What is the cause of problems?


From the 1st paper I posted above:

“Postvasectomy Pain Syndrome
The pathophysiology underlying PVPS is a deviation from the natural progression of events within the ejaculatory system following disruption of the vas deferens. The definitive cause for PVPS is not known and may be the result of a number of subclinical processes occurring within the epididymis and further up into the spermatic cord. Theories have included epididymal congestion, painful sperm granulomas, vascular stasis, and nerve impingement.”

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

And the 1st article:

"Etiology of PVPS
The etiology of PVPS is still uncertain but there is some understanding of possible mechanisms for the pain. The currently available evidence suggests that several processes lead to the histological findings seen in PVPS. There may be a final common pathway leading to chronic testicular or epididymal pain that involves damage to scrotal nervous structures via immune system inflammatory effects, back pressure affects in the post-vasectomy closed system, or via perineural fibrosis from either of these processes.

Postulated etiologies for PVPS have included pressure from epididymal congestion, inflammation, or compression of paravasal nerves by sperm granuloma, interstitial fibrosis in the epididymides, or perineural fibrosis (14). Studies of epididymectomy specimens from patients with post-vasectomy pain have shown evidence of pathological changes possibly related to longstanding obstruction. This interstitial fibrosis and perineural fibrosis seen in the epididymides of affected men could explain the pain (15)."

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

From the last article:

"Well-recognised complication
Post-vasectomy pain syndrome is a well-recognised, but poorly publicised complication of vasectomy. As is exemplified by this case, it is an intermittent or constant, unilateral or bilateral testicular pain that occurs for longer than three months and interferes with daily activities prompting the individual to seek medical advice.

Intermittent pains are often triggered by physical exertion, sexual activity or ejaculation. It may occur immediately postoperatively but more commonly develops months to years later.1

This delay is due to a gradual rise in pressure within the epididymis caused by continued production of sperm that are released into a system now closed by ties or clips on the vas deferens.

The painful build-up of sperm may be prevented or relieved by an ‘epididymal blowout’ or by recruitment of macrophages into sperm-destroying granulomas within the epididymis.2

Providers of vasectomy, both NHS and private, are encouraged by 2004 guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) to inform men of the risk of chronic pain. However, general awareness of the complication remains low and information regarding the level of risk is often ambiguous.

The risk of chronic pain is commonly described as affecting ‘some men’ or ‘a very small number of men’. However, multiple UK-based studies of post-vasectomy pain have demonstrated that the proportion of men who develop pain after a vasectomy is almost 15%.

The number of men who seek medical advice or rate their pain as severe, and therefore qualify for a diagnosis of post-vasectomy pain syndrome, is up to 6%.3 This does not correlate with the level of risk described to patients and it may influence their decision."

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

So basically,

  1. Some men get a different reaction to the vasectomy from average , some significant pain occurs for up to 15%, 1/7.

  2. A smaller number of men get more severe pain, between 1% and 6%, depending on source, so this occurs in 1/100 to 1/17. Most people posting here are in that bucket, or have been

  3. Back pressure is one of the primary causes, and can still occur in open ended vasectomy at possibly lower rates but the open end tends toward closure over time , also these men may develop pain from sperm granulomas due to increased leakage into the scrotum.

  4. For another group the pain comes from nerve damage during the procedure or possibly also from immune response.

Some men get all of these causes, nerve damage plus congestion, plus immune reaction, plus granulomas!

You have to now be the best informed potential vasectomy candidate regarding chronic pain risks ever at this point!

It’s your choice of this is a “good risk” however. Most people here in the 1% to 6% (1/100 to 1/17) with more severe levels of pain would not say so


@rickydicky seems like you’re adamant on getting vasectomy and that your mind is already made. There’s no point in trying to trivialise pains to the members of this forum and no point in dragging this thread any longer.

Mate, have it done and good luck to you, all best.


Thanks for the input. you must agree its weird that guys on here are in pain an everyones treatment is different. I saw some guys saying open ended conversion helped them so much an saved them while others who had open ended said it cauced a bunch of headaches.


Not really, cutting into a very nerve rich area of the body and then blocking a pair of tubes that are meant to flow potentially causes a number of different painful issues as is outlined in my post above.

The chronic pain outcomes are pretty well recognised by major international urology bodies.

Some of those issues emerge over time as structures in the testicles are altered by congestion, structures in the testicles are overwhelmed by back pressure, fine nerves are entangled, fibrosis is caused, sperm leaks into the testicles and causes granulomas, immune reaction , inflammation etc. Some people are more atopic so this immune dimension impacts them much more than others. Sperm leaking to where it is not supposed to be is highly immunogenic, can cause inflammation and pain. I was one of those to an unusual degree, as I was told at reversal surgery.

My scrotal tissues were inflamed, bloody and full of leaking vessels. I also was in a shed load of worsening pain for the year prior.

Doctors are often unsure exactly how to solve those different but reasonably common issues, but there are many papers. Testicular pain as a whole is hard for docs to resolve.

A number of different treatments have been tried and documented in peer reviewed medical journals and if correctly applied shown to help, men cycle through those treatments under an experienced urologists guidance until they get out of often very severe and life altering pain. Some men never are pain free despite all treatment however.

Each surgery on the testicles is more intimidating than the last and living with the sometimes very severe pain can destroy people’s lives, families, jobs, homes, mental health.

This should all be pretty clear already from what I and others have posted above.

Sigh, really if you want a vasectomy that’s your choice. I think I am done here now. :slight_smile: