Any advice or suggestions would be greatly appreciated. Thank you!

Post vasectomy pain (PVP) syndrome can manifest in varied presentations and intermittently over time after the vasectomy. PVP is thought to be due to congestion of the epididymis or damage to the peri-vasal nerves at the time of vasectomy. Physicians not familiar with this condition will oftentimes overlook this as a cause of pain. Scrotal ultrasounds are often obtained to rule out more serious conditions when a patient complains about testicular pain. Scrotal ultrasounds will find problems such as hydroceles, varicoceles and spermatoceles in 60-70% of men when performed randomly. Some of these pathologies found on ultrasound can be confused with PVP. Hydroceles and spermatoceles are rarely associated with testicular/epididymal pain. Varicoceles can be associated with this type of pain, but the predictive value of correcting a varicocele is only around 50% for men with testicular/epididymal pain. A detailed physical examination by a specialist can diagnose PVP and treatments for PVP such as cord denervation, epididymectomy and vasectomy reversal are successful in up to 90% of patients with this condition.

Dr. Karpman’s website

Thanks,

Prostatitis is a common problem as men get older. The symptoms of prostatitis are varied and different in individual patients. The presenting symptoms of prostatitis can include pain or discomfort in the perineum, suprapubic area, testes, penis and lower back. There are also usually associated voiding symptoms. Prostatitis is oftentimes confused for other conditions such as epididymitis and kidney stones because of the location of the radiating symptoms. Most cases of prostatitis are not due to bacterial infection and should not respond to antibiotic treatment. A discussion of prostatitis is warranted on this website since the symptoms of post vasectomy pain syndrome can overlap with prostatitis and can cause confusion for patients and physicians alike as to the nature of a patient’s symptoms. Any patient with PVPS should be evaluated for and treated for prostatitis as part of the evaluation process.

Dr. karpman’s website

Dr. Karpman’s website

Sperm is produced in the testicle and then travels to the epididymis where it matures and is stored. The epididymis is then connected to the vas deferens at the opposite end from which it is connected to the testicle. The vas deferens then travels behind the bladder until it is connected to the ejaculatory duct. Vasectomies can only be reversed by reconnecting the vas deferens at the previous vasectomy site or by connecting the vas deferens directly to the epididymis. Since the epididymis has been removed (epididymectomy), re-connecting the vas deferens will not have any benefit since there is no epididymis. To my knowledge, donor organ transplantation of the epididymis has never been perfomed nor would it be successful if attempted.

Dr. Karpman’s website

I’ve received opinions from both ends of the spectrum. An older more experienced doctor who prefers surgery and a younger less experienced doctor who thinks I should live in pain for a year before doing anything about it. I’m confused. Obviously, my family is suffering, my work is suffering and my overall quality of life is suffering. In addition to this I have the added burden of my cycling career on my mind. Meanwhile, my teammates and sponsors continue to ask about my status as I’m falling further and further every week. Living in this pain is not an option. How long should I wait before I have something done? Would a nerve block be viable option to get me through the summer?

Post vasectomy pain can be a disabling condition for the small percentage of men who suffer from this condition. Regardless of the cause of this pain there are effective treatment options. Conservative therapy with anti-inflammatories and warm baths is usually the first line of therapy that most men respond to. However, if the pain persists then patients should consider more invasive treatments such as spermatic cord blocks, cord denervation, vasectomy reversal or epididymectomy. Everybody has a different pain threshold and lifestyle. There is no right answer to how long a patient should wait prior to more advanced treatments. If the pain is bothersome enough that it causes an impairment in the quality of life or activities of daily living, then one should consider earlier rather than later intervention.

I have been reading your articles. I had a vasectomy 20 years ago 1988 and still suffer from discomfort mostly on the right side as we speak. I am 57 years old and will due any recommended procedure to alleviate this pain. The discomfort started immediately after the procedure. Standing or sitting to long on hard surface. Sore after sex. Went back few times for nerve blocks. Been seen by 3 or 4 different urologists. Been treated for chronic Epiditamytas, Prostatitis. Scrotal scan that showed a small cyst and told that is not a cause for pain. Cystoscope that showed slightly enlarged prostate, but not a cause for pain. Sometimes feels like a deep groin pain with a sensation up to the lower right abdominal area. I am from ATLANTIC CITY , NJ. Who do you recommend in this area.

Try the The Society for the Study of Male Reproduction’s (SSMR) website for local specialists.

From Vince:-
I had a traditional vas performed a month ago. Afterward, I has some pretty severe pain, bruising, and swelling. The swelling has gone down, but I have a hard lump in one side of my scrotum about the size of a testicle. It’s like I have 3 testicles now! Blood has also been oozing blood from the incision. I talked to the nurse of the Dr who did the procedure and she said I have a hematoma. They seemed uninterested in seeing me and suggested that it should go away. They put me on a diarrhea-inducing antibiotic even though there are no signs of an infection. I feel a loss of trust in this Dr. What do you recommend? Should I go see another Dr?

Post-vasectomy pain can be a very difficult condition to treat. Vasectomy is a simple procedure performed by many different physicians, but only a small subset of these surgeons are comfortable with, or capable of treating post-vasectomy problems. A doctor might dismiss the patients concerns because he/she is not familiar with the various diagnostic and treatment options available for men with this condition. Patients should always seek a second opinion if they feel that their physician is not addressing their concerns appropriately. A review of the previously answered questions in the archive might be helpful for answering some concerns regarding any post-vasectomy signs and symptoms.

The Society for the Study of Male Reproduction is the largest governing body of male infertility specialists who commonly deal with problems related to vasectomy. This is a professional society whose membership is limited to those physicians with specialized training and experience in the diagnosis and treatment of various problems specifically related to the male reproductive system. Most of these physicians have advanced fellowship training in this subspecialty. Their website has a list of physicians that can be used as a good referral source for finding a specialist in any geographic area, including countries in Europe, Asia and the Americas. I would caution any reader about commercial websites that solicit physicians for money to be listed as “a specialist” on their websites. These websites do NOT have any qualifications for the listed physicians on their site and any physician willing to pay a monthly fee can be included regardless of his or her competency or experience. These commercial referral sites are pretty apparent by their design and will usually have some reference to advertising or sponsorship on the site.

In May 2007, I had a vasectomy reversal in hopes of relieving the pain.  However, there was no relief at all.  This leads me to believe that the pain was not at all due to pressure or whatever, but trauma caused by the original vasectomy. 

In Feb 2008, I saw the same surgeon who performed the reversal.  He was able to numb up the area by injecting anethestic directly at the cord.  Thus, according to him this makes me a good candidate for the sperm cord de-nervation procedure.

I am 99% ready to do it, but I would like to know of possible risks.  Is it possible that after the procedure one might become impotent or incontinent? Could the area be even more painful?  I have not read of such incidences, but after the miserable experiences I have had so far, I am praying for the best, but truly expecting the worst. 

Vasectomy reversal is one of the several options available for patients with Post Vasectomy Pain (PVP). However, the procedure is not universally successful and approximately 69% of patients will have improvement or resolution of their pain symptoms after vasectomy reversal. Prior to considering vasectomy reversal as unsuccessful for PVP, it should be confirmed to be patent with a semen analysis and palpation of the epididymis on the affected side. If the vasectomy reversal is successful in relieving the blockage established by the vasectomy, the epididymis should feel decompressed. Persistent PVP after a vasectomy reversal can be further treated with epididymectomy or spermatic cord denervation. There is no guarantee that either one of these procedures will cure the pain, but success has been reported in 87 and 76% of patients undergoing epididymectomy and spermatic cord denervation, respectively.

My husband and I thank you in advance.

Post vasectomy pain can be due to one of several different causes. “Nerve entrapment” is one of those possible causes of PVP. This can occur during the actual vasectomy procedure or during the healing process when some scar tissue forms involving a nerve. Sexual position can be related to the degree of pain experienced in these situations, however, it would be difficult to study formally this causality. The treatments for PVP include anti-inflammatories, warm baths, and injections of steroids or local anesthetics. Surgical options include vasectomy reversal, spermatic cord denervation or epididymectomy. A urologist would be the doctor to see. Dr Larry Lipshultz at Baylor College of Medicine in Houston, Texas is the leading specialist in your area.

The type of ligature or clips used for a vasectomy procedure has no relevance to post vasectomy pain. The pain is not caused by any certain type of material used but more so by the technique of the vasectomy procedure. If the vasectomy was done low on the vas deferens or some nerves are entrapped during the procedure this can cause post-operative pain irrespective of the type of suture or clips used. A physical exam and ultrasound of the scrotum is important to rule out other possible causes of testicular pain after a vasectomy. If the examination and ultrasound are unremarkable, treatment for post vasectomy pain should be sought.