Blue Balls: Understanding Epididymal Hypertension

The toughest man alive will experience a weakness in the crotch area.

Pain in the testicles is probably the most debilitating symptom in a young man, and it’s a weakness you can’t train with conventional exercise.

But sometimes, men can experience testicle pain without a hit between the legs.

What if your balls adopt a blueish hue and start hurting after sex?

Is there something wrong with you?

What is blue balls?

Blue balls is the name most people give to epididymal hypertension. It is also known as testicular vasocongestion.

This is a reversible condition that affects men of all ages. It does not have severe consequences and usually happens after sexual intercourse.

Having sex or an erection for a very long time without achieving an orgasm can trigger epididymal hypertension.

What you can see is a bluish tinge in your testicle. Patients often report pain or a sensation of weight between their legs.

Luckily, it is not very common, but blue balls can be disturbing and annoying (1).

Out of curiosity, you may also want to know that a woman can also feel a similar sensation in the clitoris and vulva. It is commonly known as blue vulva.

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If you recently experienced an episode of epididymal hypertension, you probably had the following symptoms (1,2):

A blueish tone in your scrotum

This happens because the blood is temporarily stagnant in the scrotum. It is left without much oxygen and adopts a darker tone.

Pain or a mild discomfort

Nerve terminals detect low oxygen levels as an injury or lesion. They start sending pain signals to the brain, alerting that there’s a problem down there.

Heavy sensation in the scrotum

Sensory nerves are affected too, and the scrotum feels numb. This gives you a feeling of heaviness or weight.

Causes of Epididymal Hypertension

Most patients with epididymal hypertension experienced this problem during intercourse or after having sex.

They probably held their erection for a very long time, and this is what triggered epididymal hypertension.

Upon a man’s arousal, the penis fills with blood, and the testicle blood vessels expand, too. This change leads to increased blood flow, expanding the penis and triggering an erection.

The testicles will also have a slight increase in size. Such an increase is only noticeable in prolonged sexual arousal.

During an erection, the blood is held in the male genitals, and that is why the penis stays stiff. After sperm is released, the blood vessels go back to their standard size, and the blood is released.

But if you didn’t have an ejaculation and keep an erection for an extended period, the blood stays in place, and the oxygen supply starts to go down.

In most cases, men with blue balls experienced this problem after very long foreplay with their partner or after practicing masturbation exercises to delay ejaculation.

Other causes of testicular pain

But what if you experience testicular pain that is not related to sexual arousal? If that’s the case, you may need to rule out other causes. For example (3,4):

Trauma and tight clothing

Naturally, a direct hit in your crotch will trigger very severe testicle pain. But even tight pants can have a similar effect by cutting the normal blood flow to your scrotum.

Testicular torsion

Pain due to testicular torsion starts suddenly, and it is very severe without any previous trauma.

It happens when your testes twist around the spermatic cord. This also cuts down the blood flow to the testicles, and it should be treated promptly by a doctor.


This is inflammation of the testes, which may happen if you’re infected with mumps and other viruses. Some infections may also travel from the urinary tract to the testicles, causing orchitis.


This is similar to orchitis but affects the epididymis instead of the testis. It can be related to a sexually transmitted disease and sometimes improves without treatment.


They are varicose veins located in the testicles. They are similar to hemorrhoids or varicose veins in your legs but concealed inside the scrotum. Thus, you may never see them or feel them.

Still, they cause testicular pain when sitting for a long time. You could also feel a sensation of heaviness in the scrotum.

The symptoms develop slowly over time as the veins become more prominent.

Testicular cancer

Tumors in your testicles are another cause of testicle pain. In this case, the symptom does not appear all of a sudden. It develops over time and becomes worse as time passes.

Other conditions such as kidney stones and diabetic neuropathies may also cause testicular pain.

Should you see a doctor?

People with a diagnosis of epididymal hypertension do not require urgent medical attention. Their symptoms are typically relieved after a few hours or minutes.

However, if you’re experiencing intense pain, it is essential to talk to your doctor about it.

We also recommend speaking to your doctor if this is happening very frequently and affecting your sexual performance (1).

Remember that testicle pain is not only caused by blue balls. This is a rare cause, and more common diagnoses include varicocele and epididymitis.

If the pain is very sudden and intense, look for medical attention immediately because it could be a testicular torsion.

Medical assistance is also required for testicular cancer. So, talk to your doctor if you feel a lump in your testicle and pain that irradiates to other parts of your body.


Epididymal hypertension usually resolves by itself. Thus, not many studies have evaluated the matter further to provide medical treatment.

According to a case study published in the Official Journal of the American Academy of Pediatrics, sexual release can be a successful treatment.

In other words, ejaculating can do the work of releasing tension and bringing back a normal blood flow to the testicles (1,2).

The article also described Valsalva maneuvers as a suitable alternative. They are performed by holding breath, bearing down as if trying to go to the bathroom, then breathing out and straining hard for a few seconds (2).


We’re not the only ones who feel sexual frustration from time to time.

If you’re engaging in prolonged sexual activity, your testicles may rise against sexual tension, giving you blue balls.

The medical name is epididymal hypertension, and it is not a dangerous condition.

It happens when blood pressure increases in the genital area. However, it goes back to normal after ejaculating. 

The symptoms include a blueish color in your scrotum, mild pain, and physical discomfort. It should differentiate from testicular torsion, varicocele, and other causes of testicular pain.

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  1. Ahrendt, D. M., & Roncallo, P. G. (2005). Emergencies in adolescents: Management guidelines for four presentations.
  2. Rockney, R., & Alario, A. J. (2001). Blue Balls. Pediatrics, 108(5), 1233-1234.
  3. Jefferies, M. T., Cox, A. C., Gupta, A., & Proctor, A. (2015). The management of acute testicular pain in children and adolescents. Bmj, 350.
  4. Kumar, P., Mehta, V., & Nargund, V. H. (2010). Clinical management of chronic testicular pain. Urologia internationalis, 84(2), 125-131.

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