Testicular Congestion Syndrome (A.K.A. “Blue Balls”): What You Need To Know

Andrew Siegel, MD   3/11/17


“Blue balls,” a.k.a. “lover’s nuts,” is a commonly used colloquialism describing a malady marked by testicular and scrotal pain occurring after prolonged sexual arousal and stimulation without sexual climax.  Today’s entry explores this not uncommon situation that virtually every adult male has experienced at one point in his lifetime. The typical scenario is prolonged foreplay that ends there, with all arousal and no ejaculation. It’s like a stifled sneeze.  Thank you, Pixabay, for image above.

The sexual research by Masters and Johnson showed that the primary reaction to sexual stimulation is an increase in blood flow known as vaso-congestion (with the secondary reaction being an increase in muscle tension).  Orgasm is defined as the release from the state of vaso-congestion and muscle tension. If prolonged sexual stimulation occurs without ejaculation—congestion without decongestion—congestion does not dissipate, which can result in what is commonly known as “blue balls.”

The physiology of “blue balls” is as follows: With sexual arousal, there is increased arterial inflow of blood to the genital region, while the veins—which carry blood away from the genitals back to the heart—constrict, resulting in blood trapping that causes penile erection.  With the arousal process and the increase in genital blood flow, the testicles as well become somewhat swollen and turgid. With continued sexual stimulation in the absence of orgasmic resolution there is insufficient drainage of blood from the genitals resulting in further engorgement. The “blue” in “blue balls” describes a bluish tint that is related to venous engorgement. This tint is exactly the same as the bluish tint seen in the veins of your hand.  In addition to venous congestion, there is likely a contribution from sperm under pressure in the testicle and epididymis (structure above and behind testes where sperm are stored and mature), a condition known as “epididymal hypertension.”

Testicular congestion is a painful and frustrating condition, causing a tense, heavy, pressure-like, weighty discomfort and ache in both testicles. It feels as if someone is squeezing the testicles—a very unpleasant sensation. This situation begs for sexual release, after which the congestion and pain generally rapidly dissipate. If this does not happen with partnered sex, masturbation is the key to rapid relief.

Bottom Line (summarized poetically):   Blue balls are real…and a cure is coming.

Wishing you the best of health,

2014-04-23 20:16:29


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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com



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One Response to “Testicular Congestion Syndrome (A.K.A. “Blue Balls”): What You Need To Know”

  1. Delayed Ejaculation: Serious Shortcomings (Despite What You May Think) | Our Greatest Wealth Is Health Says:

    […] arousal and erection without ejaculation can sometimes result in testicular congestion, a.k.a. “blue balls,” a condition in which the testes become swollen, painful, and bluish in tint because of venous […]

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