Introduction In males, an isolated gross postcoital hematuria is a very rare clinical phenomenon. No cases of postcoital macroscopic hematuria have been previously reported in females. Aim To report a case of female urethral fibroepithelial polyp (FEP) associated with recurrent postcoital hematuria. Methods A young (31 years old), eumenorrheic woman complained of three episodes of postcoital macrohematuria. The patient was assessed with a detailed history, with a bimanual pelvic examination and with bidimensional and tridimensional ultrasonographic and color Doppler analyses of the internal genitalia and of the urethrovaginal space. Main Outcomes Measures Transvaginal two-dimensional (2-D) ultrasonographic evaluation of internal genitalia, bladder and urethra and three-dimensional (3-D) analysis of the urethra and paraurethral structures. Results The 2-D transvaginal evaluation and the 3-D reconstruction showed a polypoid hypervascularized structure arising from the anterior urethral wall. A cystourethroscopy confirmed the presence of a FEP arising from the anterior wall of the urethra and allowed its removal. Conclusions A gross postcoital hematuria may be associated with a urethral polyp. The ultrasonographic evaluation of the urethrovaginal space can facilitate the diagnosis.