Are blue balls real? What actually happens when you’re left hanging?

Have you got blue balls? Often, a piece of sex slang used in jest when you’re on a dry streak, many people still believe that it’s nothing more than a myth. The truth is that the real myth about blue balls is that it’s a myth. Blokes aren’t imagining it. The discomfort often referred to as 'blue balls' is a real experience for some people.

Sexual dysfunction is a big issue among men worldwide, with an estimated 322 million men globally suffering from erectile dysfunction alone, but is blue balls something to worry about [1]?

The good news is no. Blue balls are rarely anything to worry about and usually won't require immediate medical help. In this guide, we’ll go through what you’re feeling, why it happens, and whether it’s something to go to your GP about.

What is “blue balls”?

Blue balls is a commonly used informal term for temporary testicular discomfort that some people experience after prolonged sexual arousal without ejaculation. It is sometimes referred to as epididymal hypertension, although it is not a formally recognised medical diagnosis [2].

There’s no straight definition everyone agrees on about this type of genitopelvic pain because pain can happen post-arousal for any number of reasons. That’s why you might also come across some healthcare providers describing it as arousal orchialgia. Others might even go with the more straightforward option of acute testicular pain to describe your temporary discomfort [3].

The truth is, there’s little scientific literature on it specifically, which is why there are still many debates about its exact definition and place within sexual medicine. One study has also found that blue balls have been used for bypassing sexual consent, with significant numbers of females saying they felt pressured after receiving sexual advances into having sex because of their partner's fear about blue balls [4].

Myths about blue balls in men's health

Beyond the myth that blue balls are just a cultural expression and don’t exist, there are other myths as well.

The biggest myth is that it’s a medical condition to be concerned about. Sexual arousal without orgasm isn’t going to cause any long-term damage. It’s one of those annoying forms of mild discomfort that tends to disappear with time.

Of course, the other myth is that your balls are going to turn blue. Some people might see a faint bluish hue because of the build-up of blood below, though. If you’re genuinely getting blue-coloured balls, this isn’t blue balls but could be something called testicular torsion, which requires a trip to the emergency room immediately [5].

Finally, getting relief for your goolies doesn’t have to mean having sex. Masturbation alone can relieve symptoms, but there are also non-sexually related activities that can get you back on the straight and narrow again, including taking a cold shower.

What causes blue balls scrotal pain?

It is thought that the discomfort may be related to increased blood flow and pressure in the genital area during prolonged arousal, though the exact mechanism isn't fully understood.

But what can actually increase the risk of blue balls?

It’s thought that three factors come into it, including [6]:

• Delayed Ejaculation – Roughly 1-4% of males are projected to have difficulties with ejaculating, even when they’re engaging in sexual activity [7].
• Anejaculation – Anejaculation is the inability to ejaculate at all, even when sexually aroused.
• Semen Retention – Coitus reservatus, or a behaviour where people intentionally avoid ejaculation. Some men do this for some supposed benefits, such as those espoused by the online NoFap community, of which Aussies comprise 5% of their membership [8].

How long does the discomfort from genitopelvic pain last?

The heaviness, aching discomfort of blue balls isn’t going to leave you laid up with a sick note for the next few weeks. If you’re feeling uncomfortable, it’ll usually resolve itself after a few hours. You don’t need to do anything.

If your symptoms are lasting longer, the answer is to take action. Again, the go-to option is to set some time aside and ejaculate, whether you’ve got a sexual partner or not.

How do you get rid of blue balls? 

When the pain persists, many people find that ejaculation or reducing arousal can help relieve symptoms. However, experiences vary, and persistent or severe pain should be assessed by a healthcare professional.

You can also try out the following to help manage your symptoms and relieve blue balls:

• Painkillers – A simple over-the-counter option you might use for a headache may help some people, but always follow the label directions and speak to a pharmacist if unsure.
• Exercise – Go for a brisk walk or get on your bike, and it could help divert some of the blood flow away from your goolies and into other parts of your body, cutting the uncomfortable sensation.
• Cold Options – Putting a cold compress on your scrotum can ease the pain, as can taking a cold shower. The latter can be especially effective at combating your sexual desire and clearing your mind.
• Distract Yourself – Focus on something else until it passes. Switch on the TV, read a book, or have a chat with a friend to stop prolonged sexual arousal and clear some of that excess blood.
• Breathing Techniques – Some studies have shown that engaging in breathing exercises, including deep breathing, can slow your heart rate, which reduces the vascular pressure below the belt by stopping that extra blood supply from pooling [9].
• Urinating – Going to the bathroom could also help with the pain. When you urinate, you’re reducing the compression by emptying your bladder.

The truth is, though, most blokes won’t need to do much of anything, and the chances are you won't need formal medical treatment. It’ll pass away on its own in the vast majority of cases and is nothing to worry about. 

How to prevent blue balls

Preventing blue balls is precisely the same as managing them. For some, regularly ejaculating is part of a healthy sex life, even if you’re not currently partnered up. The other option is to prevent yourself from becoming sexually aroused in the first place.

If you’re having trouble with blue balls and can’t or won’t bring yourself to orgasm for one reason or another, the answer is to distract yourself. Redirect your energies to other projects, whether it’s work, a hobby, or even just staying physically active.

Is it blue balls or something else? 

How do you know you’ve got blue balls and not something more sinister? Luckily, what differentiates this condition from more serious problems is the lack of alternate symptoms.

Someone who’s got blue balls might feel a bit of pain and heaviness, but that’s about it. Other symptoms that could indicate other conditions include:

• Acute swelling
• Nausea
• Redness
• Fever
• Lower abdominal pain

That’s not to say you can’t have these symptoms with blue balls, but it’s highly unlikely. These symptoms often point to issues like epididymitis and orchitis, which are different forms of inflammation typically caused by sexually transmitted diseases [10].

Doctors usually get to the heart of the matter with urine tests, blood tests, or imaging studies. The goal is to essentially discount other conditions by the absence of symptoms, rather than looking for a specific blue-balls-related symptom.

Is there an equivalent for women?

Women might not have balls, but they’ve also got a condition for them. It’s informally known as blue vulva, blue bean, or pink pelvis. It’s caused by the same mechanism as in the male genitals. The only difference is that instead of the pressure building up in the blood vessels of the testicles and penis, women get the build-up in their clitoris, labia, and vagina.

Like with men, there’s nothing to worry about. Reaching orgasm or reducing arousal will solve the problem.

When do you need to talk to a doctor about blue balls?

You probably won’t need to talk to your primary care doctor about blue balls, as the chances are you're only suffering from mild pain. Generally, if your pain lasts for an extended period or you've got intense pain, that’s when it’s time to call your GP and see what they say.

If you’ve got pain plus any of the following symptoms, though, you need immediate care:

• Pain while urinating
• Severe pain
• Swollen lymph nodes
• Pus-like discharge
• Nausea
• Vomiting
• Fever

All of these could be signs of a more serious condition, such as kidney stones, a sexually transmitted disease, or testicular torsion. Note that testicular torsion is a serious medical emergency necessitating immediate surgery, or you could lose the testicle [11].

Beyond medical issues, it’s also recommended that you call your healthcare provider if blue balls are bothering you or are affecting your sexual performance.

Like all potential forms of sexual dysfunction, help is available via healthcare professionals, including through Pilot’s ED Treatment program and access to specialised therapists.

If blue balls or any other form of sexual difficulty is on your mind, get in touch with your GP at the earliest opportunity.

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