Hematospermia is an uncommon source of referral for imaging. When considering the adequate modalities for its evaluation, the patient's age, duration, and associated symptomatology need to be taken into consideration. Younger patients with transient hematospermia and without associated signs or symptoms usually require a clinical approach and reassurance. In the setting of symptomatic hematospermia, persistent hematospermia, and in older patients, imaging may be indicated to assess for possible etiologies. However, there are variations on the initial imaging approach for the evaluation of a patient with hematospermia, in which literature data, and clinical consensus provide guidance on the imaging modalities most suitable for the assessment of possible etiologies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.