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The agonizing pain known as blue balls is well known to just about any man who was ever a teenager, an ache caused by prolonged arousal without release — a condition often referred to by urologists as epididymal hypertension. But what causes this syndrome? Although anecdotal evidence suggests that epididymal hypertension is fairly common (especially in adolescent men) there is for some reason a remarkable dearth of peer-reviewed scientific literature on the topic. Case reports and speculative essays have been published, but a universally agreed-upon understanding of the mechanism is still lacking. According to one speculative paper published in Medical Hypotheses: Dr. Abraham Morgentaler, an associate clinical professor of urology at Harvard Medical School, gave a layman’s explanation in a post for BuzzFeed Health: Two things are thought to be going on. First, the increase of blood to the penis, caused by the restriction of outflowing blood, fills a penile chamber called the corpus cavernosum, which in turn puts more pressure on the various tubes directing various fluids flowing through that region. The second factor, most agree, is that the production of seminal fluid puts even more pressure to expand (epididymal distension) within these already compressed tubes, and this can build up in a painful way absent an ejaculatory release. This is described in an October 2000 case report — the first ever peer-reviewed study of blue balls — of a 14-year-old male presenting with testicular pain: There appears to be some disagreement among medical professionals regarding the blue part of blue balls. Morgentaler, speaking to Buzzfeed, proffered this explanation for the name: Speaking to Men’s Health magazine, however, Weill Cornell urologist Richard K. Lee suggested a slight tint of blue may be possible, but likely not without additional confounding issues: Blueness aside, the existence of the potential for discomfort is well-accepted. It has also, however, become a hot-button issue in sexual politics, as pain caused by foreplay without release has sometimes been employed by men or adolescents as a tool to guilt a partner into further sexual activity (I could die!). Such a tactic, while objectively immoral, also relies on the false assumption that there are actual long-term health risks associated with blue balls. The consensus is that, save the coincidental occurrence of a testicular torsion, there are no long-term complications from the discomfort. In the 2000 case report, the authors suggested it could be remedied through sexual release or a dubious heavy lifting mechanism, which not only sounds like it potentially adds insult to injury, but also nimbly dances around the concept of masturbation altogether. This point was not lost on a number of published letters in response to the report bemoaning the fact that the easiest solution was not explicitly stated: If masturbation isn’t your jam, Morgentaler has another easy solution: Just give it some time, rest a bit, and it will go away on its own. Perhaps these simple solutions are why there is such a dearth of scientific research into the ailment.
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