Blue...Vulva?
- Dr. Heather Swain PT, DPT, CIDN, CPT
- Apr 4
- 9 min read
Are orgasms optional, or necessary? Is it different for males than females? The way we have historically answered those questions has been culturally dependent, and steeped in debates regarding morality, and sex differences between males and females.
Before we take a look at the evidence in human anatomy and physiology for both sexes, it's important to acknowledge some of the psychosocial factors at play when we consider how our bodies are designed to work.
Epididymal Hypertension-"Blue Balls'"
The concept of epididymal hypertension, more commonly referred to as "blue balls", has long been recognized by males as an unpleasant experience to avoid. It has frequently been used to argue that sexual stimulation and reaching climax is a need, not just a desire. While it is healthy and normal to want to avoid pain in most circumstances, at times epididymal hypertension is used to justify morally questionable behavior.
This can occur in the form of justification of self-stimulation, or coercion of a partner to assist in providing sexual stimulation. It's important to acknowledge that opinions on morality, as it pertains to sexual behavior, are diverse. While some people believe that anything goes, others hold beliefs that sexual stimulation should only occur in specific contexts, or that certain sexual behaviors are appropriate while others are not.
On the note of coercion, however, it is generally societally agreed upon that individuals should retain a right to consent, or decline to consent to engage in sexual activity. Epididymal hypertension can be used to imply to a partner, that it ought to be permissible to expect that the partner assists in addressing the problem. It's insinuated that it would be cruel to leave a person experiencing epididymal hypertension in pain.
Like many things pertaining to sex, we don't as often consider the double-standard applied to this concept. While epididymal hypertension has often been applied as a justification for males to need to reach climax/orgasm, it has received very little attention in females.
Gorgeous Engorgement-Arousing The Circulatory System
During sexual arousal, the human cardiovascular system goes to work in both sexes. In males, blood flow is directed to the penis. This process is called engorgement, and is generally considered a positive one that grows the penis to display its full size. The pressure of the added blood flow presses out on all sides, making the penis hard, and allowing it to hold its shape during penetration of a partner.
In females, engorgement also occurs. Though less visually apparent, we should still think of the circulatory system's work of engorgement as gorgeous. The additional blood flow to the pelvis is helpful for the body to produce natural vaginal lubrication, supply the nerves and muscles in the area with blood and oxygen to work their best, and adds a little extra cushion for your partner to bump up against the bones in the pelvis during sex when your bodies meet.
Like most things in life, the amount of blood flow that is good vs. bad exists on a continuum. Some blood flow is good and helps with the body functions mentioned above. For some individuals, even a little extra blood flow that causes some mild achiness is actually considered desirable. The mild ache creates a yearning for reaching climax that makes some people perceive the climax/orgasm as more enjoyable when it's finally achieved. This is typically referred to as delayed gratification, edging, or orgasm denial, depending on the length of time climax is delayed, and the level of engorgement and associated achiness or pain that results.
While for some individuals this is a consensual process and part of enhancing sexual enjoyment, as previously discussed, coercion of a partner or non-consensual engagement in these activities is generally considered morally questionable or illegal.
Blue Vulva Syndrome
Unfortunately, the signs of sexism run deep even in the medical community. The fact that epididymal hypertension has a medical name beyond "blue balls", and the same phenomenon in women has simply been named to match the colloquial name in men, is telling. It's even more ironic that while epididymis in males can turn a bluish hue, females may not even experience this color change.
One potential name option would likely be "vulvar hypertension" and are nowhere to be found on major medical sites. In fact, at the time of this writing, it's difficult to call blue vulva syndrome, "vulvar hypertension", because we can't find any research showing that the local blood pressure in the vulvar region during arousal has even been formally measured.
Hypertension is the name for high blood pressure and typically refers to the pressure of blood against the walls of the arteries and veins. In both males and females, vasocongestion, is a term that refers to swelling in the blood vessels. One could argue that a better name might be "vulvar vasocongestion".
Nomenclature aside, blue vulva syndrome can produce similar discomfort for women as epididymal hypertension can in men.
The female pelvic floor is like a lot like a boat or a hammock. Its job is to support and hold up the weight of the organs above it. The added pressure of the increased blood presses against the nerves in the area, and can trigger a heavy, achy, painful feeling. Carrying the extra weight of the blood volume can also make a woman's muscles tired, sore, and overworked.
When To Seek Help
The good news about epididymal hypertension and blue vulva syndrome is that in most cases they are temporary. When the body realizes that it no longer needs the added blood flow in the pelvis and genitals, it will gradually shift the blood back into circulation around the body.
The exact length of time this normally takes isn't well established, and it may depend on several factors, such as how much blood was redirected to the pelvis, how long the period of arousal lasted, or cardiovascular health factors like blood pressure and heart rate. This can make it difficult to decide at what point seeking medical attention for epididymal hypertension or blue vulva syndrome is important.
Though not specific to epididymal hypertension, prolonged blood engorgement of the penis does have some accepted time frame guidelines. Anyone who has listened to a commercial for medications for erectile dysfunction can probably tell you that men are encouraged to "seek medical attention for an erection that lasts longer than 4 hours". We even have a name for this unwanted, prolonged erection: priapism.
Women, on the other hand, who experience what is/was called pelvic congestion syndrome, are not so aggressively marketed to about what is considered abnormal and when to seek help from a medical provider.
**Some are currently advocating that pelvic congestion syndrome be renamed "pelvic vascular diseases" in an effort to differentiate specific causes for the dysfunction in the circulatory system. A syndrome, by definition, is a simply a group of symptoms that occur together. Syndromes in medicine are disorders that the medical community does not currently understand the causes of.
At this point, there is a lack of research on the subject; specifically in women to establish a guideline for when to seek care. Right or wrong, in these cases, the medical community often applies the guidelines they establish for men to women until further research can be performed.
If greater than 4 hours is too long of a time for blood flow to be directed to the pelvis in males, it may be a starting point for establishing a guideline for women. It's important to acknowledge, however, that given the lack of clear guidelines, it's always best to consult with a licensed medical provider to determine if your experience of blue vulva syndrome, may actually be suggestive of pelvic congestion syndrome or pelvic vascular diseases.
Treatment Strategies
Prevention
It's worth mentioning that prevention is a viable treatment strategy. If it isn't a good time to engage in sexual activity for whatever reason, the best treatment strategy may be to not put the body in an aroused position in the first place.
Orgasms/Climax/Ejaculation
Assuming that the "prevention ship" has already sailed, we'll start with the most natural resolution-orgasms. When male and female bodies reach climax/orgasm, rhythmic muscle contractions often occur. These contractions repeatedly, rhythmically compress the veins and arteries that run into the muscles to supply them with blood. This allows the body to pump the blood out of the pelvis in both males and females and reset the system.
In males, this is more obviously visible. The scrotal sac containing the epididymis and testes will decrease in size after ejaculation. In females, the area of blood engorgement is more internal, so the change is not as easily visualized.
For individuals who have difficulty reaching climax due to orgasm disorders, or perhaps their sexual rendezvous was interrupted unexpectedly, other options exist. We can help encourage blood flow in the body using temperature, exercise, and body position.
Temperature Control
When cold is applied to the body, a natural circulatory effect occurs to aid in thermoregulation. The body will generally move blood inwardly into circulation to try and keep warm when exposed to cold. This can take the form of a cold shower, applying a cold pack externally to your inner thighs, pelvis, or genitals, or internal application. For women who experience vaginal swelling, products such as cool water cones, or thermal pelvic wands exist that can be inserted into the vaginal canal.
Kegel Exercise
Movement and exercise are another way to get your blood moving. While general exercise, like walking, can be helpful to get your heart rate up, pelvic exercise can better target the specific areas of swelling. Pelvic floor muscle contractions, often called Kegels, can specifically compress the veins and arteries and assist in pumping the blood out of the pelvis.
While performing Kegels is the most common option, many people (close to half!) have difficulty performing a Kegel correctly based on verbal instructions alone (1). Women especially tend to have poor sensory awareness of how to utilize their pelvic muscles (See: Sensory Speed Bumps: Cultivating Pelvic Awareness in Women).
If Kegels aren't working for you, it may be best to schedule an evaluation with a pelvic floor physical therapist to make sure that you are doing them correctly. With verbal instruction alone, 25% of people actually perform the movement backwards and are unknowingly relaxing their pelvic floor muscles rather than contracting them (1).
Bridges & Body Position
Another strategy that can be performed alone or with Kegels is to let gravity assist you. Moving the body into a bridge position either repeatedly and actively with your muscles, or once and placing pillows under the hips to support you, can encourage blood flow out of the pelvis. This can be a good recovery position for blue vulva syndrome, as well as for women who experience pain and pelvic heaviness after sex.
Cremasteric Reflex/Geigel Reflex
In males, if they aren't able to control lifting and moving their epididymis voluntarily, exercising the nervous system can be used to their advantage. The cremasteric reflex involves stroking or pinching the inner thigh and will result in a lifting of the scrotum, testis, and subsequently the epididymis. Repeated activation of this reflex and the subsequent movement may aid in blood flow to the epididymis.
In females, its equivalent is called the Geigel Reflex. However, because women don't have a cremasteric muscle, it instead results in some tightening of an inguinal ligament. Unfortunately, it is most likely less helpful for improving blood flow in women than men.
Massage
Massaging the areas engorged with blood flow may aid in gently pressing the blood back into circulation. This can be performed on the external surface of the vulva, internally in the vagina, or on the external scrotal tissues.
The challenge with utilizing this technique, is that if it is sexually stimulating to you, your body may continue to be aroused and send blood flow to your pelvis. Other techniques may be preferrable if you find the massage to be arousing.
Closing Thoughts
To address our original question, "Are orgasms optional, or necessary?" we have to ask the follow up question, "Necessary for what?"
Neither epididymal hypertension or blue vulva syndrome are typically considered "fatal" or "life threatening". A person would be hard pressed to argue that an orgasm is necessary for them to live.
If we turn to the question of, "Is an orgasm necessary to avoid pain and discomfort?," the answer to that question is also most likely, no. There are other strategies that can be used to manage the discomfort from the increased blood flow to the pelvis in both males and females associated with blue vulva syndrome and epididymal hypertension.
It is also noteworthy, that pain itself is sometimes a part of life. While human beings generally prefer to avoid pain and discomfort, it is sometimes deemed worth suffering depending on the context. For example, many men and women choose to endure the mild pain and discomfort of swollen, blood engorged muscles after a tough workout at the gym for the purpose of making their bodies stronger. Some of them even come to enjoy that soreness.
At a more intense level, people sometimes choose to undergo surgeries that will temporarily result in pain to obtain some kind of health or cosmetic benefit. Many women choose to endure the temporary pain of childbirth in order to accomplish a greater good of having a baby.
When determining if achieving an orgasm is necessary to avoid the pain and discomfort associated with blue vulva syndrome or epididymal hypertension, each person has to consider the context of their personal situation, and if relevant, the wants, desires and needs of their partner.
Disclaimers:
As always, the above content is intended as educational content and is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in a pelvic floor evaluation to discuss your unique case, click to Book Online and schedule an appointment.
References:
(2) www.HEP2go.com
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