What are blue balls and when to worry

Dr Roger Henderson
·5-min read
Photo credit: peakSTOCK - Getty Images
Photo credit: peakSTOCK - Getty Images

Blue balls is the slang term for a condition medically known as epididymal hypertension. It refers to the aching or mild discomfort felt in the testicles by men or people with penises after having an erection or being sexually aroused, but without reaching orgasm. Blue balls can also refer to sexual frustration and is not usually serious. But when should you be concerned about testicular discomfort?

Dr Roger Henderson looks at blue balls symptoms, causes, possible treatments and when to see a doctor:

What is blue balls?

Epididymal hypertension occurs much more commonly in teenage boys than adult men, where there is prolonged sexual arousal without orgasm.

There are various theories as to why testicular discomfort may occur in this situation but the most likely is that sexual arousal without orgasm in men can cause pressure and venous congestion to build up in the epididymis – the tube around the testes that delivers sperm to the vas deferens for release at orgasm.

Blue balls symptoms

The symptoms of blue balls are very simple, and consist of pain or discomfort in the balls following sexual arousal, sometimes associated with a bluish tinge to the scrotum (the sac containing the testicles).

The term ‘blue balls’ was given to the condition because some men report a bluish tinge around the testicles because of increased blood flow to the area and an increase in blood pressure.

What causes blue balls?

When men become sexually aroused, blood flow increases into the penis and testicles allowing an erection to occur and for the testicles to increase in size slightly. When orgasm occurs, this blood flow returns to normal but if it does not happen then discomfort may occur, especially if there has been arousal for a long time without orgasm.

Blue balls appears more likely to occur in young men and adult males if they become easily sexually aroused, or if they practise masturbation techniques that delay orgasm. For most men however, it is an unusual occurrence.

Photo credit: Yulia Reznikov - Getty Images
Photo credit: Yulia Reznikov - Getty Images

Other causes of testicle pain

If the discomfort only occurs during sexual arousal without orgasm and at no other time, blue balls is the most likely cause. However, if testicular discomfort occurs at other times other possible conditions include the following:

🔵 Epididymitis

Epididymitis is inflammation of the epididymis, usually due to an infection including sexually transmitted infections.

🔵 Kidney stones

The pain of kidney stones is severe and can travel down to the tip of the penis and testicles.

🔵 Trauma

If the testicles are hit, or squeezed due to over-tight underwear then a low dull ache may occur in them.

🔵 Mumps

Mumps can cause orchitis – inflammation of the testicles – and should be medically assessed.

🔵 Urinary tract infections

Urinary tract infection (UTI) symptoms can include lower abdominal pain and discomfort in the testicle area.

🔵 Testicular torsion

Testicular torsion is a medical emergency and needs urgent treatment. It occurs when one or both testicles twist inside the scrotum, cutting off the blood supply and causing pain and swelling. Emergency surgery is usually required to treat it.

🔵 Testicular cancer

It's rare, but pain and tenderness in either testicle can be a symptom of testicular cancer.

It's important to examine your testicles regularly. If there's anything unusual about them or you are concerned about any of the above conditions, consult your GP.

When to see a doctor about blue balls

In simple epididymal hypertension, medical assessment is not required as it can be simply treated. However, if there is significant pain during sexual activity or it affects sexual performance or erections then discuss this with your doctor.

If there is testicular discomfort with any lump or enlargement in either testicle, any pain in the lower back or any chronic dull pain in the groin always seek medical advice about this.

Blue balls treatment

The easiest and simplest way to treat blue balls is to have an orgasm - including by masturbation - and this usually quickly reduces any symptoms. If for any reason this is not possible, becoming sexually unaroused is the next option here and ways of doing this include the following:

✔️ Take a cold shower

The old cold shower trick has been recommended for generations with the thinking being that the cold reduces swelling of the genitals and reduces sexual thoughts. If no shower is available, using a cold compress on the area can have the same effect.

✔️ Distract yourself

Distraction treatment by listening to music or exercising can be effective. Exercise may also be helpful as it can divert blood away from the genitals to other parts of the body.

✔️ Get busy

Sexual urges - much like cravings for cigarettes or cake - will pass if you interrupt them. Keep busy by working or concentrating hard on another activity.

✔️ Talk about it

If you are not happy with your sex life, talking therapy can help you explore your thoughts and feelings around sex, love and relationships. Try cognitive behaviour therapy (CBT), a talking therapy based on changing unhelpful behaviours to improve how you feel, or speak to a sex therapist.

Further help and support

For any concerns about your sexual health, your first port of call should be your GP. Alternatively the following resources may help:

  • NHS: to check for any medical issues or be referred to a therapist, visit you local GP or local sexual health centre.

  • COSRT: find therapists that are able to work with relationship or sexual issues.

  • ATSAC: resources for the treatment of sexual compulsivity and addiction.

  • Relate: relationship counselling and support for couples and families.

  • Institute of Psychosexual Medicine: trained professionals can help people with a wide range of sexual difficulties.

Last updated: 23-04-2021

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