Post Vasectomy Pain Forum

Approaching 1 year of pain with no answers. Insight greatly appreciated!

Hey all, here is my story. Sorry for the length; I’m just throwing out every detail I can, hoping something will click with someone.

I had my vasectomy in late 2018. The only thing remarkable about it was that when the doctor snipped my left side I had a pinch of pain. He then asked if I were on any blood thinners (I presume the bleeding didn’t stop as fast as usual). It was the first snip he’d made; the right didn’t really have any pain. For a couple of months afterwards I was sorer than I had anticipated, especially on my left side, but eventually that went away. Sperm showed up on my first post-op test, but were gone with a second test a few weeks later.

The rest of 2019 was fine; a few times I had a little bit of soreness at the end of a long/vigorous day, but it wasn’t really enough to even warrant Advil.

Fast forward to February 2020. I had a wicked cough for a couple of weeks, towards the end of which I started getting an achy pain in my left testicle. I figured it was irritation from coughing so much, but after it persisted my urologist ordered an ultrasound. They diagnosed me with epididymitis and prescribed antibiotics, which did nothing.

I should describe the pain. It varies from very mild/non-existent to like an 8.5 out of 10. Pain is a dull-to-strong- ache, very rarely sharp or acute. At its worse, I can barely function. My testicle is sensitive to the touch. Sexual activity always makes it worse. If I have an orgasm I have increased pain, sometimes for as little as 8-12 hours, sometimes for several days. Just getting aroused will often cause aching afterwards. Other things that usually aggravate it: some physical activities (especially lifting), sitting in a hard chair, vigorous hiking/climbing. Stress seems to worsen it too. Things that help(at least in the moment): being in a hot bath, sometimes rest, often times going for a walk, and tighter underwear seems to be better than looser. Sitting with my hips opened wide (feet together) also helps sometimes. The pain sometimes extends up into the side of my hip. It feels like my testicle is swollen, sorta like there’s a pouch surrounding it that is inflamed.

My original urologist said to avoid lifting things and wait 6 months. I waited 5 before I couldn’t take the pain anymore and went to see him again. He tells me I’m the one-in-whatever number case that has permanent pain. He says my options are reversal, testicle removal, or a “block” that might help for a little bit. None of which would be handled by him, and he says he’s done all he can for me. He never once even physically examined me after my surgery.

He offers to set up a second opinion with his boss. 2nd urologist is at least nicer, but mid-exam says “well, it (a vasectomy) isn’t really my specialty”. I ask him about activities to avoid, etc. He says to “just live my life” and sets me up for consult with the pain clinic.

Frustrated, I seek a 3rd opinion, with a doctor at a different provider. He says the original ultrasound doesn’t show much. Says I’m a 1-in-400 case. Advises against a reversal and encourages me to see the pain clinic. Honestly, I got steamrolled in that appointment. He flew through a bunch of questions, rarely let me give complete answers, and just seemed to want to get me out as fast as possible.

The 4 weeks since the latest appointment have been rough, as depression has set in. I have also been seeing a different doctor for some weird numbness I’ve been having since December. He has prescribed Cymbalta, with the hope that it both helps with the depression as well as influences how my brain perceives the numbness (and maybe the testicular pain). I also have the appointment with the pain clinic next week, although I’m not entirely sure what kind of “block” they’d be doing. I am willing to try it at least.

Does anyone have any insight? I really feel like I need to see someone who specializes in this, as honestly just poking around this site a little bit has been more illuminating than seeing 3 urologists. Does anyone have a recommendation for someone in the Northeastern USA? The urologists have been focused on my vas, but maybe that isn’t the exact cause? Anything I should know before going to the pain clinic?

Thanks for reading; at the very least maybe it’s been cathartic to type this all out.

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Hi, sorry to read what you are going through. While your description of pain does not resonate exactly mine, your experience with doctors does. Since you’re US based, I’d strongly recommend to reach out to the PVPS docs available. The sooner the better. Don’t let any amateur work on you if you can have a pro.
Pain management is likely an avenue worthwhile exploring in parallel. You can read mixed experiences on this site regarding Cymbalta, or other pain meds, but if it helps you, why not.
Good luck!

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Sorry for the length; I’m just throwing out every detail I can, hoping something will click with someone.

Yeah, unfortunately everything in your story clicks. This sounds like a completely typical PVPS story to me.

Read around the site for other tricks that work for a few guys

Unfortunately I’d say your most likely scenario is put up with it indefinitely and hope it gets better over time or try the reversal and cross your fingers.


Edit to say sorry, that’s sort of a negative attitude in my post.

Plenty of things to try out, from supplements, to diet changes, to drugs, to physical therapy. It can be a frustrating process but many people find solutions that they feel good about.

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Sorry this has happened to you. My advice would be to spend time reading through this site. There is a lot of insight and information here, that you probably won’t get from an appointment with a urologist.

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The recurring comments about the doctors has been astonishing to me. I just figured I’d had some back luck with them, being in a fairly rural area. A quick search here finds a list of doctors, I will check that out. Please lmk if there are other resources you’re aware of, thanks!

Thanks, yeah I haven’t spent a ton of time yet, but there is absolutely a lot more info than actual doctors have provided me thus far.

No need to apologize, I knew what you were trying to say. It’s not an easy thing to be upbeat about.

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Doctors don’t like PVPS victims like us because they know in their hearts that vasectomy is dangerous and that they’ve sold out for their Gulfstreams and Country Club memberships. The doc who did my reversal in 2006 was very outspoken against vasectomy and told me he was treated like a “skunk at a garden party” at AUA conferences.

In general, the ladder of treatment goes something like this:

  1. Anti-convulsant meds like amitriptyline, gabapentin, or Lyrica
  2. Pain management injections to the GF or II/IH nerves or urology injections to the entire cord
  3. Surgery which includes reversal, cord denervation, epididymis removal, or orchiectomy

I HATE speaking on behalf of the entire forum, but being a veteran since 2005, the anecdotal evidence from victims seems to be to avoid epididymis removal as it seems to never work and almost always leads to more surgeries.

I had a vas in March 2005, good for 8 months, then pain onset in October, and reversal in June 2006. Generally a very good result despite two setbacks since then. I’ve been pain-free 80-90% of the time since the reversal (3 years of pain since reversal out of a total of 14-1/2 years since). Not perfect, but the reversal solved other problems like low T and high PSA from the vasectomy, too.

Denervation was not a widely available option in 2005-06 but is more common now. It has mixed reviews on this forum. Many have gone straight to radical orchiectomy and while it sounds barbaric, it seems to yield good results.

Again, if anyone suggests epi removal, leave the office and run for your life.

My suggestion - I would contact Dr. Sijo Parekatill at his new clinic in Orlando, I believe called Avant Garde Urology or such. He did his fellowship at the Cleveland CLinic under the doc who did my reversal and treats mainly men dealing with scrotal pain. When dealing with my recent relapse 2016-2018, I underwent three separate cord blocks by him, two including botox. Since the 2nd botox injection, I’ve been pretty much pain free again. I’m not aware of anyone else offering this therapeutic cord block treatment in the entire US. You can do a teledoc conference with him for $100 but, based on your description, I’m sure he’ll see you. You sound like a classic case like the rest of us that he treats.

If you’re in the Cleveland area, Dr. Shoskes will do a diagnostic cord (anesthetic only) and, if there’s temporary pain relief, he’ll suggest cord denervation. I like Dr. Shoskes, too, not as warm as Dr. Parekatill or his mentor Dr. Thomas, but skilled and competent. He doesn’t offer therapeutic blocks but turns you to Pain Management for those.

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Yea…it was astonishing to me too. Especially since when I asked the Dr., who did my vasectomy, if I had a complication could it be fixed and he said “yea, absolutely”

Surprise surprise, he lied.

I’ve been to UVA, Duke, UNC, and Wake Forest facilities, and at first it was disappointing…until the reality set in that PVPS was hard to diagnose and even harder to treat. It’s a risk of a vasectomy.

Sorry you are here man. I had my vasectomy late 2018 too (December). I had some early issues but everything really went to shit for me September 2019. Things sound like they went to shit for you 5 months after me.

I’m getting a reversal March 1st. Hopefully this helps.

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@raising4girls has already summarized the options pretty well. Definitely recommend talking to Dr. Parekattil, he is one of the best resources re PVPS out there, and easy to talk to, compassionate, and the money will be well invested. Having said that, I’d definitely try natural anti-inflammatories, and pain killers, for some while, and in parallel explore physical therapy, muscle relaxation exercises, maybe you’re into yoga, mediation, mindfulness etc. to simultaneously get grip on anxiety if that has settled in by now. All the best and please keep us posted how you’re doing.

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good luck with the reversal! I had held out hope during all of this knowing that was always an option, but was discouraged when doctor #3 advised against it. glad to know that it might still be a viable option.

thanks for the bevy of information! $100 for the teleconference sounds well worth it at this point. Cleveland is a long drive but doable, and I can fly to Orlando pretty easily if it comes to that. It is not clear to me what the local pain clinic would do, is there any downside to letting them do something?

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thank you for the insight. I’ve dealt with anxiety to some level for a long time, and certainly between the pain and the pandemic it has gotten worse lately.

Read up on your local hospital systems’ Pain Management clinics. Their websites are likely to specify if they offer nerve blocks for groin pain. For example, the Cleveland Clinic’s (where I’m at) talks about blocks to the Pudendal, Genitofemoral, and Ilioinguinal/Iliohypogastric. Have had blocks of all 3 and also pulsed RF ablation of the pudendal and GF. They were able to get rid of my perineal pain but not my scrotal pain, and that’s why I sought out Dr. Parekatill. Dr. P. offers what we on the forum call a “mega block” to the cord. He hits you in 5-10 spots under anesthesia and, in more extreme cases like mine, will add botox to the cocktail. That did the trick for me.

One side note. My Pain Mgt. guy always told me how little serum (anesthetic, steroid) he used. He seemed to pride himself on his skill of getting to the right spot so he didn’t need to use much solution. I mentioned this to one of the surgeon’s I saw, and he said that’s his biggest complaint about Pain Mgt., that they use anesthetic and steroid like it’s a scarce commodity. I learned this in hindsight, but knowing that now, that’s another reason I’m more a fan of Dr. Parekatill’s more aggressive approach.

That said, no downside at all to working with your local pain clinic. Yes, there IS some risk to pain management injections, no doubt, but my view continues to be that a needle is far less risky than a scalpel. I came VERY close to having denervation or neurectomy during my 2016-18 setback, but am glad the injections worked well enough to help me avoid surgery.

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Update for those who requested one:

I had a selective nerve block done in early March, which didn’t really seem to help much/at all. I also started taking CBD oil daily in late February, which I think maybe helped dull the pain a bit, but not much more. I am also now 3 weeks into physical therapy to strengthen my hip on that side, which I think seems to be helping a decent amount. My pain levels, while still a nuisance, have overall been better the past week in particular.

Overall I am mentally in a much better place than I was in the late winter. Whether that is the Cymbalta, the CBD, or probably a combination of everything, I’m not certain.

I’ve talked with Dr. P. twice and have had pretty good chats with him, and he is recommending a reversal. With ejaculation/arousal being the single biggest contributing factor, I think he believes congestion to be the biggest issue, and wants to put me back to the way I was when I was pain-free.

Before this recent window of modest improvement, I had decided to go through with said reversal. Now, I am wavering a bit, obviously nervous that I don’t want to make things worse. I believe ultimately that the reversal is probably my best chance at having the least amount of pain and living a normal life. I think I just need to muster up the courage and conviction that it’s the right choice.

@mgs44

Hey, I commented on this thread February 5th and I had a reversal 2 months ago. You can check out my updates in the below link. A lot of what you are experiencing are very similar to what I experienced. The only difference is my pain level was constant, even when doing nothing. It got much worse with activity and sex was a nightmare. Getting aroused would be enough to put me on my knees.

Sorry you are still dealing with this. I know how bad it sucks. You are not alone.

glad to see that you’ve seen a lot of improvement so far! I read through your thread the other day and felt encouraged by it!