Post-Vasectomy Pain

Roughly 1 in 1000 men are affected

Vasectomy is a safe, common office procedure many men undergo every year as a form of permanent, non-drug birth control.  Complications are few and rare.  A vasectomy usually takes less than half an hour to complete and is often done under just local anesthetic.  It can be a liberating procedure for couples to enjoy a robust sex life without the worry of pregnancy.

But, some men can develop debilitating pain after vasectomy.

 Post-vasectomy pain syndrome (PVPS) is a recognized condition that affects roughly 1 in 1000 men after vasectomy.  It can happen immediately after the procedure or it can take months to even years to develop.  Very few urologists specialize in the treatment of this condition.  There is no way to predict what man will suffer from this condition.  As a specialist in vasectomy reversal, one treatment option for PVPS, I see at least a dozen men a year with this condition.

When a man undergoes a vasectomy, his sperm production does not change.  The sperm build up in the space underneath where the vasectomy site is.  Some men are very sensitive to increased pressure in the vas deferens and epididymis, the gland where sperm are stored.  There is therefore an obstructive component to PVPS and men that have this problem often complain of severe pain with ejaculation.  There are also a bunch of nerves that run along the vas deferens and, when the vas is blocked, nerve pain can develop.

 These men have constant pain that worsens with any activity that agitates the scrotum.  Many men with nerve pain post-vasectomy claim they can't run anymore or do any serious athletic activity.  Nausea and vomiting is unusual with PVPS and one should be more concerned with an acute scrotal condition called testicular torsion if these symptoms occur.

 There is no increased risk of torsion after vasectomy, however.

Treatment for PVPS includes medical management, physical therapy and finally, surgery.  Most men will get a trial of antibiotics for a presumed epididymitis post-vasectomy.  If the pain goes away, the man didn't truly have PVPS.  Anti-inflammatories such as ketorolac or ibuprofen can often improve pain and decrease inflammation.  A spermatic cord block which involves instilling a combination of numbing medicine and a steroid anti-inflammatory can often settle down post-vasectomy discomfort.  Surgery is a last resort.  There are essentially 3 surgeries for PVPS.  The most straight-forward is a vasectomy reversal.  Men who have obstructive pain tend to do very well after reversal and most become pain-free if there is a good return of sperm to the ejaculate.  The problem with reversal is it cancels out the benefit of vasectomy in that, if done well, the man becomes fertile again.  Additionally, vasectomy reversal is not covered by insurance in most cases.

 Another approach is epididymectomy.  In this operation, the surgeon removes the epididymis in hopes of alleviating the obstructive pain.  This procedure permanently prohibits the man from fathering a child through natural conception as it is surgically impossible to perform vasectomy reversal after epididymectomy.  The recovery time is much longer than reversal as well.  It can take 3-6 weeks to get back to normal activity and there is a higher risk of injuring the blood supply to the testis.  Lastly, there is a procedure called a microscopic spermatic cord denervation.  This procedure is becoming more popular as more urologists learn how to perform it.  It essentially involves cutting all the nerves into the scrotum to decrease the nerve pain from a vasectomy.  The advantages of this procedure are better insurance coverage than reversal, preserved sterility and quicker recovery time than epididymectomy.  

Physical therapy is another, non-surgical approach to PVPS.  Some men develop significant pelvic pain after vasectomy.  Their pelvic muscles inappropriately tighten up in response to the abnormal testicular pain they are experiencing.  There are pelvic floor physical therapists that can teach men how to relax those muscles and take the stress off the scrotum and testicles.

As a specialist in PVPS, I have a regimented approach to this condition to figure out which men would benefit from medical vs. surgical therapy.  The key to remember is, this is a very rare condition and I don't dissuade men from vasectomy based on such a small risk.  If you or your partner is suffering from PVPS, however, don't give up.  Find a specialist in your area that can help you.

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