Blue balls: a brief history

Blue balls is a mundane complaint that generates substantive popular lore but has little coverage in the sexual medicine literature.

To draft a first medical history of relevant nosology and etiology.

The Latin, French, German, Dutch, Italian, and English literature was mined.

As expected from a period of not only widespread scaremongering concerning masturbation and "semen loss" but also "overly rigid continence," scrotal pain reminiscent of blue balls was well covered between the 1820s and 1920s, under variably inclusive nosologic headings: "hernia seminalis," "orchioncus," "simple spermatocele," "epididymis distensa," "irritable testis," "testicular epilepsy," "testicular neuralgia," "spermatic colic," "stone-ache," "epididymitis sympathica," "epididymitis erotica," "epididymitis antiperistaltica," "paradidymitis erotica acuta," and "epididymo-deferential colic." Even an analogical "ovaralgia erotica" was hypothesized. Observations had the radical potential of supporting poena naturalis (natural punishment) arguments against "too strict" continence and even pro masturbation. This historical push toward concepts of normal and habitual sexuality was fortified by equally tendentious concepts of "constitutional" or "temperamental" predisposition in some men. Yet the clear potential of the diagnosis to moderate strong prevailing sentiments against masturbation remained poorly realized until well into the early 20th century.

Discomfort of the blue balls variety widely animated clinical sexual discourse from the early 18th century onward. It specifically informed interlocking, gendered ideas about sexual entitlement expressed in normative frames for sexual habits, eroto-sexual constitution, and behavioral health.