Post Vasectomy Pain Forum

Difference between congestion and nerve pain?

Whats the difference in pain feeling between congestion and nerve pain? I have some days where I’m like a 2/10 and others where I’m like 8/10, like flare ups.

Curious as to what is what. Thanks!


Based on what I’ve read, nerve pain usually shows up sooner, were as congestive pain shows up months to year later. Because the exact causes and mechanism of PVPS are poorly understood, this distinction is also not very clear cut. I’ve read that nerve pain is usually sharp and burning, where as congestion is achy and feels like pressure.

I think the two are related. First of all, all pain is transmitted via nerves, so what we are really asking is: what is the mechanism that is causing the pain? I think what most people would cause congestive pain is when the pain is mostly caused by the pressure build up; but, why doesn’t this happen to everyone?

Pain can be caused by fibrosis, scar tissue, inflammation, pressure, etc. Late onset of PVPS may be caused by changes in sperm production and or a “blow out” of the epididymis. However, the reason that the prospects of success of a reversal go down with time is because as time goes by, the vasectomy causes damage to the small tubes inside the epididymis through scarring due to inflammation and or blow out. The question is: why do some people develop pain so early on and why do some guys never have pain even after years?

I personally was convinced that I had congestive pain, but upon reflection, I think it was mostly nerve pain. My pain started about a week after my vasectomy and got worse over the next few weeks until it topped off, then started to slowly recede. It was always worse with ejaculation. If I had to guess, there was nerve entrapment around the cauterization sites that was getting triggered from the pressure and muscle contractions. My reversal helped me a lot. I was still soreness and burning, but the feeling of pressure was gone. If I had to guess, I think the sites of entrapped nerves were removed, and when everything healed, there was no pressure there to push on it.

Again, PVPS is so under researched, especially for a common result of a very common, elective procedure.

That was a good thorough response, thanks!

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What was the time between your vas and reversal? Also in this context, how do you define …“prospects of success of a reversal go down with time…”?

That’s the $1MM question.

Back in 2005-06 during my initial bout with PVPS, I met some guys (virtually) who were classic congestion. Pain during and especially after ejaculation, pain focused in the epididymis, described as a dull ache.

I never really had that. I was pretty sure I had pain from the granulomas on my vas tips and/or nerve damage. Back then, the only guy doing cord denervation was Levine in Chicago, so my only practical option reversal, and one of the pioneers in treating PVPS with reversal was in my backyard, so I went for it. I definitely wasn’t congested. After the reversal, doc told me I was leaking fro both vas ends, basically having blown thru the cauterized ends with a natural conversion to open-ended. Pretty sure that created an autoimmune response that cratered my T levels and jacked up my PSA to 4.2.

During relapse in 2016-18, since I was already reversed and patent, I clearly didn’t have leakage, granulomas, or congestion. Turned out to be a damaged left GF. My strong guess is that I had nerve pain from nerve damage back back in 2005-06 and that the scar tissue removal enabled the nerve to calm down.

Hard for me to know what congestive pain is since I likely never had any. In truth, I think a small portion of PVPS victims suffer from congestion and that more have nerve pain/damage than we know.

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Congestive pain or nerve pain…

This question seems to plague pretty much every pvps forum I have ever participated in. So much stuff has already been posted over the years, and hear is some more of the same ol same ol.

I have heard people say, sperm granuloma gets to much attention on this website. I’m like… really? That’s because it’s one of the key players in vasectomy pain, pvps, etc.

A few links below that shed some light on what’s accepted as fact and what’s not. Our minds can wonder and/or hypothetically wander from there.

If pain is the primary symptom of sperm granuloma, then pain after vasectomy is called as congestive epididymitis.

Granulomas typically occur two to three weeks after the vasectomy procedure.

Granulomas after a vasectomy are very common. Statistics on exactly how often granulomas occur vary greatly, ranging from 15% to 60% depending on the study.

What is a granuloma?

A sperm granuloma is a small mass or lump that may develop following a vasectomy. Essentially, the lump is an inflammation that is created by extravasated sperm. Extravasated means that the sperm leaks or is being forced out of the cut end of the vas deferens.

A granuloma is not cancerous or life-threatening. It may be painful and can be treated using over-the-counter anti-inflammatory /pain medication. If it causes unbearable discomfort, it may need to be surgically removed. However, they generally heal by themselves. Uptodate suggest that between 15-40% of men may develop a granuloma post-vasectomy

Source -

There’s a bunch of interesting sperm granuloma and vasectomy related stuff in general in the link below.

Many men seem to think congestion only develops later down the road. It seems that many men’s opinions and/or thought process revolve around their own personal experience. While there is some truth to such thought processes and/or experiences - there doesn’t seem to be a one size fits all answer.

My pre vas paperwork clearly says the congestion usually resolves itself in 2-12 weeks post vas. Usually is not typically. Such information can be found all over the place. Again, based on what I have seen in forums like this one, there doesn’t seem to be a one size fits all timeline, answer, etc, regarding congestion, congestion related, etc

Prior to the procedure, urologists sell us a lot of half truths, smoke and mirrors, bullshit, etc. Many of us are quite aware of this. That’s not breaking news.

So much of this stuff is easily found online. I’m sure it’s a bit easier to find if you know what you are looking for.

I’m not a fan of Wikipedia for controversial topics, but their input on pvps echos a significant amount of what has been previously posted.

See mechanisms of pain.

Another decent pvps resource that is easily found.

I had a closed ended vasectomy and I blew out at the end of my vas’s in a matter of weeks. I know of to many others that had the same thing happen in the same early timeframe. I know of others that took significantly longer to blow out at the end of their vas/s and start leaking.

Nerve pain, congestion pain… Whatever the case, I digress.

There’s a bunch of potential reasons as to why some men experience pain and other don’t. A lot of that stuff has already been described and or hashed out many times in a previous posts, previous threads, etc.

As has already been said, all pain is nerve pain. I and many others typically try to rule out what could be causing the pain, rather than identifying an individual case simply as a nerve pain or a congestive pain. All to often, we are talking about the same thing.

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“During relapse in 2016-18, since I was already reversed and patent, I clearly didn’t have leakage, granulomas, or congestion. Turned out to be a damaged left GF. My strong guess is that I had nerve pain from nerve damage back back in 2005-06 and that the scar tissue removal enabled the nerve to calm down.”

  • When you say you relapsed. What in particular are you referring to? Did you have pain on the testical/epididymis or was it localized to a certain spot. Considering a reversal for “flare up” type pain I’ve been having however nervous on doing it. Are you still in pain?

Great question. My timeline is odd but here goes. Note that my pain has always been mainly left side. Even when painful on the right, I’ve believed it was referred from the left.
March 2005 - vasectomy
October 2005 - pain onset, scrotal and radiating up into groin and inguinal canal
June 2006 - reversal
November 2006 - pain-free
November 2008 - pain again, same pattern at 2005-06
March 2009 - pain-free (only treatment was meds)
April 2016 - pain started again after first bike ride of the year, similar pattern, though more pain in epi and later into the perineal area
November 2018 - finally pain-free again following a multitude of injections

I DEFINITELY understand the perspective on getting reversed. I was there, too, and would never talk a guy out of it. The feeling of being put back together, I think, helped my outlook and attitude toward recovering. I get it.

That said, I DO encourage guys considering reversal to consider steroidal injections first. I had numerous injections during the 2016-18 timeframe. They’re not risk-free, and some guys here have been made worse. In my case, perhaps I was lucky, but they were able to help me break the pain cycle.

Most of what I’ve read and heard suggests that the chances of having a successful reversal is inversely proportional to the length of time since the vasectomy. That is, the longer one waits to get a reversal, the less the chances of success, where success is in case means the return of sperm, and if the source of pain in a PVPS case was pressure, the elevation of pressure.

The reason for this seems to be that as time goes by after a vasectomy, the epididymis gets damaged by pressure and autoimmune response. The weak tubes and “blow out” leading to scaring, or they can become blocked due to scaring from inflammation.

It is also possible that once the body “turns off” sperm production, after longer periods of time, it takes longer to turn it back on, if ever.

Many reversal specialists I’ve talked to said that sperm is always present if the reversal is done inside of 2 years, then after that rates drop. There are surely exception to this rule.