Treating Post-Vasectomy Pain

Roughly One in 1,000 Affected After Surgery

Taking pain medicine
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Vasectomy is a safe, common office procedure that many men undergo 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. For many couples, it can be a liberating procedure, allowing them a robust sex life without the worry of pregnancy.

However, in some instances, a man can experience debilitating pain following the procedure.

Post-vasectomy pain syndrome (PVPS) is a recognized condition that affects roughly one in every 1,000 men who undergo a vasectomy.

PVPS can happen immediately following the procedure or take months or even years to develop.There is no way to predict who will get it or how severe the pain may be. Treating the condition can also be difficult as there are very few urologists who specialize in PVPS.

Causes of PVPS

When a man undergoes a vasectomy, his sperm production does not change. The build-up of sperm can increase pressure in the vas deferens (the duct that conveys sperm the testicles to the urethra) and epididymis (the gland where sperm are stored). It is this obstruction that can cause pain, sometimes severe, in vasectomized men whenever they ejaculate.

In addition, there are bunches of nerves that run alongside the vas deferens. The blockage of these ducts can cause the nerves to be trapped in fibrous tissue, resulting in a continuous pain that only worsens with any activity which agitates the scrotum.

So debilitating is the condition that running or any serious athletic activity becomes almost impossible to perform.

If left untreated, PVPS can lead to an acute condition called testicular torsion in which the spermatic cord that brings blood to the scrotum twists and cuts off the blood supply.

Non-Surgical Treatment of PVPS

Treatment for PVPS can include prescription and non-prescription medication, physical therapy, and if all else fails, surgery.

Treatment often begins based on the symptoms. For example, a vasectomized man who has epididymitis (the painful inflammation of the epididymis) will often be prescribed antibiotics in the event the cause is bacterial. If the pain goes away, we know for a fact that it wasn't PVPS. Other treatments would then be explored to deal with the PVPS-related symptoms.

Among them:

  • Oral anti-inflammatories such as ketorolac or ibuprofen can often improve pain and alleviate inflammation.
  • A spermatic cord anesthetic block (SCAB) is a technique involving the combination of numbing medicine and a steroid anti-inflammatory to relieve post-vasectomy discomfort.

Physical therapy is another, non-surgical approach to PVPS. Some men develop significant pelvic pain after vasectomy. Their pelvic muscles will often tighten up in response to the abnormal testicular pain they are experiencing. There are a number of pelvic floor exercises a physical therapist can teach to help men relax those muscles and take the stress off the scrotum and testicles.

Surgical Treatment of PVPS

Surgery is always considered a last resort. There are essentially three types of surgery used to treat PVPS: 

  • Vasectomy reversal is the most straightforward of the three. Men who have obstructive pain tend to do very well after reversal with most becoming pain-free. The problem with reversal is that it cancels out the benefits of a vasectomy and, if done well, can lead a man to be fertile again. Additionally, vasectomy reversal is not covered by most insurance.
  • Epididymectomy is a procedure where the surgeon removes the epididymis in hopes of alleviating the pain. This procedure permanently prevents the man from fathering a child and deletes reversal as an option if he ever changes his mind. The recovery time is much longer than a reversal, often taking three to six weeks to get back to normal. There is also a higher risk of injuring the blood supply to the testis.
  • Microscopic spermatic cord denervation is a procedure that is becoming popular as more urologists learn you perform it. It essentially involves cutting all of the nerves into the scrotum to decrease the pain caused by a vasectomy. The procedure preserves sterility, has quicker recovery time than an epididymectomy, and is covered by many insurance policies.

    A Word From Verywell

    Work with your specialist to figure out which surgical or non-surgical option is most appropriate to the pain and discomfort you’re feeling. It’s important to remember that there is always more than one option. Seek a second opinion, if needed.

    PVPS is a rare condition and should never dissuade a couple from exploring vasectomy as a birth control method. If you or your partner is suffering from PVPS, don't give up. Find a specialist urologist in your area who can help you.

    Sources

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