Why do one’s loins ache after a session of nonclimactic arousal?

Dear Cecil:

After recently engaging in some high school-style sex (prolonged stimulation without orgasm), I experienced the painful phenomenon of, you should pardon the expression, "blue balls." And yet after another similar incident, perhaps even more prolonged, no such painful results occurred. Why do one's loins ache sometimes after a bout of non-orgasmic eroticism, and not at other times? Is this a health hazard to be concerned about?

Cecil replies:

Why this happens some times and not others is one of those imponderable mysteries, Chuck. However, the health issue is something else again. Many urologists believe that extended tumescence without orgasm can cause congestive prostatitis, an extremely painful condition of the prostate gland. Among other things, the prostate gland secretes the clear fluid which is the vehicle for the sperm in male ejaculate. When not in a state of sexual excitement, a normal male’s prostate will cook up about one-tenth to four-tenths of a teaspoon of prostatic fluid a day. This ordinarily drains into the urinary tract and gets excreted. During periods of sexual arousal, however, the prostate kicks into overdrive, churning out 4 to 10 times as much fluid as usual — far too much, some say, to pass into the urine quickly. If the man fails to have an orgasm, the stuff backs up in the prostate and causes congestion. In younger men this is often characterized by pain in the pelvic area and painful and swollen testicles. The usual treatment is continence, perhaps accompanied by ice-packs and/or an anti-inflammatory drug.

In severe cases the congestion can block the urinary tract, which passes through the prostate, meaning you can’t relieve yourself and you fill up like a water balloon. Symptoms may include pain in the lower back or rectum (the prostate is located next to the rectal wall), burning sensation during urination, unusually frequent urge to urinate, and sometimes pain and minor bleeding after ejaculation.

Other causes of congestive prostatitis include an unusually volcanic session of lovemaking, in which repeated orgasms within a short time can overload the system. Some doctors say any sudden change in your sexual habits, whether it’s sex followed by abstinence or vice-versa, can lead to prostatitis. Still others say long-term abstinence all by itself will do the trick — hence the expression “the priests’ disease” (also known, I’m informed, as “the Brandeis University freshmen’s disease”). Not everybody buys this, though. Some researchers believe the prostate adapts fairly readily to its owner’s requirements and that prostate problems have some other organic cause.

Prostate problems usually don’t become chronic until you’re well past 40, but here’s something else you can worry about in the meantime. At least one researcher has suggested that pressure in the gonads during sex can cause a back-up of sperm into the prostate, which in turn can lead to prostate cancer — further proof that everything fun in this world is bad for you. Presumably a lengthy bout of non-orgasmic sex, in which the pressure never gets relieved, would make cancer even more likely. Sounds grim, but look on the bright side: it offers a valuable addition to the frustrated male’s arsenal of can’t-miss makeout lines. Now, in addition to “I’m leaving tomorrow on a suicide mission” and “Hey, they might drop The Bomb tomorrow,” there’s “Cheezit, honey, you want me to get cancer?” Try it, Chas, and maybe next time you’ll get past first base.

Send questions to Cecil via cecil@straightdope.com.

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