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The Physiology of "Blue Balls"
Since this Healthcare Doctor Website (Another Fine
CodeWarriorz Thoughts Information Portal)
deals with a variety of health related topics, I thought I would explain a
phenomenon that
many males can experience at some time in their life, and , because it is an
indeed unpleasant
experience, that this may help those who go through this, understand why they
are having it.
"Blue Balls" is a lay term for a strong, uncomfortable
feeling of pressure in the genitals in general,|
but the testicles particular.
In some ways, it is similar to the type of pressure males
feel when they need to urinate.
Various websites give their explanations of this
phenomenon.
One such site
http://www.askthecouch.com/2_past_template.asp?article=116
gives this explanation:
".The basic
physiology behind blue balls is, during sexual stimulation, the
male's genitals become engorged with blood, including the testicles. Prolonged
stimulation, as in hours, results in the scrotum getting to the point of
actually squeezing the testicles which hurts."
A more formal article on this topic is found at
http://pediatrics.aappublications.org/cgi/content/full/106/4/843
" PEDIATRICS Vol. 106 No. 4
October 2000, pp. 843
EXPERIENCE AND REASON:
"Blue Balls": A Diagnostic Consideration in Testiculoscrotal Pain in Young
Adults: A Case Report and Discussion
"Blue balls" is a widely used colloquialism describing
scrotal pain after high, sustained sexual arousal unrelieved because
of lack of orgasm and ejaculation. It is remarkable that the medical
literature completely lacks acknowledgment of this condition. The
case reported here illustrates that a good history may help make the
diagnosis, offer the possibility of prompt relief, and avoid any
unnecessary evaluation. Clinicians should be aware of this condition
and consider it in the differential diagnosis of scrotal pain.
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CASE REPORT |
A 14-year-old male presented to the emergency department
with a history of severe bilateral scrotal pain of 1.5 hours' duration.
There was no associated nausea or vomiting. The patient denied
fever, chills, or feeling systemically ill. He described the pain as
sharp, stabbing, constant, and unaffected by position. There was no
history of dysuria, urethral discharge, previous urinary tract
infections, trauma, or any history of prior sexual intercourse. The
patient was a reluctant historian.
On further history he noted that 1 week earlier he had
experienced a milder form of this scrotal pain that had resolved slowly
over 2 to 3 hours. In each instance the pain started when he had
been "messing around," engaged in foreplay with his first girlfriend,
kissing and fondling while fully clothed. In neither case did
he ejaculate, and the pain began immediately after stopping foreplay.
On physical examination the patient was alert and
nontoxic. He appeared uncomfortable and in moderately severe pain. Vital
signs were normal, and physical examination was unremarkable except
for diffuse testicular tenderness, increased over the epididymis
bilaterally. Cremasteric reflex was present bilaterally. The urine
analysis was normal. The patient's pain resolved spontaneously
during 1 hour of observation in the emergency department. Telephone
follow-up several weeks later revealed that the patient had begun to
have sexual intercourse with his girlfriend, and no further episodes
of testiculoscrotal pain had occurred.
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DISCUSSION |
A review of the literature was undertaken but no comment
or reference to "blue balls" in any urologic, pediatric emergency
medicine, general emergency medicine, or adolescent medicine textbooks
could be found.1-5 Medical librarians at 3 institutions
conducted separate literature searches. Cross-references were made to
articles in the sexuality literature, adolescent health literature,
and to articles about scrotal pain. The one article found was from a
human sexuality journal.6 The article is nonreferenced and
the information came from "common knowledge and experience."
Specialists in urology and adolescent medicine were
contacted, and although they all knew about "blue balls," their information
was anecdotal and not related to medical training. The great majority
of adult, pediatric, urologic, and emergency physicians, as well
as nurses and nonmedical people informally surveyed, know of this
condition, yet no one was aware of any medical references. Certainly
the urologic and adolescent literature is full of subjects equally
sensitive and potentially embarrassing. What is the pathophysiology
of this condition? Sexual arousal produces pelvic venous dilatation.
Perhaps if this persists and testicular venous drainage is slowed,
pressure builds and causes pain. Is epididymal distention the
cause of the pain? As with any disease entity, there is probably a
spectrum of pain with "blue balls" varying from brief, mild
discomfort to severe, sustained pain, as in the case described.
The treatment is sexual release, or perhaps straining to
move a very heavy object in
essence doing a Valsalva maneuver. In the one article found, the
author talks of straining to lift an immovable object such as a car
bumper. He claims the pain often disappears within 15 to 30 seconds.
Does this work?
How many young men have suffered unnecessary pain and
anxiety if a simple maneuver could bring immediate relief? Is pain always
bilateral? How many patients have had surgery to rule out testicular
torsion or transient testicular torsion where the pain is episodic,
when the true diagnosis was "blue balls"? Is the incidence of
this condition high in age groups starting sexual exploration? The
answer to these questions might easily be obtained with careful
histories and further research. Patient education might be integrated
with clinical research. It would seem logical to incorporate discussions
of "blue balls" into age-appropriate sexual education.
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CONCLUSION |
In summary, "blue balls" is suspected to be common among
young male adults and should be considered in the differential diagnosis
of acute testiculoscrotal pain in such patients. A search of the
medical literature shows a paucity of information for this condition
and suggests that a greater awareness and discussion of this entity
would benefit both physicians and their patients.
Jonathan M. Chalett, MD
Department of Pediatric Emergency Medicine
Mary Bridge Children's Hospital
Tacoma, WA 98415
Lewis T. Nerenberg, MD
The Permanente Medical Group
Kaiser San Francisco
Department of Pediatrics
Kaiser South San Francisco, CA 94080
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REFERENCES |
-
Campbell's Urology. 7th ed.
Philadelphia, PA: WB Sanders Company; 1997
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Fleisher GR, Ludwig S. Textbook of Pediatric
Emergency Medicine. 3rd ed. Baltimore, MD: Williams & Wilkins; 1993
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Barkin RM. Pediatric Emergency Medicine.
2nd ed. St Louis, MO: Mosby-Year Book; 1992
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Tintinelli: Emergency Medicine; A
Comprehensive Study Guide. 4th ed. New York, NY: McGraw Hill Text; 1995
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Neinstein LS. Adolescent Health Care: A
Practical Guide. 3rd ed. Baltimore, MD: Williams & Wilkins; 1996
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McIntrye RV. Relieving male pelvic congestion.
Med Aspects Hum Sexuality. 1989:51
"
Another
site gives this advice:
"Everyone's body manufactures different amounts of semen, and that amount can
change over time, both in the short term and the long term. Perhaps it's true
you're generating a lot of semen right now. However, your semen is not being
stored in the testicles and causing them to ache. (Semen is stored in an organ
called the ampulla; see
Science
Corner, Semen Production & Ejaculation.) The ache is probably from
testicular vasocongestion, known on the street as "blue balls." It usually
results from prolonged arousal that doesn't end in ejaculation. Blood builds up
in your testes when you're aroused, and the blood tends to leave after you
ejaculate. If you don't ejaculate it the blood tends to stay there, causing
discomfort. So for you specifically, if you get this discomfort but you aren't
doing anything in particular to cause arousal (making out, looking at erotic
pictures for a long time, etc.), I'd suggest that you masturbate more often to
relieve the discomfort. If you are in fact causing the condition by getting
aroused but not ejaculating, don't do it if you want to be comfortable and
"save" your semen. Or just continue to masturbate, but when you have sex, hold
off your ejaculation for a while. That will build your semen back up."
Yet another
site says this about "blue balls"
" Blue Balls
Say those two little words to a man, and his face will
tell you what they mean: pain. But what causes that uncomfortable feeling? When
a man is aroused, his testes are filled with blood. If he does not have an
orgasm, the testes can become swollen and tender because of the extra blood. He
may also experience lower abdominal pain if the vas deferens (tubes extending
from the testes to the seminal vesicles) are irritated. This condition is known
as blue balls. The bad news is that it is painful; the good news is that it does
not cause any permanent damage."
OK....THAT'S FOR GUYS...BUT CAN LADIES HAVE A CONDITION
SIMILAR TO "BLUE BALLS"?
" Dear RSA,
I can not understand how women say sex is still fulfilling even when they don't
get off. However, if a guy gets blue balled, he's in a world of hurt. What’s up
with this?
Ryan, West Point
Ryan,
Thanks for asking this question. This is one of the fundamental differences
between men and women and the cause of much misunderstanding on both sides. What
follows is an oversimplified explanation, but basically it boils down to the
fact that there are big differences in male and female physiology and male and
female sexual and emotional response.
From a physiological point of view, because
of the way male sex
organs are constructed, there is a physical imperative for a man to
ejaculate once aroused. Once a guy
gets close to coming, his penis is completely engorged with blood, his testes
have started contracting in preparation for
ejaculation,
and the gateways of his internal plumbing have already started opening in
anticipation of a flood of spunk. All kinds of stuff is happening internally in
order to propel the sperm around the pipes and out into the world, which
requires a lot of force. Your semen has to travel through about two feet of
tubing just to get from your balls to the end of your cock. So a lot of pressure
builds up in there. The next time you bust a nut, take a moment to marvel at the
feat of physics and engineering that your body pulls off to produce the
hydraulic spectacle of a cum geyser.
Female
ejaculation aside, the mechanics of a woman’s orgasm are a lot different.
When a woman cums, her orgasm produces internal, rhythmic muscular contractions
of the uterus and vagina that, from a biological and procreative perspective,
are meant to suck sperm up toward the ovaries so she can be inseminated. If a
woman gets aroused to the point of almost coming, but doesn’t have an orgasm,
the experience may feel physically unsatisfying to her, but it isn’t going to be
physically uncomfortable the way it would be for a man.
So if a woman doesn’t have an orgasm, but
says that sex is fulfilling to her, what the heck is she talking about? Well,
the truth is that most of the time men and women want and expect different
things from their sexual encounters. While both men and women enjoy the physical
pleasure of sex, for most men the goal is primarily achieving a physical
release, whereas for women, the goal is less straightforward. Women get more
into the emotional aspects and implications of sex. For them, being physically
intimate is a way of being emotionally intimate. Many women say that having sex
makes them feel emotionally “bonded” to their partner. This also explains why
men and women often behave quite differently and have different sets of
expectations after having had sex, and why men are usually more
comfortable with having casual sex or one-time encounters. Of course, this is a
broad generalization - men can also be very emotionally engaged during sex, and
sometimes some women just want to get off. But most of the time, most men and
most women are coming from different places as far as sex is concerned.
Understanding those differences can help you both get your respective needs met
while avoiding confusion and hurt feelings. "
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