Hemospermia is a common benign condition, but is prevalence remains unknown, and can result from several causes. The etiology is idiopathic in about 50% of cases. The advent of transrectal ultrasonography has afforded the opportunity to best evaluate patients with hemospermia. Eighty patients affected by hemospermia were studied with Stamey test, semen analysis and culture, and transrectal ultrasonography (TRUS). Infection was detected in 16/80 of the cases (20%), while in 11/80 patients (14%) was present only excessive white blood cells in expressed prostatic secretions. TRUS showed abnormalities in 70/80 of patients (88%), including periurethral and ejaculatory calculi (42/70 pt., 60%), dilated seminal vesicles (22/70 pt., 31.4%) and müllerian duct cyst (6/70 pt., 8.6%). Stamey test and TRUS are the more usefulness investigations in hemospermia, since they can demonstrate the pathologic causes in about 90% of the cases.