Post Vasectomy Pain Forum

Advice Needed - What would you do if you were me?

I’m sure many of you have read my posts over last 4 months, but generally speaking many of them were updates or responses. But now I’m at a bit of a crossroads having crossed the 5 month mark and nearing the 6 month milestone in a few weeks, so I’m asking for everyone’s advice.

I first want to acknowledge that I’ve been very fortunate to not be experiencing as severe and torturous of symptoms as many of the guys here. So I certainly don’t want to come off as “poor me” when, at least to this point, I’m a lot better off than many.

If you want to see a detailed version of my history you can look at previous post of mine. Here’s the summary – had a painful vasectomy on Feb 5. Experienced consistent discomfort for the first 6 weeks and had two follow ups with PA until follow up with Uro at 6/7 week mark. Uro suggested NSAIDs and time. I turned a corner at week 8 and had 4-6 weeks of steady improvement. After crossing the 3 month mark at the beginning of May I was convinced I was going to make a full or close to full recovery. No more jock strap, NSAIDs, or icing. Then had a setback at end of May with enlarged and sensitive epis. It took a few weeks of NSAIDs for that to resolve. I had a couple of good weeks, and then had a couple of days last week experiencing some “zingers”, but NSAIDs managed to reduce the pain a good amount. I’ve now put together 4-5 days with no zingers and have only been doing icing throughout the day to help alleviate discomfort/irritation at back of left teste where epi elbows into the vas. This area tends to get sore with increased activity since my thigh rubs against it when walking. I can feel it gets slightly enlarged/firm when irritated. Icing helps quite a bit, and NSAIDs would knock the pain out almost entirely I’m sure. But I can manage just fine throughout the day without the NSAIDS.

So here’s where I’m at-- based on Mankoski 10-point pain scale, the first 8 weeks after vas I was probably bouncing around between 3-5. During my best 4-week span probably 1-2. During recent setback probably 3-4, but NSAIDS reduced pain down to 2. Now, aside from couple instances of zingers, ive been about a 2.5. I can work, take care of my kids, and most things I was doing prior to vas aside from certain triggers like prolonged sitting and strenuous activity. I normally take NSAIDs not because the pain is so bad I feel like I need to, but because they make me much more comfortable if I’m going to have an active day with the family. So currently taking Zyflamend, wearing normal briefs for support, and icing around 3x a day. I’ve taken NSAIDs only a few times over last couple of weeks. So I’d you were me what would you do???

1.) Continue what I’m doing and reassess at 6 months (I keep a daily pain log). If things seem to be trending better, or at least not getting worse, stay the course.

2.) Schedule follow up with Uro regarding sensitive area at elbow of epi/vas.

I realize my pain levels aren’t as bad as others, but I’m discouraged at the fact that even on my best day I’ve still experienced mild discomfort, and now I’m approaching 6 months and nervous that I’ll be dealing with this long term. Do you guys recall or know of anyone getting better on their own after experiencing pain 6+ months out? I’ve searched here and only found a couple of instances where that is the case, and numerous where it eventually led to reversal, other surgical intervention, or long term pain management.

I’m really hoping to avoid any further surgical intervention, but would want to be aggressive with conservative treatment since I’m still under 1-year.

Any thoughts or suggestions would really be appreciated. Thanks!!!

I remember seeing a urologist for the first time at 6 months post-vas. He told me he thought my pain would burn out. Well, here I am 8 years later. Yea, I think he was wrong. Personally, I would get aggressive at 6 months and at least try a reversal if you haven’t.

I second what @Sentosa wrote. I was told to wait, to give it time, to let it resolve on its own -it only got worse. In hindsight I wish I had acted much earlier. I was on the right path but lack of trust into doctors and then my divorce together with Covid-19 put everything on hold. Here I am 3 years later not only with burning nerve pain but also lower back pain and autoimmune issues - divorced, disappointed and a bitter man. I believe in the concept of pain centralization and would do everything early on to fix things while you still can.

@Sentosa and @Juno

What were your pain levels at 6 months? Despite my setback I am still trending positive over last 3 months and even last couple of weeks. I started keeping my pain journal in late May so I could keep an accurate account of my pain and told myself I would assess at 6, 9, and 12 months. If I wasn’t getting worse, or continued improving over those 3 month increments, I was going to continue conservative measures as necessary. So if I run into situations like yours where it gets worse after 6 months, by 9 months I’d be seeking medical intervention. But based on numerous opinions on this board, it seems like general consensus is to give yourt 12 months before considering reversal.

The definition of chronic pain to my knowledge is around 3 months, after that it’s considered chronic and a pain condition by itself when nerves become hypersensitized and you still feel your pain in the CNS when the original pain has subsided. I’m by no means an expert but that’s how I understand it.
I had pain straight at the surgery and never recovered. I had / have blue balls feeling, too, but my biggest problem is burning pain in the scrotum. So I guess it’s nerve pain. To my surprise though it hasn’t spread to eg legs as others report - I don’t really understand it, nor do the doctors I saw.
I had a pain journal early on but have not consistently kept it up to date. I think I still have same or more pain than after 6 months.
I was thrown at with all medications available available to the uro and my GP so they might have masked some pain early on. Bottom line e is: I had strong pain from day 0 and it never got better.

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My original uro prescribed Neurontin at about 4 weeks to prevent pain centralization. I only took it one day because it made me feel incredibly irritable and weird and didn’t help the pain any.

I think doctors might have a tendency to mistakenly interpret long term pain as centralization when there is really something else going on, be it congestion, inflammation, scar tissue, muscular dysfunction, whatever. I think this because many guys who get a reversal report that the pain immediately goes away or changes character. Seems like if it were originating higher in the nervous system this is not what you should expect.

Also, ascribing the pain to centralization let’s them avoid contemplating reversal as a treatment option, which is a can of worms no uro seems eager to open.

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@Juno thank you for the additional details describing your pain. Would you be able to assign a number on a scale from 1 to 10 to that pain? did your pain ever decrease for a period of time? When you say you had pain from day 0 and it never got better, do you mean it never improved even slightly? My pain has definitely varied over the last 5 months, but I’ve never been in constant excruciating pain. I would say the highest pain number I’ve been experienced for any amount of time is probably a 5.5 or 6, and that was for a limited number of hours. NSAIDs have always reduced discomfort if not relieved it.

Looking at my old notes, and from my memory, I was really in pain, 6-7, the days/weeks after the vasectomy; Tramadol and Gabapentin/Pregabalin helped to reduce it to 3-4 after 6 months; I tapered off Tramadol in 2019 without an increase in pain. I tried to get off Pregabalin - am still taking it today. Had 2 diagnostic blocks that made things worse for me, and I think I still suffer from the last failure in fall 2020. I would describe my pain today still as 3-4.

i want to make contribution. İ am not vasectomied. İ had mesh in inguinal Canal. After surgery my pain was 2-3…i had redo surgery and my pain became 6-7. Every surgery has its own Riscs and can make situation worse.

@dsyejaculation

I am glad you made the contribution and I appreciate it. The risk of increased pain by seeking further surgical intervention gives me serious reservations given where my pain levels are at currently. If I recorded my pain today on a 10pt scale it would be a 2. I’ve not iced or used NSAIDs and I’m wearing normal briefs. If I continue around this level my plan was to stay the course maybe pursue other non invasive conservative measures. But I wanted to get everyone’s opinion because I don’t want to regret not being more aggressive in my 6 month window by not seeking medical therapies such as steroids or something.

Thanks again for you reply

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