“Blue balls” is a term familiar to most people, including healthcare providers. It refers to the discomfort or pain experienced in the scrotum due to prolonged sexual arousal without orgasm. While the exact cause of the pain is unknown, it is believed that the slowed drainage of blood from the testicles in the absence of orgasm during sexual arousal is responsible. Sexual arousal involves increased blood flow to the genital area, leading to engorgement of the genital structures, which resolves quickly after orgasm. However, in the absence of orgasm, the increased blood flow takes longer to return to a non-aroused state, resulting in discomfort or pain in some individuals. The genitals may also take on a blue hue due to the lingering presence of deoxygenated blood under the skin.

Despite the widespread use of the term “blue balls” and the abundance of information available online, there is surprisingly little research on this phenomenon in medical journals. A recent survey conducted in 2021 by the Science Vs podcast team, in collaboration with a research team, aimed to examine who experiences discomfort during sexual arousal without orgasm and the consequences of this experience.

The Issue of Sexual Coercion

The survey results revealed that “blue balls” are not limited to individuals with a scrotum, as sexual arousal occurs in all bodies, as long as there are no obstacles to physiological sexual response. Just over 42 percent of participants with a vulva reported experiencing discomfort resulting from sexual arousal without orgasm, while 56 percent of respondents with a penis reported this experience. Furthermore, the discomfort and pain experiences were overall mild and infrequent, which is consistent with the lack of medical research and clinical attention to this topic.

However, the survey results also revealed a concerning issue of sexual coercion. Significantly more participants with a vulva (40.1 percent) than with a penis (3.7 percent) reported pressure to engage sexually in this situation. Sexual coercion involves actions like begging, pleading, and making someone feel guilty about the pain or that it is their fault that the pain is there. Pressure to engage in sexual activity in response to pain without orgasm is a form of sexual coercion, which is associated with negative outcomes in terms of health and well-being, such as increased risk of depression and anxiety, low self-esteem, and negative sexual self-perceptions. Sexual activity in response to coercion certainly does not conform to enthusiastic and freely given sexual consent.

There has been a recent discussion about sexual coercion in response to “blue balls” on TikTok, where it was claimed that men use it as a ruse to convince partners to engage sexually with them. This has resulted in an uproar, with many people recounting experiences of continuing sexual activity out of guilt to prevent their partner’s pain. While the survey results showed that many participants reported in their own words that the experience of pain without orgasm should never be used as a coercive tactic, almost half of the participants, mostly women and some men, reported pressure to engage sexually.

It will take effort to change ideas related to sexual expectations in our society, many of which are gendered. The traditional sexual script, which emphasizes heterosexual men’s pleasure, is a guideline for “appropriate” sexual behavior in heterosexual couples. The orgasm gap, defined as the higher orgasm frequency in heterosexual men as compared to heterosexual women during partnered sexual activity, is only one example of the real-life manifestation of this privileging of men’s sexual pleasure. Sexual coercion in response to pain due to sexual activity without orgasm is another example. It has been shown to occur in men who have sex with men as well.

Our research has found that there are plenty of things that can help with the pain that does not involve coercion, including masturbation, waiting it out, cold or heat application, and engaging in nonsexual activities such as exercising, sleeping, or studying. It is time to take the management of this pain into your own hands, so to speak, as it will pass, and it is not a valid excuse to implicate unwilling others in its resolution.

While the phenomenon of “blue balls” is a real experience for some individuals, it is not limited to those with a scrotum. The discomfort and pain experiences are overall mild and infrequent. However, the issue of sexual coercion related to this phenomenon is a concerning one. It involves pressuring someone to engage in sexual activity in response to pain without orgasm, which is a form of sexual coercion. It is important to change ideas related to sexual expectations in our society, many of which are gendered, and to find ways to manage the pain that do not involve coercion.

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