Post Vasectomy Pain Forum

American Urology Association 2012 Guidelines

AUA 2012 guidelines here:

AUA 2012.pdf (2.0 MB)

I sifted through this document. Though it mentions chronic scrotal pain, it doesn’t specify PVPS, unless I missed it. On Yahoo I mentioned that it would be nice to see statements from the AUA, UpToDate, and Campbell all together. I guess that Campbell’s latest version is still in process. So, here’s what I have:

From UpToDate
“Historically, rates for the post-vasectomy pain syndrome have been reported as
very low (<1 percent). However, surveys have found that the incidence of
"troublesome" post-vasectomy pain is reported by about 15 percent of men, with
pain severe enough to impact quality of life in 2 percent; survey respondents,
however, may not have been representative of all post-vasectomy men [40,41].”

From AUA
“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.” (page 12)

“Medical journals report that about 1-2% of men develop significant chronic pain in the scrotal sac after vasectomy. This pain can last for months or years and can even be permanent.” (From the appendix.)

From Campbell Walsh Urology (see version 11 when it comes out)

Thanks for starting this Tim!

Uptodate’s text the last time I checked reads:

Historically, rates for the post-vasectomy pain syndrome have been reported as very low (< 1 percent). However, surveys have found that the incidence of “troublesome” post-vasectomy pain is reported by about 15 percent of men, with pain severe enough to impact quality of life in 2 percent; survey respondents, however, may not have been representative of all post-vasectomy men [40,41].

I can’t provide a link to the resource as Uptodate.com is a proprietary online database, but if you do have an account, you can check on www.uptodate.com.

It’s important to note that the word historically isn’t used very precisely. The < 1% number was based on the reports in Campbell Walsh Urology, which I have debunked as never having any evidence whatsoever. Uptodate doesn’t seem to want to own up to the fact that this history was never in fact true.

The Campbell Walsh update won’t be available publicly until 2016. You can find some details of the edit on my blog though.

If this looks satisfactory to everyone, I’ll move Tim’s AUA quote and citation and this message into a separate message thread so that it’s easier to find going forward.

Vic, awesome blog post! Thanks for correcting my UpToDate quote. Not sure how I messed up the cut and paste! …And sure, start a new thread if that makes it easier to find.

@victor and everyone, I thought I would revive this topic just to see if there’s any additional information from the medical community about the % of vasectomized men who develop PVPS. Someone mentioned a statement from HSA recently, but I’m not sure that exact figures were quoted. Collecting the most recent statements from the medical community will help us in our efforts to educate people (and perhaps even some of our urologists who still don’t believe in PVPS.)

Pretty severe thread necromancy here…
But I haven’t found this aspect of AUA’s vasectomy guidelines discussed anywhere else on this forum. Maybe it’s just cause I haven’t been around long enough, and this has been debated to death earlier. But here goes:

AUA guidelines from 2012 (pdf download) (web version).
In another thread yesterday I made a point that the AUA don’t have any references to the 1-2% pain number. Turns out I was wrong, cause I hadn’t read the thing closely enough. I wasn’t corrected however, so maybe most others have missed this detail as well.
In the online version, about 1/4 from the top of the document, there’s a discussion on how they came up with the 1-2% pain rate. It’s on page 10 of the PDF-version.

Copy-paste, bold emphasis by me, links to references for your convenience:


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.


65: Leslie TA, Illing RO, Cranston DW et al: The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int 2007
66: Choe JM, Kirkemo AK: Questionnaire-based outcomes study of nononcological post-vasectomy comlications. J Urol 1996
67: McMahon AJ, Buckley J, Taylor A et al: Chronic testicular pain following vasectomy. Br J Urol 1992
68: Morris C, Mishra K and Kirkman RJ: A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men. J Fam Plann Reprod Health Care 2002


So - these are AUA’s reference articles.

My initial thoughts are that AUA acknowledges that Leslie et al 2007 is the most robust study for PVPS, but it’s their opinion that men only need to be informed of what Leslie described as “quite severe and noticeably affecting their quality of life”. AUA’s opinion is that men don’t have to be informed that Leslie found that almost 15% have chronic pain with average VAS-score 3,4.

This may have some implications. We all know that the 1-2% pain is further perverted in information given to patients. Many say that "only 1-2% get ‘soreness’ or other benign words.

Maybe knowledge of the discussion in AUA’s guidelines can help people who think of writing a complaint against their vasectomist. If the written patient information use words that implies anything less than “severe chronic scrotal pain”, you may have a legal basis to throw the AUA guidelines back in your vasectomist’s face. This based on AUA’s reference paper, that also discusses moderate pain.
The written info I got for instance, use words that can roughly be translated to “tenderness”.

The difference between AUA and their European counterpart EUA’s guidelines is that EUA just says:
Chronic scrotal pain: 1—14%, usually mild but sometimes requiring pain management or surgery.
Only reference is Leslie 2007.

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I realize that the 1-2% statistic is fairly unpopular on this forum, but based on my unscientific observations over the last three years on social media I think it’s plausible – for men that have pain that does not go away without surgery.

The way I see it, about 15% of men still have some pain at 3 months but most of them end up pain free or close to pain free by the 1 year mark. I’d guess most of them clear up by around 9 months. So of your 15% chronic pain, 13-14% are “short haulers.” That leaves your 1-2% of men who either have to just live with pain indefinitely or try surgery.

It could be a bit higher, but you typically see this type of “tree pie chart”:

themarriagebed

(Link)

With 95% or more reporting that it was fine, and in the end worthwhile.

So I do think that the long-haulers are in the low single digit percent.

The problem with the AUA comment is the bait and switch. They throw out the 1-2% statistic, but the description they give is of the short-haulers. I.e. pain for a while but only a small fraction need surgery to fix their pain. (And no mention of men for whom surgery fails.)

They should be consistent. If they are going to describe the short-haulers, they should use the 15% statistic. If they are going to use the 1-2% statistic, they should describe the long-haulers.

Also, a lot of places used to use the somewhat hilarious 0.9% figure, which reminds me of how they price used cars in the USA.

The EUA guideline is more correct IMO.


By the way, a lot of uros seem to have an intuitive sense that the incidence is about 1:1000 men. This number is interesting because if you say 10% of men have a vasectomy, and 1% of those have PVPS, well that’s 1:1000 men from the general population. So going by those numbers it’s a “rare” disease.

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This study says otherwise.
Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years. BJU Int 2004
Two populations studied, 1 and 10 years after vasectomy. After 1 year 13,8% had pain. After 10 years 16,8% had pain.

5% had VAS-score above 5 after 10 years.

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I’m totally open to finding out that the real numbers are higher than 1-2%. Just describing what it has looked like from the window into social media. The best study I know of is the 2020 meta analysis that found 5% (Link)

Most of the studies have been retrospective, including the one you linked, and do not get 100% of the participants to reply, which unfortunately raises questions about systematic biases.

We really need prospective longitudinal studies to nail down the number, but as you commented elsewhere, those are probably not coming any time soon.

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I think a lot of people forget about or underestimate the statistics involved with latter stage post vasectomy pain syndrome, late stage post vasectomy pain syndrome, and alike.

Type late stage post vasectomy pain syndrome into a search bar and search for those specific words. I am looking at numerous pages of reference at the moment and many of those studies have been posted on this site numerous times in the past, including yesterday.

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There are several projects I’d like to work on, but definitely don’t have the time. One of them is to go read every study I can find about the incidence of PVPS and weight each study as to how many guys were in the study, what was the methodology, etc.

Another project I’d like to do is a head to head comparison of IUD and vasectomy.

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This is what they tried to do in the meta analysis you linked. I’ve read that somewhat thoroughly, and I think they cheated to get the results artificially low. There’s a table where they show what each included study says about Pvps incidence. Look at it. The most thorough study, Leslie 2007, isn’t included because they used the possibly wider term “chronic post vasectomy scrotal pain” (or similar), instead of “post vasectomy pain syndrome” So the 15% from Leslie isn’t calculated into the 5% average they found. But - one shitty study that just mentions briefly that “oh yeah, one single guy complained pain”, is included as a 0,4%, which pulls the average down. So the 5% number for pvps is really artificially deflated, as far as I can tell.

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Oh man. There is definitely a lot of room for mischief when you have a big range of numbers from lots of different studies with so many different properties.

If you haven’t seen this post you’d like it I think:

Not too many studies have been done on the impact of vasectomy on marriage. Maybe some stuff in the 1970s when vasectomy was starting to get popular.

Mostly you just hear that vasectomy makes sex life better because nobody’s worried about babies and all that. As a side note, vasectomy could lower a guy’s libido and still result in more sex if it makes the wife more likely to want sex. The guy’s drive isn’t usually the limiting factor as far as that goes. But I digress.

Key takeaway is this study says 20% of the marriages failed after the vasectomy, and in one third of those failures the guy blames the vasectomy. So that would suggest vasectomy causes divorce 6.8% of the time.

Not a particularly small study either but I just find it hard to believe that they found such high numbers.

If that study could be replicated, it is just catastrophically bad news for vasectomy marketing.