Epididymal Hypertension (Blue Balls)

Epididymal hypertension, or "blue balls" is a widely-used term describing scrotal pain caused by high, sustain sexual arousal unrelieved because of lack of orgasm and ejaculation.1

What Causes Epididymal Hypertension?

When individuals with male sexual organs are aroused, the blood vessels to the penis and testicles expand allowing a greater volume of blood flow. Over time, this blood causes the penis to expand and stiffen, leading to an erection.2 The testicles also increase in size, causing them to feel heavier. Typically, the blood in the penis causing the erection is released after orgasm, or as a result of decreased physical arousal. Excessive blood may stay in the genital area of some individuals who become aroused for an extended period without a release or decrease of arousal. This may cause pain and discomfort for some. The testicles may even start to turn blue due to the excess blood and increase in blood pressure.2 If an orgasm is achieved, the blood vessels will return to their normal size and the volume of blood in the genitals quickly returns to its normal level. By contrast, if a male does not have an orgasm, blood in the genitals builds up through a process called vasogongestion and may create sensations of heaviness, aching, or discomfort.


The reason this condition is termed “blue balls” is that the scrotum may turn a bluish hue from the accumulation of deoxigenated blood in the testicles. Oxygen rich blood on the surface of the skin creates a red color, while blood with little oxygen appears blue. The longer blood stays in the testes and scrotum without circulating to the heart and lungs, the less oxygen it obtains and the more blue the skin appears.

 Epididymal hypertension usually does not last long and often the pain associated with blue balls is minor. Some males may become frustrated when they get an erection during sexual activity, but do not achieve orgasm. This frustration and failure to ejaculate can add psychological stress to physical discomfort, making blue balls seem even worse. Males who feel pressure to ejaculate every time that they are aroused may attempt to coerce an unwilling partner into participating in sexual activity leading to his own climax. Consent is an important aspect of every sexual encounter and all partner(s) should always give informed consent.

How is Epididymal Hypertension Treated?

Many urologists suggest watchful waiting for patients with mild symptoms and/or transitory. Empathy and reassurance can make some individuals more comfortable and may relieve some pressure. Medical treatment regimens for patients with chronic epididymitis do not exist at this time.3 The simplest remedy for blue balls is orgasm and ejaculation. Masturbation is often the most viable way to achieve this orgasm, especially if one's partner does not want to have sex. Testicular pain may dissipate slowly after orgasm, or on its own once the individual is no longer aroused. Realizing that ejaculation is not a requirement for all sexual situations can help partners become more comfortable together and can allow them to experience better sexual intimacy. Females can also be affected by pelvic congestion, or “blue vulva”, and they may alsoexperience the discomfort of unreleased vasocongestion. During sexual arousal females’ vulva, uterus, and ovaries swell with blood, causing the same feeling of heaviness and aching that males experience in their genitals. This discomfort in females can also be relieved by having an orgasm or merely waiting for a period of time.4 Note that the term “blue vulva” or the generic term “pelvic congestion” is different than “pelvic congestive syndrome”. Pelvic congestive syndrome, unlike blue vulva, is a condition where enlarged varicose veins cause chronic aching in the pelvic region. The pain or discomfort one experiences from pelvic congestive syndrome (PCS) cannot simply be relieved through orgasm. If the pain associated with PCS does not discipate, embolization procedures are often conducted. An embolizarion is a minimally invasive, outpatient procedure where a patient is placed under local anesthesia and a physician inserts a thin catheter into the femoral vein of the groin to relieve pressure. Other non-surgical treatments for PCS may include physical therapy or electrical nerve stimulation. Please see our article on pelvic congestive syndrome for more information.


Concluding Remarks

Epididymal Hypertension, or “blue balls” is common among young male adults, and its occurence should not be stressed over to an extreme extent. Recent medical literature suggests that a greater awareness and discussion of this topic would benefit both physicians and their patients, and further research is necessary to try to understand the full extent of epididymal hypertension.1 Typically, there is no need to see a doctor or clinician about epididymal hypertension. If this condition is causing intense pain regularly, or if it is affecting your sexual performance, you may want to talk to a doctor or a sexual therapist.2



  1. Chalett, J. M., and L. T. Nerenberg. “‘Blue Balls’: A Diagnostic Consideration in Testiculoscrotal Pain in Young Adults: A Case Report and Discussion.” Pediatrics, vol. 106, no. 4, 2000, pp. 843–843., doi:10.1542/peds.106.4.843.
  2. Duggal, Neel. Guide to Epididymal Hypertension (Blue Balls), edited by Daniel Murrell, Healthline Media.
  3. Nickel J. C. Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma. Reviews in Urology. 2003;5(4):209–215
  4. Sissons, Beth. “Blue Balls (Epididymal Hypertension): Myths and Facts.” Medical News Today, MediLexicon International.

Last Updated: 14 April 2019.