— A Cause of Testicular Pain

Anyone who has ever experienced “blue balls” can tell you that it is a painful and frustrating consequence of sexual arousal. Of the many causes of pain in the testicles and scrotum, blue balls are the most benign. It is not a serious medical condition, but that does not make it any less tolerable. Here is what you need to know about blue balls and what you can do to relieve the pain.

By Kristopher Bunting, MD

• Blue balls (epididymal hypertension) is a real condition that causes pain and tenderness in the testicles and scrotum after prolonged sexual arousal without ejaculation or orgasm.
• Blue balls is temporary, usually lasting no more than a few hours, but can be relieved through sexual release, a cold shower or cold compress, or the Valsalva maneuver.
• Severe, persistent, or worsening scrotal or testicular pain may indicate a medical emergency, not blue balls.

What are blue balls?

Blue balls also called “lover’s nuts” or epididymal hypertension is a condition that causes scrotal and testicular pain. Epididymal hypertension can occur after prolonged sexual stimulation without sexual release. In other words, being sexually excited by foreplay or other sexually arousing activities that do not end in ejaculation or orgasm can lead to tender and painful testicles.

Medically speaking, the condition known as blue balls is poorly understood. There is little to no research into the causes and treatments of epididymal hypertension and there is only one known case report present in the current medical literature. This lack of published research is because epididymal hypertension is not a medical emergency and has no long-term negative effects on health. It is a real condition, but it is nothing to be alarmed about.

What are the symptoms of blue balls?

The primary symptoms of blue balls are pain and tenderness in the scrotum and testicles. The skin of the scrotum can also develop a slightly bluish tint. The experience varies between individuals but can be described as aching, heaviness, or fullness of the testicles. The discomfort may also be felt in the groin and lower abdomen. Blue balls do not cause swelling, bleeding, discharge, or fever. The pain subsides within a few hours (or less) without requiring treatment.

What causes blue balls?

While epididymal hypertension is not well understood, it is believed that a buildup of excess blood in the testicles after sexual arousal causes blue balls. Blood flows into the penis and testicles during sexual arousal and normally leaves the genitals after achieving orgasm. However, when the blood does not leave the testicles it can lead to pain.

Treating blue balls

There are several ways to relieve the pain of blue balls:

Give it time: blue balls typically only lasts for a few hours at most before resolving on its own.

Sexual release: ejaculating or having an orgasm through intercourse or masturbation can relieve blue balls quickly.

Cool it down: taking a cold shower or applying a cool compress (such as a towel soaked in cold water) may help relieve the pain of blue balls.

Try the Valsalva maneuver: the Valsalva maneuver can help relax blood vessels, allowing blood to leave the testicles.

Other recommendations for relieving the pain include distracting yourself to take your mind off of sexual arousal or exercising to increase blood flow out of the groin.

Other causes of testicular pain

Having blue balls can be a very unpleasant experience, but it is not a serious medical issue. However, many other conditions can cause pain in the testicles and scrotum, including some serious medical emergencies. Pain in the testicles and/or scrotum that is severe or is associated with bleeding, discharge, nausea, vomiting, fever, or swelling can indicate a serious medical condition. If you have symptoms other than mild to moderate pain or discomfort that lasts for up to a few hours, you should seek medical help immediately.

Testicular torsion is a medical emergency that can cause intense scrotal and testicular pain that usually comes on suddenly. Epididymitis or orchitis causes painful inflammation of the testes due to an infection that requires medical treatment. Testicular varicoceles can also cause testicular or scrotal pain. Varicoceles are caused by enlarged veins in the scrotum, similar to varicose veins, that can feel like a ”bag of worms”. While this is not an emergency, it may affect fertility.

Sexual arousal without sexual release can lead to blue balls, a real medical condition that causes pain in the scrotum and testicles. It is a temporary condition that resolves on its own and does not require treatment, but there are steps you can take to relieve the pain. Sexual release is the fastest way to relieve pain from blue balls, but this should never be used as an excuse to pressure anyone into sex.

While blue balls are not a serious condition, pain in the scrotum or testicles should always be a cause for concern. Seek immediate medical attention for severe or persistent pain in the testicles lasting more than a few hours.

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