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Erectile dysfunction is a condition in which you have trouble getting or keeping an erection firm enough for satisfying sex. Erectile dysfunction affects as many as 30 million men in the United States.
Premature ejaculation (PE) is a sexual dysfunction characterized by a short ejaculatory latency, a perceived lack of control about the timing of ejaculation, and distress and interpersonal difficulty related to ejaculating too quickly.
Low testosterone or testosterone deficiency, also known as hypogonadism, is a condition in which patients develop symptoms such as low sex drive, erectile dysfunction (ED), and fatigue because the body doesn’t produce enough testosterone.
Though many men don’t like to talk about it, ejaculation problems are very common. Some of the most common issues include premature, delayed, or retrograde ejaculation.
When you think of male sexual dysfunction, concerns like erectile dysfunction (ED) or premature ejaculation (PE) probably come to mind first. But there’s another sex-related issue that’s more common in men than you might expect: difficulty orgasming.
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If you’ve ever experienced aching or discomfort in your testicles after being very aroused, there’s a good chance you’ve experienced “blue balls.” But what are blue balls, exactly? Are blue balls real?
Contrary to the name, blue balls don’t turn your testicles blue. Medically known as epididymal hypertension, blue balls is the reported pain or discomfort felt in the scrotum after a prolonged build-up of sexual arousal without release.
Though epididymal hypertension may feel uncomfortable, it’s usually not considered a serious condition. Below, we’ll break down what causes blue balls, what they feel like, and how you can relieve discomfort in your testes without guilt-tripping someone into having sex.
“Blue balls” is a slang term for epididymal hypertension. This temporary medical condition is characterized by pain or discomfort in the testicles resulting from prolonged sexual arousal without ejaculation.
In some cases, people use the term “blue balls” to describe sexual frustration. But epididymal hypertension specifically refers to the physical symptoms of having excess blood in the genitals for a prolonged period. These symptoms can include pain, heaviness, or throbbing.
Research in the journal Pediatrics shows that blue balls are more common among young male adults, with symptoms ranging from brief, mild discomfort to severe pain.
Some of the most common symptoms of blue balls (or epididymal hypertension) include:
Pain
Heaviness
Throbbing
Aching
Discomfort
Some people may feel more emotionally or mentally frustrated than physically uncomfortable, but again, that’s technically not epididymal hypertension.
When sexually aroused through mental or physical stimulation, your brain signals your blood vessels to dilate for increased blood flow to the penis. When enough blood pools, the once spongy tissue of your penis (corpora cavernosa) is now rigid and stiff, resulting in an erection.
To help you maintain this extra blood in your penis (and your erection), a fibrous membrane wrapping around your penile compresses veins and prevents the outflow of blood. In most men, blood pressure in the corpora cavernosa rises to an average of around 100 mmHg (millimeters of mercury).
When you ejaculate, the whole process reverses. The compression of the fibrous membrane decreases, excess blood flows back out, pressure releases, and you return to your regularly scheduled programming.
There’s still a lot we don’t know about blue balls, but epididymal hypertension is thought to happen because of slow blood drainage.
Ejaculation prompts the reversal of an erection and all the processes that led to it. So, without this release, your tissues will stay engorged with blood for an extended period, leading to discomfort or pain.
The discomfort from blue balls can last anywhere from a few minutes to a few hours, often depending on how quickly the body returns to its non-aroused state.
Most people don’t go to the emergency room for blue balls. They either masturbate, have sex, take a cold shower, or distract themselves with nonsexual thoughts. We’ll go into more detail about what you can do later.
But other serious health conditions can also cause testicular pain:
Testicular torsion. Testicular torsion is a medical emergency where the spermatic cord gets twisted. Without prompt medical attention (within a four- to eight-hour window), permanent damage can occur, including fertility issues. While both testicular torsion and blue balls can cause scrotal pain, testicular torsion is often associated with other symptoms like nausea and vomiting.
Epididymitis. Epididymitis is when the epididymis becomes inflamed and swells — that’s the tube connecting the testicles with the vas deferens, where sperm is carried out from the testes. It can sometimes cause testicular tenderness.
Urinary tract infections. When you have a UTI, bacteria can sometimes spread from the infected site to the epididymis or even the testicle, resulting in pain.
Kidney stones. When kidney stones block urine from exiting the body, they can cause pain in the belly, back, groin, or testicles.
Testicular cancer. Testicular cancer may cause pain and swelling in the groin area, along with abdominal pain, back pain, and fatigue.
Varicocele. Enlarged veins in the scrotum may cause mild to severe pain and swelling.
If your pain or discomfort is severe or accompanied by other symptoms, contact your healthcare provider for medical advice to rule out more serious medical conditions.
You should never use blue balls as an excuse to pressure somebody to have sex with you. Remember, this is no emergency situation. There are many healthy and respectful ways to relieve discomfort on your own — whether through masturbation, a sex toy, or simply giving your body time to settle.
A 2023 study of 2,621 men and women explored the link between blue balls and sexual coercion. It found that significantly more women than men reported being pressured into a sexual act due to their partner’s fear of experiencing pain without orgasm (aka blue balls).
According to researchers, while it’s true some men have reported severe pain, it can be sufficiently relieved with solo sex and nonsexual activities. Using guilt or pressure to initiate sex can have serious emotional and psychological consequences for everyone involved.
Coerced sexual activity has been shown to negatively impact mental wellness and increase the risk of anxiety, depression, and low self-esteem.
There are many similarities between the sexual arousal process for men and women. Like in a man, when a woman is sexually aroused, her brain signals the blood vessels leading to the vagina to dilate. The clitoris — made of the same spongy tissue as the penis — fills up with blood, creating an erection of sorts.
After orgasm, the process reverses, blood flows out, and the clitoris and vagina return to their normal sizes.
The same 2023 study cited above noted that women may also experience discomfort without sexual release. Some have informally referred to this as “blue vulva” or “pelvic congestion,” among other nicknames.
What If a Woman Doesn’t Orgasm After Getting Blue Vulva?
Despite the physiological similarities between men and women, they seem to view the discomfort of blue balls and blue vulva differently.
The 2023 study found that pain was more frequently self-reported in men and more frequently described as severe. And men didn’t report being coerced into sex as often as women.
Are blue balls real? While there’s still a lot we don’t know about blue balls, lots of men report pain or discomfort after a prolonged state of arousal if they haven’t had an orgasm. While uncomfortable, epididymal hypertension is temporary and manageable.
Remember these takeaways:
Blue balls are usually not serious. Although dealing with the build-up of excess blood and pressure can be frustrating and uncomfortable,the condition is temporary and solvable.
You can treat blue balls. DO: Masturbate, use a sex toy, have a cold shower, or exercise. DON’T: Pressure someone into having sex.
Rule out other health conditions. Other conditions more serious than blue balls can cause testicular pain, including testicular torsion, kidney stones, and testicular cancer. If your pain is severe or comes with other symptoms, ask a board-certified urologist or another medical professional specializing in sexual medicine.
Women get blue balls too — it’s called blue vulva. Many of the physical mechanisms behind sexual arousal are the same in men and women. This means women can also experience discomfort if they don’t have an orgasm. However, they’re less likely to rate their pain as severe or coerce someone into having sex as a remedy.
Chalett JO, et al. (2000). “Blue Balls”: A Diagnostic Consideration in Testiculoscrotal Pain in Young Adults: A Case Report and Discussion.
Levang SA, et al. (2023). “Blue balls” and sexual coercion: a survey study of genitopelvic pain after sexual arousal without orgasm and its implications for sexual advances.
Panchatsharam PR, et al. (2023). Physiology, Erection.
Sharp VI, et al. (2013). Testicular Torsion: Diagnosis, Evaluation, and Management.
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Erectile Dysfunction
Premature Ejaculation
Low Testosterone
Retrograde Ejaculation
Pelvic Floor Dysfunction
Anorgasmia