra; Metastatic cancers of the genitourinary system that have spread from other places in the body; Cysts or congenital abnormalities in the seminal vesicles. Symptoms that can accompany hematospermia in some cases include painful urination, pain during ejaculation, blood in the urine, lower back pain. In the presence of inflammation or infection, a high temperature and the appearance of swelling and redness in the area of ​​the testicles or scrotum can be observed. After evaluating the clinical history and performing a physical examination, a number of diagnostic tests may be ordered. Some of the most common diagnostic tests are urinalysis and microbiological cultures to identify STDs or other infections. When indicated and when a urinalysis shows no abnormalities, imaging tests such as ultrasound or MRI can detect tumors or other abnormalities. In some situations, a semen analysis may be recommended, where the semen is analyzed under a microscope. Treatment of the condition is aimed at the underlying cause, if one is found. Antibiotic treatment is sometimes required in cases where a diagnosis of prostatitis has been made. Up to about a quarter of men with hematospermia have been shown to have prostatitis. Persistent hematospermia (within a month or more) even in the absence of other symptoms requires additional or follow-up evaluation. The prognosis of a condition is related to the underlying cause of its occurrence, if one can be determined.However, most cases of hematospermia are benign and go away without special treatment. While malignancies are a rare cause of blood in the semen, the majority of cases are unrelated to the presence of carcinoma, especially in younger men.