Penetrating Questions | Come on, honey-if you don't it'll hurt!

Jina Ashline Columnist

I was fooling around with my partner one night, but before we could have sex my roommate came home. My partner left, but as he was going he complained about blue balls. I don’t really know what that means—is it serious?

—Color Confused

Dear Confused,

Not to worry, he’ll be fine! “Blue balls” is a slang
term for prolonged vasocongestion (also known as pelvic congestion), a form of testicular aching that may occur when a man does not ejaculate after being sexually aroused for an extended period of time. Vasocongestion does not have any short- or long-term side effects.

“Blue balls” gets its name from the distinct bluish tinge of the testicles that is commonly seen after a man becomes sexually aroused for an extended period of time. Some males do not actually turn blue, and in fact, it’s not even the testicles that are blue, but the skin of the scrotum.

To clarify, the testicles, or balls, are the two golf-ball sized, oval-shaped organs that are located behind the penis, covered in a “sac” of protective skin called the scrotum. Sperm and testosterone are produced in the testicles, the site of vasocongestion. When a man becomes aroused, blood flows to the penis and the surrounding area, including the testicles. The longer a man is aroused, the longer the blood stays there. The build-up of blood in the testis appears blue through the skin of the scrotum.

Vasocongestion happens every time a man becomes sexually aroused. Blood flows into the genitals, causing the arteries carrying the blood to enlarge while the veins carrying blood from the genitals to the rest of the body constrict. This uneven exchange of blood causes an increase in the volume of blood trapped in the genitals, which creates vascular tension and, when coupled with muscular tension, ensures a sustained high regional blood pressure that allows for an erection. At the same time, the testicles become engorged with blood, increasing in size by an amazing 25 to 50 percent.
If a man ejaculates, the blood flows out of his genitals and back to the rest of his body, and the arteries and veins, the volume of blood in the genitals, and the penis and testis return to their original size fairly quickly. However, if prolonged sexual stimulation of the erect penis does not result in orgasm or ejaculation, the blood flow takes longer to flow out, which may cause a build up of blood and discomfort due to a feeling of heaviness or aching in the testicles, commonly known as “blue balls.”

This happens because the blood and lymphatic fluid tend to pool, and the blood becomes oxygen-deprived. The engorged area of high blood pressure and high blood volume meets the narrowed blood vessels, which can be like trying to force water flow from a faucet through a soda straw. This is uncomfortable and can cause pain in the testis because that’s where many of the genital sensory nerves, which are very sensitive to change, are located. It is important to note that blue balls isn’t a buildup of sperm, as many commonly believe, because sperm simply does not get “backed up” in that way.

Women can also suffer from vasocongestion, and may feel pain in the vulva or general pelvic area. However, this condition is not often discussed due to socially constructed sexist attitudes toward issues relating to women’s sexuality that prevent women from understanding their own bodies. Just as for men, vasocongestion happens every time a woman becomes sexually aroused because the vulva and vagina fill with blood, which creates swelling and other changes. When a woman orgasms and/or ejaculates, the swelling from the vasocongestion is relieved.

Painful vasocongestion is more often a male complaint, but in the event that a woman is in pain she can masturbate (or her partner can masturbate her) to orgasm to relieve the discomfort, or she can just wait for the feeling to subside.

Ignorance toward women’s bodies has left us without a common expression to describe the female equivalent of “blue balls.” Pelvic congestion can refer to the pain that occurs in either sex, but “pink ovaries” is a uniquely female term to describe the experience.

Blue balls tends to be a temporary, minor pain that can be exaggerated because most men have been socialized to ejaculate every time they have an erection. Thus, a failure to ejaculate and to feel an orgasm seems abnormal and uncomfortable. If a man is extremely uncomfortable, he can masturbate to orgasm, but there is no danger if he doesn’t. Masturbation, however, will make the pain and swelling go away because ejaculation increases blood flow through the genitals, dissipating the fluid buildup.

Blue balls has often been used as a way for males to pressure females into having sex by insisting the pain must be alleviated sexually. This, however, is not necessary, and a partner should never feel obligated or pressured to relieve the discomfort.

Vasocongestion is easily taken care of without having sex. Even without orgasm, the symptoms of blue balls usually diminish within an hour, and in rare cases in up to 12 hours. Simply lying down or engaging in non-sexual activity can help ease the pain and make the feeling fade. In addition, a cold or warm compress, a shower or aspirin can help some men. Exercises such as running, walking, climbing stairs or playing sports may also ease the engorgement and aid blood flow. A man’s body will take care of this very temporary condition, just like it would a sore muscle or a physically tired body.

Not every erection has to end in an orgasm or ejaculation. This knowledge should allow men and their partners to relax, explore and learn about pleasure without this expectation.

It should also be noted that some men purposely deprive themselves of an orgasm in order to extend pleasure for both partners, to experience a different kind of pleasure or to enjoy sexual activity longer. In these situations, massaging or using a vibrator on the testicles during extended sexual activity may prevent the blood from pooling, which will prevent or decrease the experience of blue balls.

If the pain of what seems to be blue balls does not go away, there may be a more serious problem. Men with priapism, a potentially harmful condition in which the erect penis does not return to its non-erect state within about four hours after physical or psychological stimulation, or orchalgia, a chronic pain of the testicles that typically lasts for more than three months, may experience an extreme, prolonged form of blue balls that may require medical attention.

Some men who are infected with the sexually transmitted infection lymphogranuloma venereum (a strain of chlamydia) may also experience enlarged lymph nodes in the genitals that become unable to flush lymphatic fluid correctly, causing the area to swell. While it’s not harmful to get blue balls and you don’t need to call 911 for it, if you experience pain in your testicles that lasts for hours or days, extreme swelling, discoloration of the testis, a puncturing of the scrotum sac or testicles, or a persistent pain in the genitals or abdomen, then see a doctor.

In addition, the earliest symptom of testicular cancer is a dull ache or heavy feeling in the lower stomach, scrotum or genital area, similar to the feeling of blue balls, and a painless swelling or abnormal bump in the testicle. About 6,900 men each year develop testicular cancer, most commonly between the ages of 15 and 35. The American Cancer Society (ACS) recommends performing a testicular self-exam each month to identify the early signs of cancer. Check out the ACS Web site for tips on how to perform an exam (cancer.org).

Finally, a good tip for preventing blue balls and pink ovaries is communication! Before getting involved sexually, let your partner know what you want and when you want to stop so you can both be prepared and hopefully avoid reaching the point of pain. Pelvic congestion is normal and not serious, and any discomfort will eventually go away on its own!

—Jiná Ashline ’08 is a religion major with a women’s studies correlate. She is also president of C.H.O.I.C.E. Each week she will answer a question about sex and sexuality. Send your questions to jiashline@vassar.edu or by dropping a note in Box 2172.