An Overview of Blue Balls (Epididymal Hypertension)

Millions of teenage boys and young men are not delusional: Prolonged sexual arousal without orgasm can lead to pain in the testicles. The condition—known colloquially as blue balls—is common in newly pubescent boys but can also affect males who withhold ejaculation or experience delayed (impaired) ejaculation.

What Is Blue Balls?

Blue balls is slang for a condition sometimes referred to as epididymal hypertension. Epididymal hypertension is not a diagnosis per se, but rather another term used to characterize pain in the scrotum associated with prolonged sexual arousal without ejaculation.

Doctors will more often use the term "acute scrotal pain" given that there are many possible causes for pain in the scrotum, testicles, epididymis (the tubes behind the testes that transport sperm), and spermatic cord.

Though neither blue balls nor epididymal hypertension are commonly used terms in medical practice, they suggest a non-pathogenic condition associated with sexual arousal. If anything, the terms act as a placeholder until the doctor investigates other possible causes and ensures that a more serious condition is not involved.

Symptoms of Blue Balls

The symptoms of blue balls can be best described as an aching pain that occurs when prolonged sexual arousal is not concluded by ejaculation. The pain is often dull but can sometimes be sharp and extend into the lower abdomen and groin. There may also be a sensation of fullness in one or both testicles (although usually without any overt swelling).

Blue balls may be differentiated from other types of acute scrotal pain in that the discomfort doesn't prevent sex. By contrast, scrotal pain caused by trauma will often interfere with the ability to have sex.

Scrotal pain that is chronic or occurs independently of sex should not be attributed to blue balls.

What Causes Blue Balls?

Blue balls is thought to be caused by the excessive accumulation of fluid in the epididymis during prolonged arousal. Without ejaculation, the "back up" of fluid can cause the epididymis to expand, causing discomfort or pain.

Blue balls may be also the consequence of delayed ejaculation (an extended lag between sexual arousal and climax) or semen retention (intentionally avoiding ejaculation).

Because the symptoms are non-specific, doctors investigating blue balls will almost always investigate other possible causes of acute scrotal pain. These include:

• Epididymitis
• Inguinal hernia
• Nerve entrapment in the spermatic cord
• Testicular hematoma
• Testicular torsion
• Urethral stone

How to Relieve Blue Balls

If you truly have blue balls, the symptoms will typically resolve on their own. If you can't tolerate the discomfort, there are a few remedies that may help:

• Over-the-counter analgesics like Tylenol (acetaminophen) can help relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) may also help reduce inflammation and epididymal swelling.
• Exercise, especially strength training, is advocated by some. The idea is that exercise diverts blood to major muscle groups instead of the genitalia.
• Cold showers have been recommended for generations to temper sexual arousal. The cold may also reduce swelling, much as it does with injuries. A cold compress applied to the testicles may be a more practical approach.
• Masturbation has long been another homespun remedy, and it's also a strategy endorsed in some journal articles. Despite this, most doctors would consider it awkward and inappropriate to recommend masturbation as a treatment for any medical condition.

A Word From Verywell

Blue balls is a phenomenon that definitely affects some people, but one for which there are no guidelines on how to appropriately diagnose, treat, or prevent the condition. A lot of time hasn't been devoted to research, in part because it is a relatively benign condition that will almost invariably resolve on its own.

However, if the condition is recurrent or chronic, contact your doctor as this may be a sign of another, more potentially serious problem.

If the pain is severe and accompanied by fever, nausea, vomiting, scrotal swelling, abdominal pain, and frequent urination, call 911 or go to your nearest emergency room.