We Have Questions: Blue Balls

You've almost certainly heard the phrase "blue balls." But how many of us actually know what blue balls are as a condition?

Do your testes actually turn blue? What does the condition feel like? How does it happen? How do you make it go away?

We chatted with Majdee Islam, M.D., a urologist and men's health specialist at Urology of St. Louis, to find the answers to these aching questions. As it turns out, the condition might be more straightforward than you expect.

Editor's note: The following interview has been edited for length and clarity.

In an actual medical sense, what are blue balls?

Islam: Basically, from a urologic standpoint, blue balls is technically called epididymal hypertension. The idea is, whenever a guy is sexually aroused, there is more blood flow that goes down to the penis than to the testicles. So whenever you get more blood flow down to the penis than the testicles, you get a little bit of congestion. The blood stays down there because blood flow with oxygen goes down and intentionally gets trapped. And that's why you get an erection, because your blood flow is going in and not going out.

However, when you are aroused and you're not able to release that arousal or you're not able to orgasm, ejaculate, etcetera, oftentimes the blood flow stays down there for a longer period of time, which then causes the testicles to become congested. The blood flow causes a little bit of dilation, which causes some discomfort in the testicles.

Then there are some people that'll say there's a bluish hue in the testicles they can see because of that blood flow, which is why they just call it blue balls.

So, essentially, the blood gets trapped in the veins of the testicles. That's where the term 'blue balls' comes from?

Kind of. It's kind of unclear exactly why there's a bluish hue. But, yeah, the idea basically is the faint bluish color is basically from that blood that's not leaving. It's pretty uncommon to actually see the testicles become blue. Mostly, you get that congestion feeling, an achy discomfort in the testicles after not relieving themselves from this arousal.

So ejaculating would help, otherwise, is it just kind of wait and see, wait for the blood to release? How does it go away?

The big thing I always like to tell guys is it's something that's not dangerous by any means. The blood flow being in there is never going to cause any significant harm, whether in the short term or long term. But, you know, the best way to treat it is to achieve an orgasm, whether that's through self-stimulation, masturbation or with a consenting partner.

Also, there's data that shows a guy could potentially take a cold shower or do some kind of non-arousing activity, [such as] exercise. The idea of a cold shower or exercise is that then you're getting blood flow going somewhere else. A cold shower, the body is trying to get blood flow to other important parts of the body because it's cold. And when you exercise, you get blood flow going to the places that you're doing exercise with, like when you're running, to your legs. So it essentially shunts the blood flow to other places. Usually, we tell guys, if for whatever reason you're not going to do something like ejaculate, those are other great ways to treat blue balls.

Could you describe what it feels like? You said it's kind of like an ache, but are there any other symptoms?

Usually, the main symptoms are just kind of mild pain or, you know, ache, or like this testicular, almost heaviness. It's not necessarily like [the person] got kicked in the balls, per se, but it feels like they have had it. An ache, a heaviness, a mild discomfort, essentially, plus or minus this faint, just really, really light bluish color, which is not always there.

And there's no risk or actual danger to blue balls, right?

That's the important part, yeah. There's no risk to it. There's no danger to that epididymal hypertension. There's no potential risk for short-term or long-term damage to the testicles, damage to the penis. The important thing, though, is that it's pretty important to make sure they get checked out at some point, especially if it's not going away after a short amount of time, like an hour or two, mainly because there [are] things that are dangerous that cause pain in the testicles, the most common one being testicular torsion, where the testicle twists on itself. Usually, that testicle will become enlarged; it's extremely tender to touch if there's testicular torsion. But there [are] also other things like orchitis [and] kidney stones that cause that pain.

If it's causing you discomfort that's more severe or it's lasting a longer time, it's important to get checked out just to make sure those other things aren't causing that.

Do any of those conditions have similar symptoms that could make guys think they just have blue balls when it's really something more serious?

Great question. And, yeah, it is exactly that. Usually, with blue balls, it's going to be this mild discomfort or kind of that heaviness or whatever. But things like, most importantly, testicular torsion, an infection like epididymitis, orchitis, sometimes kidney stones, even sometimes testicular cancer can cause usually one-sided testicular pain, swelling, a hard area in the testicle.

If a guy's having that discomfort and there's any question, or if it seems like it's lasting more than that short amount of time, an hour or two, or if they do the things like take a shower, exercise, ejaculate and then they're still having that pain, it is important to try to get that checked out sooner rather than later.