Blue Balls Pain

Blue Balls Pain

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Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.
Jamin Brahmbhatt, MD, is a board-certified urologist and Chief of Surgery at Orlando Health South Lake Hospital.

Blue balls is the colloquial term for pain or a heavy feeling in the testicles caused by prolonged sexual arousal without orgasm in males. Blood vessels swell during arousal, and that subsides after ejaculation . If ejaculation is withheld or delayed (impaired), fluids build up, resulting in blue balls.

The condition itself—also known as epididymal hypertension—is uncomfortable, but not dangerous. It is common in newly pubescent boys, but it can also affect adult males. 1

This article discusses what blue balls mean, what happens in the body to cause them, and how you can get relief.

Blue balls is not a diagnosis, per se, but rather a way to characterize pain in the scrotum associated with prolonged sexual arousal without ejaculation. 1

Of course, the term is one you're more likely to hear in casual settings, rather than a healthcare provider's office. While most males will never need to see a healthcare provider about blue balls, as they are acutely aware of their cause, scrotal pain that is chronic or occurs independently of sex should be evaluated. 2

Medical providers will more often use the term acute scrotal pain. Prolonged sexual arousal is a very likely cause, but there are many other possible reasons for pain in the scrotum, testicles , epididymis (the tubes behind the testes that transport sperm ), and spermatic cord. 2

Whatever blue balls are called, the term acts as a placeholder until the doctor investigates the cause and ensures that a more serious condition is not involved. 2

Symptoms of blue balls can include: 1

Despite its name, blue balls doesn't cause the scrotum or testicles to turn blue. If bluish or purplish discoloration occurs with acute pain and swelling, this may be a sign of a medical emergency known as testicular torsion . 3

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. 1

Blue balls may be also the consequence of:

Because the symptoms are non-specific, doctors investigating blue balls will almost always investigate other possible causes of acute scrotal pain. These include: 2

Blue balls may be differentiated from other types of acute scrotal pain in that the discomfort doesn't prevent sex. 6 By contrast, scrotal pain caused by trauma will often interfere with the ability to have sex.

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:

People with blue balls should never pressure their partners to engage in any sexual activity without full consent or engage in any form of coercion.

Blue balls is a phenomenon that definitely affects some people. It can be temporarily painful or uncomfortable, but it is serious or a threat to your health. It typically resolves on its own with some time.

However, if your symptoms recur, are chronic, or impact sexual activity, contact your healthcare provider. This may be a sign of another, more potentially serious problem. 7

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. 3

Typically, blue balls resolve on their own within one or several hours. The condition generally doesn't require medical attention. 2
Blue balls is a term that was coined as far back as 1916. 8 Despite its name, it rarely causes blue testicles.
A cold compress applied to the testicles may alleviate pain due to blue balls. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may also help. 2 Masturbation has been described as a remedy for blue balls in some older medical journals, although few doctors today would recommend masturbation as a medical treatment.
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Velasquez J, Boniface MP, Mohseni M. Acute scrotum pain . In: StatPearls [Internet].
Schick MA, Sternard BT. Testicular torsion . In: StatPearls [Internet].
Parnham A, Serefoglu EC. Retrograde ejaculation, painful ejaculation and hematospermia . Transl Androl Urol . 2016;5(4):592-601. doi:10.21037/tau.2016.06.05
Ayad BM, Van der Horst G, S Du Plessis S. Revisiting the relationship between the ejaculatory abstinence period and semen characteristics . Int J Fertil Steril . 2018;11(4). doi:10.22074/ijfs.2018.5192
Rockney R, Alario AJ. Blue balls . Pediatrics. 2001;108(5):1233-4.
Leslie SW, Sajjad H, Siref LE. Chronic testicular pain . In: StatPearls [Internet].
Dalzell T, Victor T. Sex Slang . London: Routledge; 2008. doi:10.4000/lexis.1889
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For centuries, men have bemoaned the scourge of blue balls—but is it actually a thing? The answer is complicated.
Since the dawn of time, men have used the term " blue balls " as a euphemism for general sexual frustration. But if you’ve ever felt an aching sensation down there—or even noticed your testicles turning a darker shade—you know it's not just an excuse to get off. Blue balls can be something that actually affects you physically, too—and it (sorta) hurts.
Anecdotal symptoms of blue balls include testicular pain, an aching sensation at the base of your penis, heaviness, and a faint blue tint to your testicles. But is "blue balls" actually real, or are those symptoms psychosomatic? And for that matter, is it harmful?
"Neither blue balls nor pink pelvis (the female-bodied equivalent) is dangerous or bad for you," says Gigi Engle , ACS, certified sexologist and author of All The F*cking Mistakes: a guide to sex, love, and life . "The myth that blue balls is somehow dangerous or super painful is born out of the idea that men need to 'release their ejaculate, which is a myth designed to pressure women into sex.'"
You might have heard it in a movie or from a buddy at some point: "She gave me blue balls!" Men have long complained about blue balls as a means of pressuring women into sex, Engle explains. "A guy will pretend he's in pain and appeal to a woman's sympathy in order to get what they want," she says. "It's manipulative, wrong, and it's definitely a form of coercive assault to use blue balls to pressure someone to perform a sexual act they don't want to do."
Remember, you need enthusiastic consent—i.e., a "HELL YES!"—to proceed with any sexual interaction. Guilting someone into a hookup by telling them you have blue balls, as though it's some kind of dangerous medical condition? Nope. Not gonna cut it.
Let's get one thing clear right off the bat: While “blue balls” is a relatively common phenomenon, that fleeting testicular pain is not going to do any long-term damage. If you're having sex and your orgasm is interrupted, you might be uncomfortable for a few minutes (or even hours), but that's pretty much the whole extent of it.
Initially, there wasn’t a whole lot of research available on blue balls. We dug up one early case report published in the journal Pediatrics back in 2000, which detailed a 14-year-old boy who ended up in the ER with severe scrotal pain after “messing around” with his girlfriend without ejaculating. But the scientists admitted they weren’t quite sure what was responsible for causing the pain. That’s because, after reviewing the available literature in emergency medicine, urology textbooks, and medical libraries, the scientists were unable to find any mention of or official medical term for “blue balls.”
Now, we do have an official medical term for the unpleasant experience: epididymal hypertension.
“The condition is caused by excess blood remaining in the testicles from a wave of erections not followed by ejaculation,” explains Jamin Brahmbhatt , M.D., a urologist at Orlando Health. “During arousal blood starts to flow into the penis (ie: erection), testicles, and surrounding areas. When a man achieves orgasm/ejaculation the blood returns back to the body."
Symptoms of epididymal hypertension “include pain, discomfort, aches, or a heavy sensation in or around the testicles,” Brahmbhatt says.
There’s also some evidence that prolonged sexual attraction, leading to a stiffy that won’t go down, can cause some of the oxygen in your blood to be absorbed by the tissue in your genitals. This can leave the blood with a blue-ish hue, says urologist Richard K. Lee, M.D. , of Weill Cornell Medical College.
But Lee says this usually only happens when there’s some type of blockage. “ Erectile dysfunction drugs or blood flow-constricting devices like a penis ring could cause this, but it’s not likely to occur naturally,” he adds. So unless you've been using Cialis or a new sex toy in the bedroom, your balls likely won't actually become blue—you might just experience some mild discomfort.
There is no research-based treatment for this condition, says Brahmbhatt. “Anecdotally, the quickest way to recovery appears to be ejaculation. Other ways discussed in forums include ice packs, avoiding erections, and then exercise of some sort.”
Only having an orgasm can relieve this pressure, says urologist Darius Paduch, M.D . (Note that he does not say "partnered" orgasm—if you want to finish, and your partner isn't on board for whatever reason, go be a man and find a bathroom stall and a wad of Kleenex and take care of it yourself. Your partner doesn't owe you anything—period.)
Some people have suggested that applying ice or cold water (hello, cold showers!) or working out can help relieve the pressure, but there isn't a ton of research to support that. So for now, just stick to the old-fashioned way.
If you’re experiencing blue balls for a prolonged period of time, odds are, it’s not blue balls, but a far more serious condition, Brahmbhatt says. The sensation (and associated pain) from blue balls is typically short-lived, and of course, should go away once you ejaculate.
Brahmbhatt has seen his fair share of men that come to the ER with testicular pain that has no clear etiology, and they think it’s likely blue balls. Some guys can easily admit to the problem, whereas others are in denial. “Regardless, these patients always get ruled out for more acute problems including epididymitis (infection or inflammation of the epididymal tubules), orchitis (infection or inflammation of the testicle), testicular torsion, referred pain from kidney stones, testicular cancer, or testicular trauma/injury.”
So if you’re fooling around and don’t get to finish, odds are it’s blue balls. Go finish on up in the bathroom. But if you’re experiencing prolonged testicular pain, and masturbating isn’t helping, then get thee (and your balls) to a urologist.

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Have an orgasm to release the pressure. This is the quickest, easiest, and probably most enjoyable way to get rid of blue balls. Once you have an orgasm, all the blood drains away from your genitals, which gets rid of the problem. The sooner the better, so get started! You can do this alone through masturbation, or with a partner by having sex. As long as you have an orgasm and ejaculate, the method doesn’t matter. [1]
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Never use blue balls as an excuse to pressure your partner into having sex. You can take care of the problem yourself if your partner isn't in the mood.
Women can also feel something similar if they get aroused without having an orgasm, and the solution is the same.

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Hold a cold compress on your testicles if you don't want to have an orgasm. Sometimes, it's not the right time to have an orgasm or you don't want to have one. Luckily, you also have some other choices to get rid of blue balls. Try holding a cold compress against your testicles. [2]
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This might be a little uncomfortable at first, but it numbs the pain and also restricts blood flow. This should make you feel better until the blue balls pass.

A cold shower might seem like a cliché, but this works too! Try to focus the water on your testicles.
If you’re using a cold compress, always make sure you wrap it in a towel and don’t let it directly touch your skin. [3]
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Exercise to focus blood to other parts of your body. There is no real evidence that this works, but some men say it helps them. [4]
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Try doing some exercise to drain blood away from your genitals and towards other parts of your body. At the very least, this can distract you from the pain until the blue balls clear up.
This might be uncomfortable for a little while until the blood drains away from your genitals.

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