Are Blue Balls Really a Thing? Epididymal Hypertension 101

Written by
The Manual Team
Medically approved by
Dr Earim Chaudry
Last updated
18th May 2021

In 30 seconds…

“Blue balls” is the slang term for a condition called epididymal hypertension (EH). EH is characterised by pain and discomfort in the testicles when a man has a long-lasting erection without ejaculating.

The condition is most common among teenage boys who are starting to sexually experiment, but it can happen when you are older too.

EH isn’t dangerous and usually doesn’t require medical treatment. The quickest way to ease the pain is by masturbating to orgasm.

The term “blue balls” has long been used by guys to express sexual frustration. But did you know that it’s also the colloquial name for a real condition: epididymal hypertension (EH)?

EH refers to the pain and discomfort in the testicles sometimes experienced by men when they get an erection but don’t ejaculate. It’s particularly common among teenage boys who are experimenting with sex and masturbation for the first time.

In this article we take a look at EH and the key facts you need to know about it, including causes and treatment. We also explore other reasons behind painful testicles and when you should see a doctor.

What is Epididymal Hypertension?

EH is a sometimes painful but temporary condition that can follow an erection which doesn’t lead to orgasm. The symptoms of EH include aching, heaviness, and discomfort in your testicular area. You may also find a slight blue-ish tinge develops in the skin of your testicles.

While widely discussed, little scientific research has been published regarding the condition. A study from the journal Pediatrics looks at the case of one particular 14-year-old boy with suspected EH, but the researchers did not come to a firm conclusion.

What Causes Epididymal Hypertension?

To understand EH, you need to understand the mechanics of an erection. When you get aroused, your brain sends nerve signals that cause the blood vessels carrying blood to your penis to expand. This allows more blood to flow into the tissues in your penis, causing it to become larger and firmer. In addition, your muscles close in on the veins carrying blood out of your penis, so that more blood stays inside it. Result: an erection.

EH is thought to occur when a man has an erection for a long time without the release of orgasm. The ongoing pressure of the blood filling the penis can cause feelings of heaviness and aching in the area of the testicles. Also, it’s possible that during a long-lasting erection some of the oxygen in your blood can be absorbed into your genital tissues. That’s what then gives a blue tinge to the testicles – hence “blue balls”.

Finally, some of the pain caused by EH may be the result of pressure building up in the epididymis (the tube that carries semen), which happens when you don’t ejaculate and expel any semen.

How is Epididymal Hypertension Treated?

The good news is that EH isn’t a dangerous condition and there are a few things you can do to help reduce the pain. It’s unlikely that you’ll need to visit your doctor, unless you’re experiencing regular intense pain in your testicles. In that case, you should seek medical advice because you might have a more serious medical condition (see below).

The most tried and tested method to relieve EH is simple: have an orgasm. Naturally, that does not mean you should put pressure on any partner to have sex; masturbation would be the first port of call.

If ejaculation isn’t possible or appropriate when you’re experiencing EH, you can try to reduce your arousal as quickly as possible. That might involve the traditional cold shower, thinking non-erotic thoughts, or distracting yourself with some other activity. It’s also thought that exercise could help too, as this may divert blood from the penis to the muscles. 

Other Reasons Behind Painful Testicles

Persistent pain in your testicles shouldn’t be ignored, especially if you have any other symptoms such as: a lump in either testicle, one or both of your testicles has become enlarged, you have a dull ache in your whole groin area, or you experience pain in your lower back. These could be signs of a more serious health problem.

Medical reasons for painful testicles include:

  • Epididymitis-orchitis – inflammation of the epididymis and testicles, often caused by mumps or an STI
  • Diabetic neuropathy in your groin area
  • Testicular torsion – twisting of a testicle: requires urgent surgery to treat
  • Testicular cancer
  • Kidney stones
  • Varicocele – when the veins in the testicles become enlarged

So although EH isn’t a dangerous condition, it’s a good idea to take note of any strange sensations or changes in your testicles, as they might be signs of another health problem.

Key Takeaways…

Epididymal hypertension or “blue balls” can affect men, particularly young men, when they get an erection without ejaculating. However, it’s nothing to worry about and, usually, it’s simple to ease the pain yourself by masturbating to orgasm.

There’s no need to see your doctor unless you’re experiencing regular intense pain, or if you have other symptoms in your genital area. In that case, seeking medical advice is a sensible course of action.


  1. Jonathan M. Chalett and Lewis T. Nerenberg (2000). “Blue Balls”: A Diagnostic Consideration in Testiculoscrotal Pain in Young Adults: A Case Report and Discussion:

While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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