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Abdominal pain and low ejaculate volume

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    My husband had a vasectomy about 5-6 months ago, in late Oct. I am concerned now that we may have made a poor decision as he is experiencing complications. We have an appt. with another urologist next week, but I would appreciate any guidance before the appointment. Here are his symptoms:

    Immediately following the surgery, things seemed okay, he complained of discomfort in the lower abdominal/groin area more than anything else. When we began to be intimate again, he had pain in this same area. After a couple weeks, the pain moved to his testicles and was no longer in the abdomen. The pain was only during sexual activity, and was intermittent with varying degrees of severity. We also both noticed a significant drop in his semen volume, which didn’t bother him, but we wondered if it was a symptom of what he was experiencing. He talked to his urologist again, who said the volume was normal and didn’t change (it really had…it was obvious to us) and gave him a prescription of antibiotics and told him to take ibuprofen (he only took 1-2 tabs per day).

    When he completed the medication, things seemed to get better for a couple of weeks, but the pain soon returned to his groin/abdomen area during sexual activity. It has been over 5 months now, and he has pain at least 1/2 of the time we have intercourse. He also said the other day it was both in his abdomen and testicle again, and it is now periodically, although not often, occurring at other times as well, not just sexual activity. He did say there are days when he feels really bloated in his lower abdomen/groin, and if we attempt sex, that is when it hurts him.

    I am so confused because everything I read about post vasectomy pain specifically states testicular/scrotal pain, which my husband has had VERY little of, it is in his abdomen as I stated. I am looking for some answers and for a way to help him…and am hopeful the the next urologist we see can better guide us.

    Dr. Edward Karpman

    Post vasectomy pain is usually related to pain in the scrotum/testicles/epididymis. The fact that there is very little of this suggests that this is not the diagnosis. We have to remember that just because a man has had a vasectomy does not mean that any pain after the procedure, regardless of the location, can be attributed to the vasectomy. Just because a man has had a vasectomy does not mean that he is immune to any other medical condition. Abdominal pain and bloating can be caused by many common medical ailments such as kidney stones, urinary tract infection, prostatitis, diverticulosis/diverticulitis, gastroenteritis and even cancer to just name a few. All of which are unrelated to the vasectomy. A common mistake is to assume that a symptom is caused by some temporally related event, even when the symptoms do not correlate with the condition, as is the case in this reader. A thorough investigation as to the cause of the pain is warranted in any man who presents with persistent abdominal pain. This can include a CAT scan, obtaining microbiologic cultures and specialist consultation in other fields.

    Low ejaculate volume is not related to a vasectomy. A normal ejaculate volume is anywhere from 1.5 to 5.0 ml and sperm only constitute 5% to the ejaculate volume, or 0.075 to 0.25 ml. The fact that the ejaculate volume improved after a course of antibiotics and ibuprofen further supports the idea that this is probably related to a condition such as prostatitis, and not a consequence of the vasectomy. Prostatitis is a common condition in men that can cause swelling at the ejaculatory ducts reducing the ejaculate volume. Prostatitis is a common condition in men, especially as we get older.

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