Epididymal Hypertension (Blue Balls)

What is Epididymal Hypertension?

Epididymal hypertension, or "blue balls", refers to testicular aching that occurs after extended sexual activity or arousal without orgasm. When aroused, the blood vessels in the genital area fill with blood; if the pressure in the male reproductive tract is not dissipated through orgasm, the male might experience discomfort. The testicles might appear blue  due to color changes in the skin of the scrotum. Oxygen-rich blood on the surface of the skin creates a red color, while blood with little oxygen creates a blue color. The deepness of color and the level of pain associated with epididymal hypertension correlates to the amount of time the excess blood stays in the scrotum and testes because the blood does not circulate to the heart and lungs. The blue coloration is usually subtle—extremely noticeable color changes accompanied by extreme pain and swelling may be signs of a more serious condition (e.g., testicular torsion or epididymitis).

What Causes Epididymal Hypertension?
When a male becomes sexually aroused, the arteries that carry blood to his genitals enlarge (a process known as vasocongestion), while the veins that leave the genital area constrict, allowing less blood to escape. This uneven blood flow causes engorgement in the genital area, producing an erection and making the testes swell to be 25-50% larger than their normal size. Once orgasm is achieved, the blood vessels return to their normal size and the volume of blood in the genitals returns to its normal level rather quickly. If a male does not have an orgasm, the chronic blood congestion in the genital area can lead to a sensation of heaviness, aching, or discomfort. Epididymal hypertension is not a serious medical condition and does not cause any permanent damage to the scrotal and testicular tissues.
Epididymal hypertension usually does not last long and often the pain associated with blue balls is minor. Most males are also frustrated when they get an erection during sexual activity and do not achieve orgasm. The frustration and disappointment associated with not being able to have an orgasm can add to the physical and psychological discomfort, exacerbating the actual symptoms. Males who feel pressure to ejaculate every time they are aroused may attempt to pressure an unwilling partner to proceed with sex. Males may often use the excuse, “If I don’t cum, it will hurt”, in order to persuade the partner into engaging in any type of sexual behavior that can result in orgasm. If a partner ever feels pressured by this facetious argument, we encourage them to speak up and state their unwillingness. Consent and comfort should always be prioritized.

How is Epididymal Hypertension Treated?
The simplest remedy for blue balls is orgasm and ejaculation. Masturbation is the easiest way to achieve orgasm, especially if one's partner is not ready for intercourse. The pain can also dissipate slowly (usually within an hour) on its own, even without orgasm once the individual is no longer aroused. Realizing that ejaculation is not a requirement in all sexual situations can help a male and his partner become more comfortable with each other and can also decrease possible performance anxiety while increasing positive feelings of pleasure. Taking a cold shower or submersing the testicles in cold water can also alleviate epididymal hypertension: the cold water constricts the blood vessels and decreases swelling. Exercising is also a great way to reduce swelling; the excess blood in the genital area is released as it is immediately used by surrounding muscle groups.

Females can also experience mild pain and discomfort as a result of prolonged vasocongestion; this condition is referred to as pelvic congestion or “blue vulva.” The causes of pelvic congestion and treatment options are the same for both males and females.


  1. Brouhard, Rod. "Blue Balls." About.com First Aid. N.p., 11 Dec. 2013. Web. 22 May 2014.
  2. "Epididymal Hypertension."  (Blue Balls). N.p., 30 Nov. 2012. Web. 22 May 2014.

Last Updated 22 May 2014.



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