Why do my balls hurt after sex?

Testicular pain after sex can arise from many different reasons. If it settles quickly, it’s usually nothing to worry about. However, if it’s a persistent ache, it might be a sign of something more serious (1).

  • Medical Journal Review

  • Sexual Health Questions

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Table of Contents

The Short Answer.

There are a number of common causes of testicular pain after sex (1):

  • Epididymal hypertension (blue balls)
  • Hydrocoele
  • Inguinal hernia (scrotal hernia)
  • Type I Prostatitis: Acute Bacterial Prostatitis
  • Type II Prostatitis: Chronic Bacterial Prostatitis
  • Type III Prostatitis: Chronic Pelvic Pain Syndrome
  • Varicocele

Epididymal Hypertension (Blue Balls)

Epididymal hypertension, also known as blue balls, usually happens when a man who's aroused doesn’t have an orgasm. However, blue balls after sex or masturbation can also occur if an orgasm is withheld for a long period of time. This is true whether the orgasm is held intentionally through a practice known as 'edging' or unintentionally through prolonged sex or sexual teasing.

The reason for this is that men who become sexually aroused experience increased blood flow to the penis and testicles. Increased blood flow leads to increased pressure within the penis and testes, which eventually causes discomfort. 

The best way to get rid of blue balls is to ejaculate through sex or masturbation. If you're still having testicular pain after sex, it will generally go away between 1 hour and 1 day after sex. If you continue to have pain in your balls more than 1 day after sex, you should consult a healthcare professional.

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Hydrocoele (also spelled hydrocele)

A hydrocoele is the collection of fluid in the membranes surrounding the testes, causing swelling in the scrotum. Hydrocoele can occur after rough sex due to trauma or injury to your testicles

Hydrocoeles are a common cause of scrotal swelling and generally do not cause any damage to the testicles. Hydrocoeles are not usually painful, but they can cause discomfort if they are large.

Treatment for hydrocoele may not be required if the hydrocoele is small, the testes can be examined easily, and the amount of fluid remains constant. However, treatment is often recommended if the hydrocoele is causing discomfort or embarrassment.

A hydrocoele can be treated by draining the fluid with a needle (aspiration) or by a minor surgical procedure called a hydrocelectomy.

Inguinal Hernia (Scrotal Hernia)

A scrotal inguinal hernia occurs when tissue, such as part of the intestine, protrudes into your scrotum through a weak spot in your abdominal or pelvic floor muscles. The resulting bulge can be painful, especially when you cough, bend over, or lift a heavy object. However, many hernias do not cause pain.

Scrotal inguinal hernias can occur during sex due to increased intra-abdominal pressure combined with a weak spot in muscles. They can also occur when an existing inguinal hernia is made worse through sexual acts such as holding up a partner, thrusting your hips, grunting, or other common acts that occur during sex.

An inguinal hernia isn't necessarily dangerous, but they do not go away on their own. Additionally, they can lead to life-threatening complications. Your doctor is likely to recommend surgery to fix an inguinal hernia that's painful or enlarging.

Prostatitis after sex

Acute bacterial prostatitis (ABP) from sex

Acute bacterial prostatitis after sex happens when a urinary tract infection (UTI) causes bacterial growth in the prostate gland. Symptoms include fever and chills. You may also experience painful and frequent urination or have trouble urinating. 

Though acute bacterial prostatitis only accounts for approximately 5% of all prostatitis cases, it requires immediate medical treatment since it can lead to sepsis (3).

Chronic bacterial prostatitis (CBP) from sex

Chronic bacterial prostatitis can occur after sex due to recurrent urinary tract infections (UTIs). Similar to acute bacterial prostatitis, CBP occurs when bacteria become trapped in the prostate gland. Unlike ABP, CBP results in recurrent infections that are often difficult to get rid of. 

Chronic bacterial prostatitis also requires immediate medical attention as it can lead to other diseases or death in severe cases (4).

Chronic pelvic pain syndrome, or CPPS from sex

Chronic pelvic pain syndrome (CPPS), also known as non-bacterial chronic prostatitis, is the most common prostatitis type (5). It's similar to chronic bacterial prostatitis, but it does not come from a bacterial infection. 

Bacterial prostatitis and non-bacterial prostatitis (i.e. CPPS) are commonly misdiagnosed for each other, and both are poorly understood, difficult to treat, and cause a range of symptoms including pain, urinary problems, reduced quality of life and sexual dysfunction. 

Chronic pelvic pain syndrome from sex often happens because of stress from rough sex, nerve irritation, blunt force injuries, or damage from previous urinary tract infections. 

Varicocele (pronounced VAR-ih-koe-seel)

A varicocele is an enlargement of the veins within your scrotum (the loose bag of skin that holds your testes). A varicocele is similar to a varicose vein you might see in your leg. 

Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility in men. Varicoceles can also cause your testes to develop abnormally or even cause your balls to shrink.

Since a varicocele usually causes no symptoms, it often requires no treatment. However, if you experience pain or swelling in your scrotum, discover a mass on your scrotum, notice that your balls are different sizes, develop a varicocele in your youth, or you're having problems with fertility, you should contact a healthcare professional. 

Testicular Bruising or Scrotal Trauma

Perhaps the most common and straightforward cause of pain in your balls after sex is simply blunt force trauma to your scrotum or balls during sex. 

As you can imagine, this means that your balls might hurt because they were slapping against yourself or your partner during sex. Some types of BDSM even involve inflicting pain (for pleasure) on one's testes or scrotum. We're not here to judge what you do for fun in your bedroom, but we do recommend being careful if you're into this!   

When to go to a doctor for pain in your balls After Sex

In general, any pain in your testes (balls) after sex that lasts longer than 12-24 hours is worth seeing a healthcare professional for an examination. 

While occasional pain in your testes or scrotum can be normal and nothing to worry about, there are certain health conditions that are more serious that can cause pain in your balls. 

If you experience pain or swelling in your scrotum (ball sack), discover a mass on your scrotum, notice that your testes (balls) are different sizes, or you're having problems with fertility, you should contact a healthcare professional.

✔️ References

1. "Blue Balls", A Diagnostic Consideration in Testiculoscrotal Pain in Young Adults: A Case Report and Discussion. doi: 10.1542/peds.106.4.843

2. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. doi: 10.1016/j.eururo.2016.03.027

3. National prevalence of urogenital pain and prostatitis-like symptoms in Australian men using the National Institutes of Health Chronic Prostatitis Symptoms Index. doi: 10.1111/j.1464-410X.2009.08708.x

4. Bacterial Acute Prostatitis by Nathan G. Davis and Michael Silberman, University of Tennessee. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459257/

5. Prostatitis. The Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/15319-prostatitis