Dear Dr. Joe, What’s the Deal with Blue Balls?

Every few weeks, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality here on EMandLO.com. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

What’s the deal with blue balls?

— The Indigo Boys

Dear T.I.B.,

“Blue balls” is a commonly used colloquialism describing pain or discomfort in the scrotum/testes that occurs after prolonged sexual stimulation without ejaculatory release. Despite your high school buddy’s arguments to the contrary, it is not a justification to demand sexual satisfaction. You’re not going to die, and you won’t damage anything.

Many men (and some medical professionals) consider this condition a myth, but any man that has experienced the dull ache appreciates its legitimacy. To be frank, I’m not sure what causes the pain. I’ve heard several hypotheses, most related to the epididymis, a small structure adjacent to the testes where sperm mature. The most commonly cited theories include the backup of blood in the epididymis or scrotum; swelling of the epididymis; and backup of sperm in the ejaculatory ducts, affectionately labeled “deadly sperm buildup.” Interestingly and for reasons that I cannot comprehend, the medical profession has not dedicated a great deal of effort into deciphering this medical conundrum.

Why not? Probably because it’s not dangerous, is self-limited, and has an easy fix. A fix you say? Yes. Pop one off. Huh? That’s right: ejaculate. To placate the more serious amongst you, I did do a proper medical search – even journeyed to the medical library to do so. No mention of blue balls in any of the major medical texts. An extensive literature review revealed only one mention of blue balls in the past 25 years. The October 2000 issue of Pediatrics reported a case study of a 14 year-old boy with recurring scrotal pain after messing around with his first girlfriend. The authors were happy to report that his condition promptly resolved once he started having intercourse – effective, but not my recommended remedy for a child.

Nonetheless, the treatment is valid. Ejaculation almost always “cures” the condition. This may be accomplished by any of the conventional methods. No partner? Opposed to masturbation? You could try a Valsalva manuever, which is forcefully attempting exhalation against a closed airway (imagine trying to “pop” your ears after air travel). One obscure reference from several decades ago even recommends trying to lift a car by its bumper. I guess whatever floats your boat, Superman – just don’t call me when you get a hernia.

Stay curious,

— Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.