Post Vasectomy Pain Forum

How do Cord Blocks Work?

I’m reading an article “post vasectomy pain syndrome: diagnosis, management, and treatment options published 2017 by Varsha Sinha and Ranjith Ramasay.

It mentions that, after a spermatic cord block, “of pain subsides after injections of lidocaine up to 1-2 days, then cord block cannserve as a diagnostic test in confirming that the pain is referred to the scrotum via nerves within the spermatic cord and predict response to spermatic cord denerviation.”

I don’t understand how nerve damage during a vasectomy would not be located in the scrotum; how would nerve damage occur higher up than that?

I feel like almost all my pain is located right behind my testicles. The testicles themselves don’t feel too sore and I’m not really getting shooting or burning pain else where. It feels like the kind of pain you get with an ear infection but right behind my testicles.

I just got done with a 5 day round of prednisone and if anything I feel worse; but, I haven’t been taking my usual 2400 mg of ibuprofen for 10 days now. I know steroids can suppress the immune system. Could they also act against the macrophages trying to eat up all the dying sperm?

I don’t think I have an infection of any kind. I’m not worried about an STI, but I wonder if I could have gotten an infection during the surgery and I’ve heard some people say Lyme disease and other random bacteria can start to cause problems once the vas is sealed off. I haven’t had a fever and nothing seems red or infected, just a lot of pressure and aching.

I’m probably one of the least knowledgeable members, but can’t yanking on the vas cause damage in the spermatic cord? I could feel it pulling in my stomach when he pulled it out, was extremely swollen after and still is.

I suppose that makes sense. I was put under when they did mine but when I woke up I wasn’t in any pain and felt pretty good for the first week to week and a half, then bull ball filling set in. I would expect to have felt it sooner if they messed up my nerves in that way, but who knows.

Whatever is going on it is bilateral and gets worse with getting close to and having ejulation. Nothing is horribly swollen like I see some people say but it deffently seems that the epididimies are full and tender. After I get out of a hot bath when everything is lose I can see what I assume are the ends of the vas on the epi end almost standing up taught under what I assume is internal pressure.

At the end of the day I don’t know. The urologists I saw always seem in a rush and offered converting to open ended; when I said I’d rather do a reversal if anything they said how they do it once every 3 years but have good success rates. With that I’m trying to get a referral to see another urologist for a second opinion.

I would like to old off on surgery till the spring like I said above, to get the money together and to see if things settle down by then, but in any case I’d like to narrow things down if I can. I don’t want to drop $8000 on a reversal and possibly make it worse if I can narrow down what’s wrong.

It deffently seems to be related to the epididimies. I’m going to ask my PCM about tricyclics antidepressants; I read they can treat nerve pain. So maybe if they help it’s nerve related?

Ibuprofen seems to help but every time I stop taking the pain starts to come back.

You’re lucky they put you under, before I went in I was laughing and joking about my balls with my wife, I came out a little stunned. I could feel the whole thing, and it was extremely painful but quick so I didn’t say anything. I felt like he was pulling stitches out of my low abdomen, like totally yanked the shit out of things.

Yours sounds like congestion as it took a while to kick in, mine the pain was right from the start. And yours sounds pretty Isolated to one area, mine is lower abdomen to tailbone, everything in between including glutes, I’m thinking maybe autoimmune issue, but I feel like I shouldn’t be making a call on this kind of stuff. I ask my doctor a lot of questions, but somehow he is totally lost, pretty sad when you can’t really rely on your own doctor. He’s googling things as I’m asking him, I mean I can do that.

The reason I feel it’s autoimmune is that I feel like my body is being eaten alive, I thought for the first while it was in my head, or maybe stress from the pain, but now I’m not so sure. Even my legs, I’m having a hard time walking with muscle pain, severe headaches especially when I wake up, swelling , joint pain, low T, the list goes on and on. I don’t even mention half of it to my doctor with the fear that he’ll think I’m nuts. I honestly feel some days like I’m going to lay down and die, I don’t think I will, but that’s the best way I can describe the feeling.

Spermatic cord on myself are so inflamed that it’s hard to bend my right leg, pelvic floor same thing, swelling bulging out the bottom, have to walk with legs far apart. Last night I was at a 10 for pain, I couldn’t be around my wife, I start snapping at her and becoming some kind of asshole, this is not how I treat anyone let alone my wife, I go and lay by myself in another room, I can’t really have a conversation, can’t concentrate on Tv, nothing. Lay there and close my eyes, try to escape my body. Right now I sit and my balls are burning pressure feeling, penis feels like its being ripped from my body.

But I hear ya, tough to figure this all out, never ending frustration. The more I read, the more my head spins.

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I hear you. The urologist hasn’t been able to offer me any guidance, only options, which is something I guess. My PCM just googled what I’m saying, like you said. I have an appt with him tomorrow And I printed out medical journal articles on PVPS to help suggest medications, treatment, and it’s going to go over his head. Half the people at the urology clinic acted like I was crazy for suggesting a reversal for pain. “Why would you do that?” Uhh, to release all the pressure… “oh I guess that does make sense”.

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The thing I don’t understand is if back pressure is a issue, why it doesn’t effect some men? Are their bodies able to absorb the sperm quickly, or do they have lower sperm production, maybe lower sex drive.

This is kind an embarrassing to say, but pre vas I sometimes would ejaculate 5 times in a day, I would say easily twice daily on average, I’m wondering if being over sexed comes into this at all for some men.

The thing I don’t understand is if back pressure is a issue, why it doesn’t effect some men?

That’s one of the remarkable things about this PVPS thing. 80% of guys get a vasectomy and are basically ready to jog by the next day and never feel any pain to speak of. They are left wondering how you could possibly complain about such an easy and valuable procedure.

Meanwhile, those who get PVPS are thinking “How could I have believed that this was going to work?”

I’m not trying to derail this thread, but thought I’d mention - Some reversal surgeons will charge you another 1K if you had a cord block prior to your reversal. I’ve heard that more than once, and its been posted here by others that were told the same thing by Dr’s X-Y-Z.

Makes you wonder hu?

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Do you have any idea why that would be? Does it cause some kind of damage or make it harder to do the reversal? Or they know your more desperate at that point so up the cost?

Bottom line - I don’t know much specific regarding why, but based on the little I have heard - my most primitive thoughts lead me to scarring as the reason.

IMHO, you’d be better off asking those in the know who charge more. Interestingly enough, I’ve seen those who charge more recommend a cord block. Tell me that makes any sense. And if that wasn’t controversial enough, I doubt they warned them about the price hike if they follow through with such a recommendation. IDK.

I’m skeptical of cord blocks because I haven’t heard anyone explain what exactly they are supposed to do and how they are supposed to do it. Mostly it seems like they are a gimmick. They are a tool that lets the urologist DO something, and they sometimes provide temporary relief from pain.

I had a cord block and in my case it was disappointing. Getting the injection was really painful and upsetting feeling, and it barely had any effect on my pain levels. It might have brought them down for a couple of days, but that’s about it.

Throw in the idea that some have that it might actually do damage and I have a hard time seeing how someone is supposed to be persuaded that getting a block is a good idea.

I wouldn’t say never do it, but I wouldn’t do it without understanding what you are trying to accomplish and why it can be expected to work.

That’s my thoughts on it too. Get the good ole cord block out - we are going to help you. And the men who end up getting no benefit, or end up with complications from it are SOL on that too.

Back in my day - 2010ish - I was hearing a lot about cord blocks being a great diagnostic tool for weeding out potential de-nervation candidates. As time went on, the more I read, the more I seen, the more I heard - such strategies seemed pretty inconclusive to me. Not only that, but I heard people that were doing this stuff post comments in forums that suggested the same.

Examples - the cord block didn’t work, but we did the de-nervation anyway, and it seemed to help. The cord block worked, so we followed through with de-nervation, and it was unsuccessful. I’ve seen various other scenarios too.

I never heard of a cord block being a diagnostic tool for reversal until more recently. The first time I heard it was ~2-3 years ago. IDK.

I’m not sure how that is even supposed to work exactly. In my case, when I said I got almost no benefit from the cord block, the doctor suggested that maybe what I had was not a complication of the vasectomy, gave me a script for Elavil and proposed we do a CAT scan as a shot in the dark to maybe figure out what is going on. I wasn’t impressed and didn’t follow through with the CAT scan because I figured it would be a waste of radiation and money.

These people will send you on an endless goose chase at your time and expense, or at your insurance expense knowing damn good and well a CAT scan or CT scan will not show anything in the vast majority of cases. Your insurance will definitely cover everything that is standard run of the mill protocol, including a cord block. They’ve got you covered.

Words like gimik or racket come to mind.

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My insurance has been paying $300 a visit for the urologist to press on my balls, ask if I feel any better since the last time, then say we can cut off the ends of the vas, do a reversal (which is expensive and probdbly won’t be covered) or give it time. Seems like a racket to me. I don’t know what on earth they’re charging for. Paying for medical school I guess?

Last time they were busy so I saw their Nurse Practitionar, who just asked me if things felt or looked any different, then asking what I wanted to do. When they said a reversal wouldn’t be covered by insurance and they only do them every 3 years I took a rain check.

I know it’s probably useless but I feel like there’s got to be some metric of whether or not one’s epididimes seem full enough to cause pain, or maybe they swell in everyone but only some people get pain? What a mystery. Like is it the pressure or macrophages trying to get inside the epididimis or what? I feel the I’m worse since the prednisone but I suppose it might just be cause I’ve not taken ibuprofen in over a week.

Hard to tell, does taking ibuprofen and steroids slow down the immunsystem from reaching homeostasis and learning to deal with the sperm buildup or is that the only thing keeping the real pain at bay? I’ve been on papaya seed powder for a month now; haven’t really noticed a change but who knows maybe it would be worse if I wasn’t on it.

I might ask for more doxy just Incase I have some crazy germ like Lyme disease or something or other in my epis that is building up now. I’ve been bitten by enough bugs over the years. Who knows. What I do know is my PCM is going to look at me like I’m the dr tomorrow then probably do nothing.

I feel like a ultra sound or something might be worth a shot but then again what are they going to find? I kind of feel like at this point I just want to try to treat the pain and wait to see if it heals in it’s own. If not at least improving by March I’ll probably go for a reversal. If improving I guess I’ll have to see. It’s been up and down and seems to get worse when I stop taking ibuprofen but I don’t want to be on that nonstop forever.

Throw the check away.

That’s up to you. I don’t see any risk involved. You never know what they might find. It’s a pretty straight forward in and out deal.

I think I read something on here a while ago about someone getting an ultra sound and finding out they had an abscess in their colon or pelvic floor that had something to do with some kind of infection that set in after the vasectomy.

Such a crap shoot. But I kind of expect the urologists and drs to come up with something. It really is just such a puzzle.

I think it’s because of the additional scar tissue created from the injections.

Interestingly, though, steroids are known to break down scar tissue.

The scrotal ultrasounds I have had certainly didn’t tell anyone anything about my colon, or pelvic floor. I’ve had at least 3 of them in the past.

Generally speaking, they are specifically looking at your testicles - blood flow, epi’s, possible varicocele’s, spermatocele’s, hydrocele’s, etc.

This is a great question, and the answer is buried out there somewhere in cyberspace as I read it once before.

Pre-vasectomy, a normal man does NOT eliminate 100% of his sperm through ejaculation. I believe I read only 50% is expelled through ejaculation. It’s not entirely clear or defined what happens to the other 50%, but it’s SPECULATED that the epididimides eliminate the other half through the body. These are speculated to be the weaker half of sperm that don’t reach maturity, whatever.

Regardless, after vasectomy, we unknowingly ask our epididmides to eliminate all of the sperm we produce. So, yes, low sperm counts could be helpful in eliminating the back pressure. It’s an input vs. output. Slow down the input and the pressure on the output end gets reduced. That’s what prompted Dr. Pienkos and others later to use testosterone injections to treat pain or as a diagnostic. In this diagnostic, if pain goes down after T-injections, that supposedly indicated congestion that reversal could solve.

Some men’s epi’s simply can’t keep up with the heavy load, become congested, and then (some) become painful.