Blue Balls

Epididymal Hypertension: Myth or True Blue Medical Condition?

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Is "blue balls" really a thing?. Adam Homfray/EyeEm/Getty Images

Millions of teenage boys are not delusional; prolonged sexual arousal without an orgasm can very much lead to pain in the testicles, sometimes extending into the lower abdomen. In boys it is almost exclusively a condition of the newly pubescent, but despite the colloquial terminology—blue balls—it may not be exclusively a condition of males. Indeed, women can be afflicted with a similar pain in the genitalia from long arousal without sexual release as well as men. It is less often discussed, which probably has more to do with social norms than with biology.

True Blue Condition

The common name is blue balls, and some people actually claim the scrotum (commonly known as the sack) can become cyanotic from trapped venous blood. I'm not so sure I buy the blue as true, but then again, I don't know anyone who has looked. The official medical term for the condition in boys is epididymal hypertension. The idea is that pressure built up in the epididymis, the convoluted tube that delivers sperm from the testes to the vas deferens, becomes painful when anticipated release doesn't happen.

Symptoms

There is only one symptom pattern that can be called blue balls:

  1. Prolonged sexual arousal without release. It's difficult to define prolonged for the purposes of this discussion, but without release is the most important part.
  2. Aching pain in the testicles.

If there is any trauma, such as the testicles were hit or heavily compressed, then the pain might actually be from trauma rather than from sexual arousal. Barring any history of trauma, however, an aching pain in the testicles after sexual arousal is the hallmark of blue balls.

Other Diagnoses

The most common potential diagnosis that feels the same as blue balls is epididymitis, an inflammation of the epididymis usually due to infection. If the pain becomes more severe after substantial time or sexual release, or if it comes on without sexual arousal, see a physician.

Treatment

The hard truth is that some tales just don't have a happy ending. If you are—or have been recently—experiencing this condition, it will subside. It will most likely stop affecting you after a time or two. If you just can't tolerate the discomfort, besides masturbation there are a couple of home remedies that will probably help.

  • Exercise, especially strength training, is advocated by some. The idea is that exercise diverts blood to major muscle groups instead of the genitalia.
  • Vagal stimulation, often accomplished by bearing down as if having a bowel movement, may relieve the pressure by dilating blood vessels throughout the body. This is known in the medical community as the Valsalva Maneuver.
  • For generations, the most common word of advice has been to take a cold shower. Presumably, the cold will have the effect of reducing swelling, much like it does in injuries.

The medical community hasn't spent a ton of time on this particular phenomenon. For one thing, blue balls is an absolutely non-life-threatening condition, despite the belief otherwise by many a first-time sufferer. The pain can be excruciating, causing some patients to have a hard time walking or even standing upright until the pain subsides. Plus, any topic even suggesting sexuality among the sub voting aged crowd is politically charged and uncomfortable for many healthcare providers to broach with either their patients or their patients' parents (especially the moms).

One article in the journal Pediatrics, published in 2000, discussed epididymal hypertension as a potential diagnosis in young adult males. With the exception of a follow-up letter to the editor in the same journal bringing up both real and comical concerns about the condition and a response to that letter, I couldn't find any other legitimate clinical discussion of the condition.

Pain Release

Worse yet, the immediate relief of the pain is most efficiently handled by the immediate release of the arousal. The easiest way to do this, of course, is through orgasm.

And there's the rub (sorry, couldn't resist).

No one wants to suggest that a young man is entitled to have his every erection tended to, especially by a sexual partner. That kind of thinking can lead to him pressuring his partner (or partners) into continuing down a path that she or he is not willing to go. No means no, even if it means he's going home with an aching disappointment.

In some households, it's even worse to suggest he handle his own destiny. The idea that a healthcare provider would even consider discussing masturbation with a teenager makes some folks decidedly squeamish, and others downright angry.

I doubt we will ever see any comprehensive clinical study of this particular phenomenon. It isn't harmful and it goes away without treatment, which means it will never need pharmaceutical relief. And since it doesn't need drugs, it will never have money to fund research.

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