A scrotal hematoma is a collection of blood inside the scrotum. It occurs when bleeding fails to stop after a vasectomy, or when bleeding resumes at some point after the operation due to trauma or other conditions. Hematomas may also develop after a vasectomy reversal.
Scrotal hematomas occur in approximately 2% of vasectomies.1Adams CE, Wald M. Risks and Complications of Vasectomy. Urologic Clinics of North America. Published online August 2009:331-336. doi:10.1016/j.ucl.2009.05.009 A hematoma is a serious complication that can be very unpleasant, but it will rarely cause long term damage.
Symptoms of a scrotal hematoma
Scrotal hematomas typically occur shortly after the vasectomy procedure. They are often accompanied by swelling, bruising, and pain.
The symptoms are dependent on the location, size, and cause of the hematoma, so it’s possible to develop a hematoma without showing all symptoms. A small hematoma may cause minimal swelling and discomfort, while a larger hematoma could result in extensive bruising and pain.
Scrotal hematomas vary in size. They may be so small they aren’t even noticeable, or so large they feel like a third testicle. The reason for this is that the loose skin of the scrotum can expand greatly and may not immediately provide the pressure necessary to stop the bleeding. In these scenarios, the hematoma won’t stop growing until it becomes big enough to apply pressure to the source of the bleeding, or a spontaneous clot appears.
A hematoma will generally feel like a lump or growth in the scrotum. This hematoma mass will eventually harden as the blood forming the hematoma clots.
Treating a scrotal hematoma
Hematomas usually resolve on their own. In most cases, the hematoma will go away with a couple of weeks, but larger hematomas can take longer to dissolve. The clotted mass of blood that makes up the hematoma will slowly be absorbed into the body, so all you can really do is wait. Pain, bruising, and swelling may last for a similar amount of time, although these symptoms usually diminish as the hematoma shrinks and breaks up.
Your doctor may recommend hot baths, ibuprofen, and tight elevating undergarments as ways to alleviate discomfort and speed recovery. In extreme cases, surgical intervention may be necessary, but this is usually regarded as a last resort.
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Avoiding a post-vasectomy hematoma
While it’s impossible to completely eliminate the risk developing of a hematoma after your vasectomy, there are steps you can take to minimize the odds it’ll happen to you
Have a urologist perform the procedure
While your general practitioner may be capable of performing your vasectomy, it’s generally best and strongly recommended to find a urologist to do the job. Urologists typically have much more experience in providing vasectomy services, and experience is a significant factor in predicting the likelihood of complications after a vasectomy.
Find an experienced doctor
In general, the more vasectomy operations a doctor has performed, the lower the chance of hematoma. One study found that “the incidence of hematoma was 4.6% for physicians performing 1–10 vasectomies annually, 2.4% for those performing 11–50 annually, and 1.6% for those performing more than 50 annually.”2Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertility and Sterility. Published online May 2000:923-936. doi:10.1016/s0015-0282(00)00482-9
Do your research and find out how many procedures the doctor performs in a year. This may be on the doctor’s website, but it’s also something you can ask about during your initial consultation.
This doesn’t mean that a doctor who has done fewer vasectomies isn’t competent to perform your operation. The incidence of hematoma is minimal regardless of the number of procedures a doctor has performed, but statistically speaking, you’ll have better luck with a more experienced doctor.
Look into a no-scalpel vasectomy
The no-scalpel vasectomy method offers a number of benefits over the traditional technique, and one of those benefits is a lower risk of developing a post-vasectomy hematoma. A scalpel-free vasectomy uses sharp forceps to puncture the skin and doesn’t involve any cutting. With the no-scalpel method, there’s a lower chance of nicking a blood vessel, which means a lower risk for hematomas. Both procedures are currently standard of care, and a traditional scalpel vasectomy is also a great option if your surgeon prefers to perform it that way.
Scrotal hematoma is a rare, but a known complication of a vasectomy. A smaller hematoma may cause minor discomfort, while a large hematoma could result in severe bruising and pain.
You need to see your doctor as soon as possible if you suspect you have a hematoma. While a scrotal hematoma is usually not a serious issue, it could require special treatment or be related to another problem.
References and further readingVasectomy-Information.com has a strict sourcing policy. We rely on evidence-based medicine, peer-reviewed studies, reputable clinical journals, and medical associations. Learn more about how we ensure our content is accurate and up-to-date by reading our editorial policy.
- Cook L, Pun A, Gallo M, Lopez L, Van V. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev. 2014;(3):CD004112. doi:10.1002/14651858.CD004112.pub4
- Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertility and Sterility. Published online May 2000:923-936. doi:10.1016/s0015-0282(00)00482-9
- O’Leary B. Scrotal haematoma following vasectomy: an unusual surgical emergency. BMJ Case Rep. 2014;2014. doi:10.1136/bcr-2013-202421
- Risk of Bleeding After Vasectomy. A Personal Choice. https://www.bestvasectomy.com/risk-of-bleeding-after-vasectomy/