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Post vasectomy pain, 3 months, worried about chronic pain, investigating surgical options


#1

Hello,
I am new to the forum and wanted to share my experience after my vasectomy that was done 3 months ago, and am looking for advice how to control my pain and how to evaluate the surgical options that are out there.
During the vasectomy I already felt a sharp, sting-like pain, on the left side. I had a large hematoma covering all my scrotum for about 2-3 weeks; I thought the pain would get better once the hematoma vanishes, but I was wrong. I also noticed a strange feeling, like my left testicle was in a different position as before, especially when I pulled in my belly or tensed my pelvic muscles. Don’t know how to else describe it. Now, this sensation has gone. After 3 weeks, the urologist made an ultra-sonic check-up, saying “it was swollen”. It was indeed very much sensitive to pressure or touching of any kind. No need to say, no sex for the first months or so. I started taking Ibuprofen (3x600 mg per day) and Tramadol (4x50 mg per day). Tramadol definitely helped, I think, but at times, 4x50 mg was not enough and I increased to 5 or 6x50 mg. The pain got worse; I went to my GP, he did not know what to do with me, sent me to the ER in a hospital, again US, nothing could be seen, but I got antibiotics, “just in case”. Did not help. Then the surgeon suggested taking Gabapentin (up to 4 x 300 mg per day). Seemed to help, but with strong side effects, so I had to reduce it to 2-3 x 300 mg per day (heart rate irregularities, muscle tremors, etc.). Have had also side effects with Tramadol (micturition problems, dry mouth, itchiness). However, Tramadol also works on your Serotonin level, and I could definitely feel improvement in my anxiety (going down) and energy level (going up). Basically, Gabapentin works exactly in the opposite way (anxiety going up, extreme tiredness). Last week, I had an injection of Bupovacaine, did not help at all. In contrast, injection on the left side resulted in a small hematoma, injection on the right side gave a very sharp, almost unbearable pain, throwing me back to the days right after the vasectomy. Doctor’s in Denmark do not know what to do with me right now. I am on Tramadol (retard) pills now, and am still taking Gabapentin, but the pain is there, sometimes better, but now after the injection it has become worse, but I hope to get back to pre-injection levels.
I recently read a book by Tim Parks (“teach us to sit still”), where he explains, as sceptic, how he got a good handle on his supposed prostatitis by using meditation, based on a book called “headache in the pelvis”. I am thinking now this is all related, and how to ease up the tension down there. Does anyone have experience with using magnesia oil directly on the area, or taking magnesia supplements? Also, does anyone know what / why to take Papaya sees - I don’t understand yet why this should help.
Also, I have investigated what surgical options I have, and vasovasostomy seem the most logical for me, to connect what was disconnected. What I don’t know is, how this should help if nerves are involved. However, as said above, I had strong pain during the surgery (which I thought was an indication for nerves involved damaged), but at the same time the injection of Bupovacaine did not bring any relief. I am a bit scared of any more surgery, and I am less scared about vasovasostomy than I am about denervation. I somewhere read one should do the vaso first before attempting a denervation, and not vice versa. I don’t understand why. Maybe someone can shed light on that?
All of you in this forum have my sympathy.
BR
Juno


#2

Hi there. Thanks for sharing your story, and welcome to the forum. Given your only 3 months into this, I’d still say your still relatively early to jump into anything, and I’d definitely recommend giving things more time, but I’m all for to each his own as well. Please understand that reversal does have a chance to make you worse in the long run, and it’s happened to several guys on this site. Please do your homework before you jump into anything.

A lot of what your asking has been talked about many times on this forum, and I’d recommend using the search bar on this site to find them threads, and/or posts.

I can only think of one doctor/uro here in north America that believes de-nervation is a sensible first option for pvp/s, and I’ve never heard of anyone having it done earlier than 6~ months post vasectomy. That’s not to be confused with I know everything though.

Tramadol was one of the best medications for my pvp/s. I had minimal side effects, and excellent pain relief from it. What seems to work for one, may not work for another, and that’s pretty typical across the board far as medications, conservative treatments, procedures, surgery’s, etc.

If you have any specific questions that you can’t seem to find answers to, please ask.

Keep us posted, and good luck.


#3

Thanks, I’ve only started to use the tremendous amount of information shared on this forum.
Up to now, I’ve tried to make sense out of mostly publicly available information, which is heavy on medical terms, and one blog, see links below:






http://painaftervasectomy.blogspot.com

I am sure people have come across these articles, too; I found them as a good introductory guide to the topic, but admit I did get confused when it comes to details and x-references to other studies regarding success rates, etc. After all, I have a normal life that continues, with work in the office and work at home, and I cannot do a part-time medical investigation on such a highly complex subject. So I am really, really grateful to have found this forum where real people talk about real experiences.

So far, I tend to believe that I am not a nerve-type victim, because the cord block did not bring any relief, but instead made things worse. I was tempted to believe at the beginning it could be a nerve problem, but the pain is more constant and dull, not so much stabbing, stinging like I get it should be for nerve type problems (albeit I had sharp sudden pain during the surgery, which I still cannot put into context).

Also, I have intensified pain, for a day or two, after I ejaculate. Again, I don’t know if that is because the epididymis is swollen and pinching nerves, or caused by something else.

I have a few specific follow-up questions:

  1. How long do people take opioids like Tramadol? I took 200 mg for 6-7 weeks, now I am at 100 mg using a retard version of it. A pain specialist recommended me to switch to Tapentadol, which is class III.
    I am worried about getting addicted, but on the other hand it seems to bring me relief, and I am more scared about chronic pain development than addiction, to be frank.

  2. How long do people take stuff like Pregabalin or Gabapentin? Is that a long-term solution?

  3. Does anyone have experience with meditation or hypnosis in pain treatment?

  4. Has anyone tried massaging the area with magnesium oil?

  5. I read a few comments about “find a good pelvic PT” - what does PT stand for (physiotherapist?) and what would a pelvic PT typically do to help? It’s just something I am totally unfamiliar with.

I would really appreciate any comment.

Thanks,
Juno


#4

I personally would not put to much stock in the idea that if a cord block does this or that, it means this or that. I’ve just seen to much conflicting stuff including random cases that were posted online regarding the good ole cord block theory. Just my opinion.

I have no idea. I know of people that have taken them for pain for eon’s. Tramadol (tramadol hydrochloride) is not a true opioid either. Tramadol tablets tend to be a mix of tramadol hydrochloride which is a synthetic opioid of sorts, mixed with a low dose of acetaminophen. I took tramadol off and on for nearly 5~ years straight. I didn’t become addicted, was able to stop without issue, withdraw, etc. My side effects while on it depended on how much I took. After a certain amount, it would give me a headache of sorts. I also experienced agitation, short fused, etc sometimes. I learned what amount was best for my system over time, and how much was to much. I only took too much a couple times where I felt I was on the verge of a minor overdose, which in my case was approximately 5~ 50mg tablets in a day. I used to combine it with celebrex periodically as well. I know of a pvps guy that had a grand maul seizure while taking tramadol and celebrex at the same time. I do believe he was also consuming alcohol, and perhaps cannabis while on them RX medications as well. So, be careful, use common sense, etc. Just FYI, I do know of people, including a guy or two on this site that had awful withdrawals from tramadol, among many other RX medications.

You have many questions, and I’m not going to give you all the answers as they’d be from my perspective. You can read a lot about what you ask on this site (search terms), and you should ask your doctor as well. Theres a lot of liability involved in giving such advice, and I want you to learn from all the proper channels. Right, or wrong, at least you will have input from many angles.

PT stands for physical therapy, or physical therapist (another search term).

I’ve read all the links you posted at some point in the past. There’s a lot of similar information in the library section on this website, and I’d recommend checking that out as well.

I apologize that I don’t have time to answer all of your questions at the moment.

Feel free to post more questions if you have them, and I will answer when I get a moment, if someone else doesn’t add to this thread in the meantime.

Cheers


#5

@Juno sorry to hear your troubles. I am currently at 7 months post Vas. I currently take tramadol and Gabapetine also but at smaller doses of each. I tend to get good results from tramadol to get through the day. No one has all the answers. You have to do your own homework and make the best decision for you. Most recommend to start with conservative options depending on your symptoms. Typically this is medication, pelvic floor physical therapy, papaya seed, chiropractic, and stress relief. I think meditation helps but I personally need to do it more. Time helps most people or at least gets them to a point they can survive but again it’s your call. I am better now at 7 months then 3 months but have tried a lot of treatments. I am also planning on a reversal before end of year if I’m not in a good place. Good luck


#6

@Ben thanks mate, I am feeling with you. Have you tried a cord block? When did your symptoms start? I am thinking reversal is the way-to-go because it seems the most natural thing to do - reconnect what was cut before. I know of one microsurgeon who does only that, some 200+ surgeries a year. Spoke to him, he said a couple of guys per year come because of PVPS. Also said, that a survey among his patients with PVPS showed that almost 95% replied with good results, i.e. (some) pain relief. Don’t know any details, though (level of pain relief, when they had reversal, etc.). Have you ever heard of “medical hypnosis” for chronic pain treatment? Have you tried papaya seed, if so, how long and did it help? Sorry for the many questions, but it seems we’re in a similar spot and I’d like to lear from other people’s experiences. BR


#7

@Ben Forgot to emphasize that I tried a cord block, injecting bupovacaine on both sides, and I’m left with a bruise on the left side and had a sharp pain during injection on the right side. I am much worse than I was before the injection.


#8

@Juno yes I tried a spermatic cord block early similar to you and it made things worse for a few weeks. Is your pain mainly in the testicles or do you have other pain? My pain is mainly outside testicles in back, hip, shoulder blade, and neck all on right side. This led me to try some other types of blocks which did help me. My chiropractic friend and I actually discussed hypnotized meditation when the anxiety was high but it had been years since he did it last to a patient and we did not pursue it. If you haven’t done so already use the search option on the site which can help find other stories similar to yours. I have done extensive research on reversal and most get better but some do get worse so it’s a risk. There are also a lot of guys that gave it time and they got better even 1,2,3 years later. Sounds like you are able to work still which is good. I have not tried anything surgical to date for fear of making things worse but if I’m not at a point I’m able to live with my issues I will pursue a reversal. It’s hard for anyone to recommend what to do because the outcomes are not the same for everybody. I have tried papaya seed and it helped early when I also had testicle pain. There are threads on the site with guys getting good results. Sounds like the reversal surgeon you are working with has a lot of experience. Do some research on the different variations of reversal and ask him specific questions. Does he do full clean up? Does he do microsurgery with good microscope, does he do Vas to vas only for pain guys, how many reversals does he do a day? How do the pain patients he works on fair after reversal etc. Plenty of other questions as well but I’m on my phone so do your research and hopefully conservative methods and time get you to a good place.


#9

Hiya I’ve had this pain for a year and a half I would try landecane injection a pain blocker which I have had takes up to six weeks to work tho also get off tramadol try bumorphine patches keep gabbapentin a good tens machine helps also oral morphine yea not the best route but it’s working then get accupuntuer I’m booked in for one a week for a month if that don’t work a landecane infusion I’m not a gp just some one who feels that pain lots yea a year and a half but it’s going the right way I post here but more found on Xbox as I’m a ambassador there and also patent .com where I write on a regular post I have a thing on Facebook trying to get resurch done here in UK but I’m working on that


#10

Hi Juno. Is the surgeon in Germany named Martin Petsch? I was also looking at good reversal surgeons and found him in Germany. I am in Finland (but not Finnish) and the doctors here also don’t know what to do with me.


#11

My pain is mainly in the testicles, a dull, hard-to-localize pain, as if kicked in the balls. That’s 90% of the sensation. 10% is stabbing pain, but it’s getting less with every day after the injection. I did notice, however, that my stomach (lower right part) hurts, especially when laying. I don’t feel this pain when standing. Also, I have back pain (lower back), but I am not sure if that’s connected, because I used to have back pain occasionally before, too. And then I have a tickling sensation into my legs.
I actually have changed my strategy over the last few days after reading so many posts here (and reading a lot about guys with a reversal that did not improve or actually got out worse - which is a contracting the stats from some of the papers that I linked to above), and I feel I need to do a lot more research before making a decision whether to opt for surgery or not. I don’t think waiting for another 3 months will make any difference right now (which would make it 6 months post vas). The least thing I want is rushing into another surgery and make things worse if I am not informed. I guess that’s common to many of us here. I am not even sure right now if a) the reversal is the “best” option (if feels like the most natural one, though) and b) how to choose the surgeon. I will also start with pelvic floor PT in a few weeks, and I am thinking about trying out hypnosis. And I also bought papaya seed powder; if it won’t help, it won’t make things worse, either, I hope. How long is your vas back? And how did your pain change over time? Did you try any PT? Juno


#12

Dr Petsch seems to be one of the experts in Germany, for reversals, if you look at his reviews. I am sure you researched him.
I think I still have a lot of research to do to make this decision, as I’ve read on some posts here that also the reversal can be done in different ways, and I don’t understand these differences yet.
Where are you from? What’s your pain like? When did you have your vasectomy?
I will put another post here trying to gather names of experts across Europe, and if anyone can say anything about the quality of surgeons in Europe compared to surgeons in the US or Canada.
I personally would not mind flying to the US to get the reversal done there if they are better.
I know that’s probably impossible to answer, but I want to raise the question anyways. Maybe someone knows something. That’s what this forum is for, I think. Hope you are doing fine. BR


#13

I am originally from the US, but have lived in Finland for over 11 years now. I had my vasectomy here in Finland nearly 3 years ago. My pain started in March this year, which would have been about 2.3 years after the vas.

It started as a light ache in the left nut, but quickly changed to a more stabbing pain in my left inguinal area. By the time I was able to see a urologist about a month later, the pain was already going away. It was completely gone for about 2.5 months before coming back again in the beginning of July. Again as pain in the inguinal area. It still has not gone away. In the last week or two, I get more testicle ache then before, but the worst pain is from the inguinal area. I think when the testicle aches, it is radiating from higher up, but that’s just my feeling.

I am also not ready to make the step toward reversal yet, but I am not sure I can make this my new normal.


#14

Have you found any other reversal specialist across Europe, and have you spoken to one already?
I guess Finland must be pretty similar than Denmark or Scandinavia as a whole - no real specialists when it comes to our type of problems and surgeries. I really wonder about the UK, they must have experts there, too. I can only consider English or German speaking countries, anything else won’t work because of the language barrier and trust / confidence issues because of that.


#15

To be honest, I haven’t done a whole lot of research on it yet. I don’t really want to get a reversal yet, so I haven’t looked into it wholeheartedly.

Yes, Finland as pretty much nothing as far as support in this area from what I have been able to find out. Amazingly, I did eventually have a urologist here admit that the had no other explanation for the pain aside from vasectomy, but he, nor any other I researched, have any way to help/treat it. He referred me to a physiatrist who basically threw his hands up and gave up on me after only 2 sessions. So, now I am back to square one, medically speaking.

I am going to try to treat it conservatively myself for a while, I think, before I seriously start to consider reversal. Papaya, supplements, pelvic floor stretching, etc. I don’t want to be fertile again and I definitely don’t want to end up in more pain that I am now, so I want to see how I progress, or not, and reassess after giving these other things time. I want to know that I exhausted all my options before going under the knife again.


#16

A short update on my situation:
I have the bupovacaine injection 2 weeks ago, with bad outcome, but I think it’s getting somewhat better, I have less stinging / stabbing pain now that after the injection.
Last week I was at the supposedly best urological clinic in my country. Again, ultrasound did not show anything (what a surprise), and the doctor prescribed me an alpha blocker. He said, it would take weeks until the effects could be felt (relaxing the pelvic muscles around the bladder etc.). Well, after 2 or 3 days I started having retrograde ejaculations. Zero, nada drop of liquid. I was shocked, followed by a burning sensation that was different from the pain before.
I wonder if the medication can trigger this that fast??
One day before seeing this urologist, my GP prescribed me with a different pain killer, Tapentadol retard tablets (2 x 100 mg) instead of Tramadol. Still taking Gabapentin.
Does anyone have experience with alpha blockers?
I will stop taking them and see if I get back to “normal” wrt ejaculations.


#17

Hi Juno
I guess the alpha blocker was Flomax aka Tamsulosin (0.4 mg), miktogram maybe?
I tried that for a week or so but it did not really help me. Everything down there relaxed alright but I was still in pain.
So I stopped taking them. My ejaculation felt different but not retrograde. Probably would happen if I had continued.


#18

Tamsulosin, correct. I stopped taking them after only 2 or 3 days. Now I am back to where I was before, only had 1 “test ejaculation” and, voilá, there was the ejaculate again. At this highly specialized clinic they said it would take 1-2 weeks to build up enough medication to truly feel the effects, but the side effects I had instantaneously. Wonder if that tells me anything?
Anyways, I am trying to avoid ejaculations these days as it makes things worse.
I also went back from Tapentadol to Tramadol, as I have been very, very, very emotional over the last week or so, and now with Tramadol at least I benefit from the serotonin effect, and I feel better, even at same pain levels as before.


#19

Interesting observation that the hot burning sensation in my abdomen is almost gone when stopping Tapentadol and taking Tramadol instead. But having much more testicular pain now instead. No idea what this means.


#20

My GP / pain doctor yesterday adviced to step up Pregabalin to 600 mg/day over the next 2 weeks to see if things improve.