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What is the cause of problems?


#1

Ive been reading about peoples problems an it seems everyone is different. no clear answer to why or what is doing the damage. It seems open ended and close ended both suffer similar problems and some have it really bad while others have no problems. What do you think lowers the risk? Would a big city urologist be safer, Open ended, a dr who does reversal as well?


#2

If it ain’t broke, don’t fix it. My doc nicked a blood vessel since I had a thick scrotum on right side. He said it was tricky but instead of evaluating me before the day, and determining if no scalpel or scalpel or no vasectomy would be best, I was pushed on the day not knowing anything.

See a few urologists and see what they recommend. See if they all say same thing or something different.
I am two weeks after mine waiting for hematoma to heal. Hope to return to work Monday. Lots of pain until Thursday but still not 100%. Probably another few weeks for that. I am hoping for no long term damage


#3

ultimately it is a very unnatural procedure and no one knows what causes complications.


#4

This paper is one of the best I have read that goes through the testicular changes post vasectomy and the probable causes of chronic pain, I seem to post this about once every two months to someone in here!

Journal of Andrology Volume 24, Issue 3
Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome
Cory G. Christiansen Jay I. Sandlow
First published: 02 January 2013

https://onlinelibrary.wiley.com/doi/full/10.1002/j.1939-4640.2003.tb02675.x

See also this article:

December 4, 2014
Post-Vasectomy Pain Syndrome: Common but Hidden

Anthony R. Ellis, M.D., Assistant Clinical Professor
Department of Psychiatry, Michigan State University

Joseph E. Scherger, M.D., M.P.H., Clinical Professor
Department of Family & Preventive Medicine, University of California, San Diego

https://vasectomy-information.com/post-vasectomy-pain-syndrome-scientific-review/

This article is also very worth reading:

Identifying the cause of testicular pain
By Dr Jonathan Pinnell and Dr Lorna MacColl on the 18 January 2012


Question for guys who had reversals
Late PVP onset questions
#5

I guess your still to early to know if this was worth it or not right? for me i know having a child is about the worse thing possible that could happen. Id take living the rest of my life being homeless than having to raise a child. Im still concidering a vasectomy but not sure about what an why its dangerous . Theirs a place that does reversals and vasectomys they have no needle open ended too. Id love to be able to live my life an not live in fear anymore but ending up like the horror stories is scaring me off. Id read of people destroying their testicles with heat. if i could id just get the boys cut off .


#6

Yeah, this is my thinking. Nature never intended for these tubes to be cut. On top of that, it’s a very sensitive area of the body, with all sorts of wires and tubes down there. It’s just like when we were 12 years old and we were always worried about getting racked. It’s not a place you want any damage done.


#7

It wasn’t worth it for me. there are alternative methods to control contraception and pregnancy without the mental, emotional, and physical RISK that comes with a vasectomy. Stick with them if they are working for you


#8

There is no organ in the human boycthat regulates temperature like testicles. The maturation of sperm requires incubation that is +- 1 degree in order for it to work. Think of the complexity of the anatomy that it takes to make this happens. Vasectomy isn’t simply occluding the pathway where sperm exit. It’s a semi invasion surgery on an extremely delicate area, perhaps the most delicate area of the body second only to the neck. Medicine doesn’t understand this process or what it takes to make it all work. Hair thin nerves, blood vessels, lymph vessels, all working in stereo to provide you with the ability to reproduce.

Vasectomy significantly alters testicular function. The back up of sperm causes testicular damage as well. I haven’t even mentioned the likelihood of secondary surgical damage to one of the areas mentioned above.


#9

From the perspective of someone who has one of the most extreme cases here here’s my two cents. For me I figured out my cause through trial and errors. That area is so incredibly complex. The Dr.s who perform these things don’t even really know the complexity of the area. I can’t tell you how many blank stares I got from Drs when I asked them about genital anatomy. They are cutters and pill dispensers. Nothing more. Three years ago I had two testicles great life and family with no health: problems. Marriage was good but was feeling the strain of three toddlers 5,3, and 1 at the time. So I decided to follow in the footsteps of every other man in my family and become sexually mutilated. Pain in both sides immediately followed. This was followed by three surgeries- granuloma removal, reversal, and finally orchiectomy. Only after orchiectomy did I obtain pain relief and have since put that traumatic chapter in my life behind me and am moving forward happily. Don’t gamble with your nuts! It doesn’t matter what Dr. does it the same risks are involved IMHO. Chronic pain in your nuts is the WORST! Having kids is hard but I would rather father every child in India and Africa in exchange for PVP.


#10

Hey Ricky.

A urologist isn’t worried about pain. They are worried about you still being fertile. Because of that there is incentive for them to remove and destroy more tissue to keep them free from liability.

I would say the best type of procedure is a minimal damage/ disruption type. You could ask for no air gap, minimal cautery and no facial interposition. If I could go back in time I would tell my doctor not to remove a segment or do fascial interposition and in general to remove and destroy minimal tissue to get the job done. Would it have made a difference? It probably would make a reversal easier but I’m not sure it would help with pain. I believe for me the pain may have been caused by the location and way in which my vas deferens was isolated and removed from my scrotum and spermatic cord prior to dissection.


#11

Your name seems to pop up over and over asking same round about question. You been told over and over vasectomys are fucked up. Man just go find your uroligist and get cut roll the dice. If your unlucky you can end up like me and other fucked up people on this forum easy as brother.


#12

AT least this article was somewhat honest about the numbers.


#13

I guess that the authors of those articles probably don’t depend on selling loads of vasectomies to men in order to keep their jobs, or to pay for that nice new car /ski / beach holiday…

It’s noticeable that the commercial operators and promoters of vasectomy do not commonly quote even the AUA’s chronic pain risk stats in full. Stats which in turn are themselves lower than those which are given by a number of other national level urologist bodies.

http://www.auanet.org/guidelines/vasectomy-(2012-reviewed-for-currency-2015)

AUA states:

“Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.”

i.e. Significant quality of life impacting chronic pain is occurring in up to 1/50 men following a vasectomy in even those more conservative stats.


#14

If memory serves me right before the amended it they had it at 1-6 out of 100 required further medical intervention. sigh

Now they sound more in line with the chatter of AMA.


#15

The AUA state for comparison to other providers of patient information :

"The minimum and necessary concepts that should be discussed in a preoperative vasectomy consultation include the following: Expert Opinion

Vasectomy is intended to be a permanent form of contraception.
Vasectomy does not produce immediate sterility.
Following vasectomy, another form of contraception is required until vas occlusion is confirmed by post- vasectomy semen analysis (PVSA).
Even after vas occlusion is confirmed, vasectomy is not 100% reliable in preventing pregnancy.
The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have post-vasectomy azoospermia or PVSA showing rare non-motile sperm (RNMS).
Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a technique for vas occlusion known to have a low occlusive failure rate has been used.
Patients should refrain from ejaculation for approximately one week after vasectomy.
Options for fertility after vasectomy include vasectomy reversal and sperm retrieval with in vitro fertilization. These options are not always successful, and they may be expensive.
The rates of surgical complications such as symptomatic hematoma and infection are 1-2%. These rates vary with the surgeon’s experience and the criteria used to diagnose these conditions.
Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.
Other permanent and non-permanent alternatives to vasectomy are available."

I wonder how many U.S. providers give that to men up front in the sell?


#16

I wonder how many U.S. providers give that to men up front in the sell?

Mine definitely didn’t. I was verbally told there was a 1 in 2000 chance of chronic pain. The pamphlet I was given did not provide any numbers, but it did say:

  • The vas deferens can reconnect in rare cases. This makes you fertile again and can result in an unwanted pregnancy.

  • Long-term testicular discomfort may occur after surgery, but this is very rare.

Considering that the watered down AUA statement admits that chronic pain is 40 times more likely than unwanted pregnancy, I think it’s pretty unethical to give men a pamphlet that says chronic pain is ‘very rare’ right under the statement that pregnancy is ‘rare.’

The whole thing has destroyed whatever illusions I had about the trustworthiness of doctors. Whatever they say should be greeted with healthy skepticism – even cynicism to be on the safe side, considering the high stakes.


#17

The full unabridged AUA guide is here, which does include the higher stats statements:

Page 10

“Chronic scrotal pain. Rarely, some men complain of
persistent unilateral or bilateral scrotal pain after
vasectomy. The medical literature on post-vasectomy
pain is comprised of poor-quality studies characterized by
small sample sizes, failure to report inclusion criteria,
failure to use validated pain measures, high non-response
rates, poorly-specified definitions of outcomes, highly
variable rates and lack of clarity regarding whether active
or passive surveillance was used to determine chronic
pain rates. The opinion of the Panel is that the most
important information for patient counseling is the risk of
chronic scrotal pain which is severe enough to cause the
patient to seek medical attention and/or to interfere with
quality of life. The most robust study of this indicates a
0.9% rate of such a pain seven months after the surgery.65
Only three studies reported follow-up of three years or
more regarding severe chronic scrotal pain after
vasectomy. One group reported in a single-group
retrospective study that at 4.8 years of follow-up, 2.2% of
vasectomized men reported chronic scrotal pain sufficient
to exert an adverse impact on quality of life.66 An
additional group reported in a prospective single-cohort
design with four years of follow-up that 5% of
vasectomized men sought medical attention because of
testicular pain.67 In the sole comparative study, at 3.9
years of follow-up 6.0% of vasectomized men reported
pain severe enough to motivate the seeking of medical
care compared to 2.0% of non-vasectomized men.68
The
opinion of the Panel is that chronic scrotal pain severe
enough to interfere with quality of life occurs in 1-2% of
men after vasectomy. Medical or surgical therapy is
usually, but not always, effective in improving this
chronic pain. Few men require surgical treatment for
chronic scrotal pain that may occur after vasectomy.”


#18

NOW from Page 1, wait wait wait, now just hold on guys, where are the chronic pain risk counseling recommendations in here??? Pregnancy is 1 in 2000, chronic scrotal pain risk is WAY higher. Did someone forget?? Really it is genuinely amazing that this is not in the Page 1 preoperative consultation guidelines!

"Guideline Statements

  1. A preoperative interactive consultation should be conducted, preferably in person.
    If an in-person consultation is not possible, then preoperative consultation by
    telephone or electronic communication is an acceptable alternative. Expert
    Opinion
  2. The minimum and necessary concepts that should be discussed in a preoperative
    vasectomy consultation include the following: Expert Opinion
     Vasectomy is intended to be a permanent form of contraception.
     Vasectomy does not produce immediate sterility.
     Following vasectomy, another form of contraception is required until vas
    occlusion is confirmed by post- vasectomy semen analysis (PVSA).
     Even after vas occlusion is confirmed, vasectomy is not 100% reliable in
    preventing pregnancy.
     The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men
    who have post-vasectomy azoospermia or PVSA showing rare non-motile
    sperm (RNMS).
     Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a
    technique for vas occlusion known to have a low occlusive failure rate has
    been used.
     Patients should refrain from ejaculation for approximately one week after
    vasectomy.
     Options for fertility after vasectomy include vasectomy reversal and sperm
    retrieval with in vitro fertilization. These options are not always successful,
    and they may be expensive. "

#19

Sorry, I know I am repeating your point here Ethan. But this seems a remarkable preoperative omission


#20

It seems to be in the abridged version, but removed in the unabridged one, which is rather strange!