“Oh, my aching balls!” -Blue Balls

“Oh, my aching balls!” A comment that every young man makes or thinks when he is engaged in heavy sexual activity and his testicles are causing aggravating pain and discomfort. This blog will describe the condition and what can be done to relieve the discomfort.

‘Blue balls’ is the popular slang term for vasocongestion in the testicles. The testicles do not actually turn blue. Instead, a bluish tint appears on the skin of the scrotum because of the increase in blood supply to the area that is trapped there by constriction of the venous blood vessels giving the bluish discoloration. However, this may not happen in all young men.

Cause and Symptoms
When a sexually-matured male is aroused, the following happens:
• His parasympathetic nervous system increases its inputs, causing an increased flow of blood and lymphatic fluids to the genital area.
• Concurrently, muscles that control fluid outflow constrict, resulting in a net increase of fluid concentration.
• These actions combine to ensure that regional blood pressure is high enough to sustain an erection for penetration during sexual intercourse.
• During this process, the testicles also increase in size by about 25 – 50 percent.
When the male reaches orgasm and ejaculates, the constricted muscles relax and the additional fluids flow out from the genital area. The penis and testicles then return to their normal size.
However, when there is prolonged sexual arousal without eventual ejaculation, the bodily fluids will pool, causing congestion in the testicles and the prostate region. The blood becomes oxygen-deprived and turns bluish, giving the condition its slang term, blue balls.
The technical term for this condition is vasocongestion, which is often accompanied by a cramp-like ache at the lower abdomen, pain and tenderness of the testes, and a lingering sensation of heaviness and discomfort in the lower body.
The female homologue is usually referred to by the more general term ‘pelvic congestion’ or ‘pink ovaries’.

Treatments
Vasocongestion does not cause any short- or long-term physical harm to the person, and neither is it contagious or infectious. Although it can be very uncomfortable, it is definitely not life-threatening or an emergency. Even if nothing is done, the symptoms usually subside within an hour of onset.
If one is eager for a quick relief, the easiest way is through ejaculation, i.e., masturbation or enough genital stimulation that results in an orgasm and ejaculation. That will jump-start the parasympathetic nervous system, decreasing the blood flow through the genital area and dissipating the build-up of fluids.

Bottom Line: Blue balls is not a serious condition. However, if the symptoms last for several hours or days after sexual arousal has ceased, then do consult a health care professional to be certain that there is not an underlying cause(s) of the pain and discomfort.

Blue Balls-When It Hurts Down There During Sexual Activity

Nearly every young man has had the experience of intense sexual stimulation and an aching sensation in his testicles. It is common in young men just experiencing sexual activity and has been a source of pain and discomfort for nearly every man who embarks on his sexual career.

Blue balls is a slang term referring to testicular aching that may occur when the blood that fills the vessels in a male’s genital area during sexual arousal is not dissipated by orgasm and ejaculation.

When a man becomes sexually excited, the arteries carrying blood to the genital area enlarge, while the veins carrying blood from the genital area are more constricted than in the non-aroused state.

The good news is that this uneven blood flow causes blood to be trapped in the two chambers of the penis resulting in the penis becoming erect. This increase of blood supply to the testicles and the trapping of blood around the testicles because the outflow of blood has been decreased causes vasocongestion or engorgement of the testicles resulting in an increase in size of the testicles by 25-50 percent. This distension of the testicles results in the pain and discomfort referred to as blue balls.

If the male reaches orgasm and ejaculates, the arteries and veins return to their normal size, the volume of blood in the genitals is reduced and the penis and testicles return to their usual size rather quickly.

If ejaculation does not occur there may be a lingering sensation of heaviness, aching, or discomfort in the testicles due to the continued vasocongestion.
The condition usually does not last long and the level of pain associated with blue balls is usually minor and can be exaggerated. Most men have been socialized to ejaculate when they get an erection during sexual activity. Failure to ejaculate and to feel orgasm often adds frustration and disappointment to the reality of the physical sensation.

Men who believe that they should ejaculate every time they have an erection are likely to exert pressure on their partner to proceed with sex without taking her feelings into consideration.
Some men find that masturbation is a viable solution and are realizing that ejaculation is not a requirement in every sexual situation. This attitude allows both men and their partners to relax more and to learn that pleasure and meaning can exist without having to reach ejaculation and orgasm during every sexual encounter.

It’s nice to know that men are not alone with this problem as it impacts both sexes. Both men and women experience the discomfort of unrelieved vasocongestion. Women’s genitals also become engorged with blood during sexual arousal and, like their male counterparts, women can experience pelvic heaviness and aching if they do not reach orgasm.

Libido Letting You Down? Solutions to That Problem

For men, Libido is your sex drive and it is different from ability to get an erection or be able to achieve a successful pregnancy. Women’s libido is also different from orgasm or her ability to have an egg unite with a man’s sperm. In women, gynecologic conditions may make engaging in sexual intimacy difficult or painful and ultimately impact her libido.

Libido is the name Freud gave to our sex drive. Libido is a multifactorial situation which is influenced by hormones, psychological and physical factors, romance, and the opportunity for fulfillment. It is normal for libido to decline with age going much faster for women after menopause than for men in middle age, which has about a 1% decline each year. But nearly all couples in their 60s and 80% of couples in their 70s continue to find enjoyment with engaging in sexual intimacy.

Hormonal deficiency is a common cause of deteriorating sex drive in both men and women. The solution is very simple and consists of replenishing the deficiency with testosterone in men and estrogens in women. However, hormones won’t solve the problem if there is some other underlying reason for the sex drive going into the tank.
So what is a man and a women with a loss of severe decrease in their sex drive to do? If you are suffering from fatigue, your sex drive deficiency may be a result of anemia, thyroid deficiency, or kidney disease. A few blood tests will make the diagnosis and help your doctor put your libido back on track.

Next talk to your doctor about all of your medications including, over the counter medicines, herbal medications and supplements. If the problem is related to medications, you can usually note the onset of libido problems that occurred shortly after staring a medication that can plummet your sex drive.

If you have heart disease or have suffered a heart attack and you or your partner is fearful that sex will worsen your cardiac problem or cause another heart attack, speak to your physician. A good rule of thumb is that if you can climb two flights of stairs without chest pain or severe shortness of breadth, then it is probably safe for you to engage in sexual intimacy with your regular partner.

If you are a woman and are going through the menopause, that doesn’t mean that you have bury your sex life forever. As a matter of fact, menopause for many women enhances their sex life as they are no longer worried about conception and fear of pregnancy. Some women do lose their sex drive after menopause and this may be a result of estrogen deficiency. Talk to your doctor about hormone replacement therapy.

I suggest that if you are a woman, try estrogen first. That works for most women as it reduces their hot flashes and pumps up their libido. However, testosterone may also be effective for women in small doses as it is for men who require larger amounts of testosterone in order to restore their libido. Testosterone is available for men and women in a topical gel or a small rice-sized pellet inserted under the skin and replaced every four to six months.

Women may lose interest in sex after menopause because of vaginal dryness (VD). This VD isn’t treated with antibiotics but with topical estrogen creams or vaginal rings impregnated with estrogen or vaginal pellets of estrogen. If a woman can’t take estrogens, then there is always lubricating creams and jellies such as the old standby, K-Y Jelly that alleviates VD and the discomfort associated with the loss of lubrication.

If you are a man and are suffering from erectile dysfunction (ED), this may also impact your sex drive as well. Certainly check your hormones because if low testosterone is the problem, then replacement therapy with gels, injections, or pellets will restore your sex drive 85% of the time.

For both men and women: get lots of exercise. Regular exercise promotes good health. It not only makes you feel good all over, but restores the blood supply to the pelvic area in both men and women.

How about aphrodisiacs?
You will probably receive unsolicited E mails and mail from companies offering an improvement in sex drive and creams and lotions to make a man’s penis bigger. Absolutely none of these studies have withstood scrutiny by medical professionals and probably are a waste of your time and hard earned money. I am an amateur magician and what they have to offer would be real magic if they worked the way the marketing materials described. A loss of sex drive has a problem since the beginning of recorded history and every society and culture have been looking for the magic elixir or potion that can restore the fountain of youth. The ancients have ground up dried beetles (Spanish fly) and rhinoceros horns but to no avail, except that Spanish fly can make you sick. Included in the myths of aphrodisiacs include oysters. They, too, will not restore a man’s libido or potency. According to the FDS, there is no scientific proof that any over the counter aphrodisiacs work to treat decreased libido problems. According to Dr. Ruth Westheimer, “The largest sex organ is not between our legs but between our ears.”

A few words about Viagra, Levitra, and Cialis. These are prescribed medications for the treatment of ED and will not resolve problems with libido or sex drive. The drugs are very effective for ED but will not cure loss of sex desire.

Bottom Line: Problems with a man or woman’s libido is common to many middle aged men or women. Many of the problems are related to hormone deficiency and can be effectively treated.

When You Have A Tack In Your Sack-Chronic Testicular Pain

Chronic Testicular Pain

Chronic testicular pain is a common malady causing havoc in men with this problem. The pain can be so debilitating that men lose productivity in the work place, have sexual problems and even depression that requires treatment. Men often have anxiety about cancer. Chronic testicular pain is also called orchialgia, orchidynia, chronic pelvic pain syndrome, or chronic scrotal pain syndrome. These are all terms used to describe intermittent or constant testicular pain.

Chronic testicular pain occurs at any age but the majority of the patients are in their mid to late thirties. The pain can involve one or both testicles. The pain can remain localized in the scrotum or radiate to the groin, perineum, back or legs. On clinical examination the testis may be tender but in the majority of men is otherwise unremarkable.

Causes of orchialgia include infection, tumor, testicular torsion, varicocele, hydrocele, spermatocele, trauma and previous surgical procedures such as a vasectomy.

Any organ that shares the same nerve pathway with the scrotal contents can present with pain in this region. Pain arising in the kidney, hip, prostate gland or back pain caused by a herniated disc can present as testicular pain. Injury to nerves following a hernia repair can cause chronic testicular pain. Chronic testicular pain has been recognized as a feature of diabetic. Some men attribute the start of their chronic testicular pain to some form of blunt injury to the testicles. Unfortunately in a large proportion of patients the cause of their pain remains unknown.

Post vasectomy chronic pain syndrome
It is not common but there is a possibility that following a vasectomy an obstruction or congestion of the vas or in the epididymis may be the cause of the pain.
If the man has an injection of local anesthetic, such as xylocaine, prior to cutting the vas, this may reduce both immediate and long term post vasectomy pain.

The formation of spermatic granuloma following a vasectomy has been well documented but its protective or causative role as been controversial.

Testing
Scrotal ultrasonography is usually part of the evaluation of patients with scrotal pain. However, in the absence of significant clinical findings during physical examination and in the presence of negative urinalysis, the only real benefit of scrotal ultrasound is reassurance to the patient worried about cancer

Treatment
Surgery is to be avoided if possible. Even if infection has not been identified a small number of patients may respond to a combination of antibiotics and non-steroidal anti-inflammatory drugs. Tricyclic antidepressants, such as imipramine, sometimes relieve the pain. Those with intractable symptoms may benefit from a multidisciplinary team approach involving a urologist and a pain clinic specialist including a psychologist. Transcutaneous electrical stimulation or TENS analgesia often have favorable results. This works on the principle that transcutaneous electrical stimulation causes release of endorphins in the nerves of the spinal cord that supply the scrotum.

A spermatic cord block with a local anesthetic such as xylocaine can be done in the doctor’s office. The procedure, if successful, can be repeated in regular intervals.

For patients who fail to respond to conservative management and wish to avoid the surgical options that are available in treating chronic orchialgia, a trial with an alpha blocker might be an option.

For patients in whom all medical treatments have failed and testicular pain continues to impair their quality of life, surgical intervention may be indicated as a last resort. A number of surgical strategies have been described.

Microsurgical denervation of the spermatic cord may provide relief of chronic testicular pain. Another technique is to divide the ilioinguinal nerve and its branches.

Removal of the epididmymis or epididymectomy should be performed only if the patient had been counselled regarding the likelihood of poor results.

Vasectomy reversal
Putting the vas back together or a vas reversal has helped a number of men with chronic testicular pain.

Unfortunately a small number of patients who fail to respond to medical or more invasive treatment will ultimately undergo removal of the entire testicle for pain relief. This procedure must be the last resort.

Bottom Line:
Chronic testicular pain remains a challenge to doctor as well as the patient.
Help is usually available with medication, nerve stimulation with TENS, and only surgery as a last resort.

Pain in the Pouch- Scrotal Pain May Be Coming From Somewhere Else

By far, most causes of pain in the pouch is from the testicles and the epididymis, the gland behind the testicle where sperm are nurtured and mature. But there are other causes of scrotal pain that must be considered and which have different treatments.

Testicular tumors do not usually cause pain, but it is possible. Since testicular cancer is common in young men (between the ages of 18 and 32) and is often cured if treated early, prompt medical attention to any lump is important. If you feel something down there that is new or is hard, see your doctor right away.

Inguinal hernia—An inguinal hernia is part of the intestines which protrudes through the inguinal canal (passageway connected to the scrotum). Inguinal hernia is suspected if swelling or pain above the scrotum worsens with coughing, sneezing, movement, or lifting. This condition is fairly common, especially in young boys, and it occasionally causes pain in the scrotal area. Premature infant boys have the highest risk for inguinal hernia. This condition usually results from an abdominal wall weakness present at birth, but symptoms may not appear until adulthood.
Hernias do not resolve without treatment and may cause serious complications if not treated. Hernia repair surgery is usually required to treat this condition. Often this surgery can be done through a laparoscope which consists of a several pencil sized openings in the lower abdomen. Most men can go home the same day of the surgery and resume all activities, including heavy lifting in 3-4 weeks after surgery.

Pudendal nerve damage (neuropathy), also called “bicycle seat neuropathy,” may cause numbness or pain. Pudendal nerve damage can result from the pressure of prolonged or excessive bicycle riding (e.g., competitive cycling), especially improper seat position or riding techniques are used. Special bicycle seats have been designed to decrease pressure on the area between the scrotum and the rectum, potentially preventing or resolving this problem. Pudendal neuralgia is the painful type of this nerve damage. Sometimes called “cyclist’s syndrome,” pudendal neuralgia is painful inflammation of the pudendal nerve. The pudendal nerve carries sensations to the genitals, urethra, anus, and perineum (area between the scrotum and anus), so the pain can be felt in any of these areas. Pain can be piercing and is more likely to be noticed while sitting. If untreated, nerve damage can lead to erectile dysfunction or problems with bowel movements or urination, such as involuntary loss of feces or urine (e.g., urinary incontinence).

Narrow bike seat can cause pudendal nerve injury

Surgery—Temporary testicular pain and swelling can be expected after surgical procedures in the pelvic area, such as hernia repair and vasectomy. Post-surgery pain that lasts longer than expected should be reported to a physician. Chronic or recurring pain may be the result of a surgical complication or an unrelated problem, and may need treatment.
Kidney stones—Stones usually cause abdominal pain, but the pain radiates into the testicular area in some cases. Intense, sudden, and severe pain in the scrotum that cannot be explained by a problem in the scrotum may be caused by kidney stones.

Swelling with mild discomfort—Conditions that cause swelling in the scrotal area also may occasionally result in mild discomfort. These conditions include varicocele, hydrocele, and spermatocele. Many cases are benign (mild and non-threatening), but swelling and discomfort in the scrotal area should be addressed by a doctor. If a hydrocele (an abnormal fluid-filled sac around the testicles) becomes infected, it can lead to epididymitis, which can cause severe pain.
Unrelieved erection—An erection that does not end in ejaculation sometimes can cause a dull ache in the testicles. This minor ache, commonly called “blue balls,” is harmless and usually goes away within a few hours or when ejaculation occurs.

Bottom Line: Scrotal pain is common condition that usually involves the structures in the scrotum. However, there are other conditions that can cause scrotal pain. If your doctor evaluates these other causes of scrotal pain, effective treatment can relieve the discomfort.

When It Really Hurts Down There-Epididymitis

When men experience a painful testicle, it can be frightening and a source of not only pain but anxiety as most men associate the testicles with pleasure and reproduction. This article will discuss a common cause of pain in the scrotum and what treatment options are available.
Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms of epididymitis. Epididymitis is most common in men between the ages of 14 and 35.
Epididymitis is most often caused by a bacterial infection or by a sexually transmitted disease (STD), such as gonorrhea or chlamydia. In some cases, the testicle also may become inflamed.
Epididymitis symptoms include: Testicle pain and tenderness, usually on one side, painful urination, painful intercourse or ejaculation, chills and fever, a lump on the testicle, discharge from the penis especially if the cause is from a STD, and discoloration of the semen.

Location of Epididymis On Top and Behind the Testicle

Causes
Epididymitis has a number of causes, including: STDs, particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men. Boys, older men and homosexual men are more likely to have epididymitis caused by a nonsexually transmitted bacterial infection. For men and boys who’ve had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection. Epididymitis may be caused by urine going backward into the epididymis. This is called chemical epididymitis and may occur with heavy lifting or straining.

Diagnosis
Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.
Other tests your doctor might order include: STD testing. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging is a noninvasive test, which uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions, such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor may use this test if your symptoms began with sudden, severe pain.
A nuclear scan of the testicles is also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.

Treatment
Epididymitis caused by a sexually transmitted infection (STI) or other infection is treated with antibiotic medications. If you have significant pain, you will probably receive an anti-inflammatory medication. Your sexual partner will also need treatment.
When you’ve finished your medication, it’s a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up. If it hasn’t, your doctor may try another antibiotic. If the infection still doesn’t clear, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or an STD.

To ease your symptoms, try these suggestions: Bed rest-depending on the severity of your discomfort, you may want to stay in bed one or two days. Mild relief will occur if you place a folded towel under your scrotum. Wear an athletic supporter or jockey underwear. A supporter provides better support than boxers do for the scrotum. Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes. Don’t have sex until your infection has cleared up. Ask your doctor when you can have sex again.

Bottom Line: Epididymitis is a common cause of scrotal pain. Epididymitis is usually a result of an infection and can be successfully treated with antibiotics. See your doctor whenever you have scrotal pain or you find a lump or bump in your scrotum.

An Unkind Twist of Fate-Testis Torsion

There are very few surgical emergencies in medicine but one of them is torsion of the testicle. Testicle torsion is caused by the twisting of the spermatic cord, which causes a loss of blood flow to the testicle and a lack of life-sustaining oxygen to the testicular tissue. Torsion is the most common cause of testicle loss in adolescent males.
Causes
The cause of the majority of cases is the result on not having the testicle anchored to the bottom of the scrotum. As a result the testicle is allowed to twist more easily, resulting in compromise of the blood supply to the testicle. This can occur spontaneously or may be associated with blunt trauma to the testicle. This anatomic defect is present in both testicles.

Torsion of the testis with loss of blood supply and oxygen to the testicle

Symptoms
Testicular torsion is characterized by excruciating one-sided testicular pain with sudden swelling. Men may also have nausea and vomiting.
Testicular torsion is seen most frequently in the 12-18-year-old age group, and most cases occur in men under 30 years of age. However, it can occur at any age, including in newborns.
Getting help
Testicular swelling and pain should be evaluated immediately. The diagnosis is easily made with a scrotal ultrasound. Once the diagnosis of torsion is confirmed, immediate surgery is indicated. There is about a six-hour window for the testicle to be salvaged; surgical treatment within this time frame is associated with a 100% salvage rate for the testicle. After six hours, the salvage rate decreases, and if surgical repair is performed after 24 hours, the testicle is no longer salvageable. The surgeon, usually a urologist, will untwist the spermatic cord and which will improve the blood supply to the testis. The testis is then anchored to the bottom of the scrotum and the opposite testicle is also surgically secured to the bottom of the scrotum since the condition frequently affects both testicles.
Bottom Line: Testicle torsion is a surgical emergency. With early diagnosis the testicle can be saved by surgically securing the testicle to the bottom of the scrotum.