The Myths and Facts About "Blue Balls" (Epididymal Hypertension)

Millions of teenage boys are not delusional; prolonged sexual arousal without 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. It is less often discussed, which probably has more to do with social norms than with biology.

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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. 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 the anticipated release doesn't happen.


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

  1. Aching pain in the testicles
  2. Prolonged sexual arousal without release

It's difficult to define "prolonged" sexual arousal, but "without release" is the most important part.

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, 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.


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.

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.

We probably won't 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.

Frequently Asked Questions

What is blue balls? 

"Blue balls" is a slang term sometimes used to describe epididymal hypertension. Epidydimal hypertension is a condition that can affect people with male genitals and, while it is generally not serious, it can cause significant discomfort.

Epidydimal hypertension is caused when blood does not fully leave the testicles after an erection, causing the swelling of the duct that transports sperm (called the epididymis). This usually occurs after a prolonged erection.

Why is it called blue balls?

In severe cases, the swelling of the epididymis can cause the testicle to turn a bluish tinge accompanied by testicular pain, heaviness, and aching.

Unlike other conditions that cause testicular swelling, "blue balls" occur after a prolonged erection. The risk may be increased if an erection-enhancing device ("cock ring") is worn tightly for too long.

Other causes of testicular swelling may be more serious, including acute epididymitis, testicular trauma, orchitis, and testicular cancer. These can cause prolonged or chronic swelling and require medical attention.

How long does blue balls last? 

Typically, epidydimal hypertension will resolve on its own within one or several hours. Blue balls generally doesn't require medical attention.

How do you get rid of blue balls?

There are no guidelines for the treatment of blue balls. Some people have been known to apply a cold compress to the testicles to help relieve discomfort. An over-the-counter analgesic like Tylenol (acetaminophen) or Advil (ibuprofen) may also help.

If the pain and swelling don't resolve or rapidly get worse, do not hesitate to seek immediate medical care. In some cases, the pain may be the result of testicular torsion in which the epididymis is abnormally twisted, cutting off the blood blow and causing severe pain, testicular swelling, and fever.

Testicular torsion is considered a medical emergency. If left untreated, testicular torsion can cause permanent damage and impaired fertility.

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