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Post vasectomy pain question

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    I am hoping you can help me. My situation seems different then all the other cases I have researched and read about. I had a Vasectomy September 2001. Clips were used. I was experiencing discomfort after the procedure. I went to see my Urologist after a couple of weeks of continued discomfort. He dismissed it as a simple infection. I was given a prescription for a round of antibiotic. I completed the round of medication within the time frame given. No relief. I decided to give it more time and did not go back to see the Urologist. My Symptoms were a sharp pain, like a needle was run from my testicle up into my abdomen. At times this was very sharp and I would just need to let the pain pass after a minute it would fade away. The sharp pain went away after the first few months. I was left with a slight discomfort in my testicular / groan area. The discomfort was like having a bad case of “Blue Balls” (getting very aroused but not being able to have any release or ejaculation). The only thing that gave relief to the discomfort was ejaculating. After having sex the discomfort would go away for 2 to 3 days. Then the discomfort would return. I could handle the discomfort during the day, but at night it would keep me up. When I went to sleep, I would be able to sleep generally until 3:00am. Then like clock work, I would wake up every 15 to 30 minutes. The rest of the night is spent looking at the clock every 15 to 30 minutes as I would fall in and out of sleep, until I needed to get up for work.I spoke with my Family Doctor and he recommended I see an Urologist he knew. I meet with this Doctor and was told I should see a Physiologist, because he could tell I was very emotionally affected by the discomfort. His conclusion, it is in my head. He did not provide any medical help. I did see a Physiologist for a few sessions. He had experience working with patients that suffered from chronic pain and its effects on mental well being.

    This helped me deal with the anxiety I felt on the 2nd or 3rd day, after last having sex. I knew the discomfort and sleepless nights were about to start again. This anxiety of the up coming discomfort placed a great deal of stress on my marriage as well. Getting with the Physiologist, help me mentally deal with the cycle of discomfort and allowing it to control my happiness.

    A friend referred me to a new Urologist he had used. My friend was experiencing pain during sex or after, the exact opposite of mine. He prescribed a twice a day for 2 weeks of soaking in warm water for 30 minutes. I did this to the letter with no results. I meet with him a second time and he referred me to a colleague that specializes in the Practice of Anesthesiology and Chronic Pain Management. He had had success with some types of post Vasectomy related pain before. My case did not fit his experience. I was prescribed LYRICA Pregabalin. This did not provide any relief.

    I had started taking over the counter sleeping pills. I would take one a week on average. They would help me sleep a little better (I would still wake up in the middle of the night, but not as often) on day 3 and some times day 4, after last having had sex. After 4th day, it did not matter if I took a sleeping pill or not, I would not be able to sleep. The discomfort would peak on day 4 and no matter how long I went with out ejaculating, it would not get any better or worse, just a constant dull pain.

    I asked my Family Doctor to prescribe a sleeping pill that did not have the residual effect the over the counter pills did. The over the counter pills would make me feel groggy for the first part of the next morning. He prescribed Lunestra. These worked much better, but again after day 4 (since last ejaculation), they did little to help me sleep through the night. I never took more than one a week.

    Dr. Edward Karpman

    Chronic pain after a vasectomy can be variable in nature. In this case, it seems that most of the conservative methods to deal with the pain have been tried. In the small percentage of patients who do continue to experience chronic pain after a vasectomy and have failed most of the conservative options, surgical treatment is recommended. In order to confirm that the pain is truly from the testicle/epididymis and not radiating from another area of the body, a spermatic cord anesthetic (block) should be used as an initial diagnostic test. A spermatic cord block will anesthetize all of the nerves from the testicle and the epididymis. This should temporarily relieve the pain/discomfort which is diagnostic.

    If the test confirms that the pain is radiating from the testicle/epididymis, three surgical options exist. A vasectomy reversal would re-connect the cut ends of the vas deferens and restore patency to the reproductive system. This has been shown to completely improve pain in approximately 69% of patients. Another option is to perform an epididymectomy, remove of the epididymis. This has been shown to improve pain in 87.5% of patients with this condition.

    The final option is to denervate the spermatic cord, remove the nerves that innervate the testicle and epididymis. This has been shown to be successful in approximately 76% of patients with this condition. Each of these procedures is associated with its own unique side-effect profile. A discussion with an urologist is important to understand which procedure would be most beneficial in each individual patient.

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