Post Vasectomy Pain Forum

How is the Military not seeing a PVPS Impact on Readiness?

Vasectomy and Vasectomy reversals, Active Component

I read this article, which covers an observed period from 2000-2017 of active duty vasectomy and reversal numbers. Says that between 2000-2017 a total of 170,878 active component servece members underwent vasectomy, but states that the impact on readiness is: “vasectomy is a safe, simple, economical, and effective method of permanent contraception … vasectomies have a minimal impact on readiness.”

Even if only 1% of men develope PVPS, that would be 1,700 active service members going down for PVPS in the last 20 years. I understand that’s only a handful at any given time, but that’s 2 infantry battalions of people. Considering the higher 1-10 % some sources sit, even if those cases improve for most people, how is this not something that is being noticed?

No mention of PVPS in this article that I’ve seen. You would think it would at least rate a sentence. I’m rattling a bunch of cages over this systematic failure to properly counsel people on and acknowledge the risk of vasectomy. I’m probably gong to end up on a Tricare hitlist at this rate.

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I looked at the top reference in that article. It is a study published in British Journal of Urology titled: “Complications of Vasectomy: Review of 16,000 Patients”

Here is the abstract:

Abstract

Sixteen thousand, seven hundred and ninety-six men underwent vasectomy between 1970 and December 1983 and have been reviewed. Post-operative side effects were few and significant complications were reported in 0.9%. Failure to achieve sterility occurred in 72 men, 69 of whom have been analysed. The early recanalisation rate was 0.36%. This rate was not influenced by the operative technique used, but varied markedly between individual surgeons. Experience and care with technique should result in a failure rate of 0.2% or better. There were six cases of late recanalisation in men previously thought sterile by two consecutive azoospermic analyses 4 months after vasectomy.

Sounds pretty impressive, right? I mean, they looked at 16,796 men who had a vasectomy and say that “post-operative side effects were few, and significant complications were reported in 0.9%”

Here is an excerpt from the article full text:

In 1983, 800 men were asked to return questionnaires, but only 534 replied (67%). Of those that responded 7.7% sought medical advice for postoperative pain and 3.6% for bleeding. In seven men there was a discharge from the wound (1.3%), five men developed scrotal haematomas (0.9%), and of these one man was admitted to hospital for attempted drainage; 80% returned to work within 3 days, 96% within a week.

Couple of thoughts:

  1. The study was done in 1983 which was 36 years ago. Seems like they could get something more recent if they tried.

  2. The study was done by the Elliot Smith Clinic, which did the vasectomies.

  3. They did not send a survey to 16,796 men. They sent a survey to 800 of those men, and 534 of them responded, which is 3% of the 16,796 men.

  4. Of the respondents, 7.7 asked their doctors for help with postoperative pain.

  5. Of the respondents, 4% did not return to work within 1 week.

You starting to see the blind spot where the PVPS guys could be hiding?

From the “Discussion” section at the end:

The 13-year experience of the Elliot Smith Clinic supports the view that vasectomy is a simple, safe and effective procedure for birth control. Side effects are few. Our figures suggest that about 10% of men may need to seek medical advice afterwards, but the impression gained from unsolicited comments made by patients was that many consultations were for reassurance and might have been prevented by more careful pre-operative counselling. The most serious side effect revealed from our questionnaire was scrotal haematoma, with an incidence of 0.9%, but only one man in 534 needed admission to hospital as a result.

Again with the squirrely wording. "We did 16 thousand vasectomies. We think it’s simple, safe and effective with few side effects. Sure, about 10% of the guys asked for help from the doctor after their vasectomy because they are worried about how things are going. We got the impression that better pre-operative counselling would sort that out. 7.7% of guys asked for assistance with post operative pain. We do not recognize this as a “significant complication.” Our 0.9% “significant complication” statistic does not count anything other than hematomas.

So there are some clues there that there is more going on than meets the eye. Based on AUA numbers, about 250 of the men got PVPS. Why didn’t the clinic’s study detect that? My guess would be that they are filtering their experience through a defective lens. The men that come back and complain of pain are sent home with a potential remedy as many times as necessary until they stop returning, at which point the clinic declares victory. Why were their insights into chronic pain obtained via “unsolicited comments” rather than quantifiable survey responses? Sounds like their question list could use some improvement before it really captures what is going on.

Focusing on this bit:

but the impression gained from unsolicited comments made by patients was that many consultations were for reassurance and might have been prevented by more careful pre-operative counselling

This is a pretty vague statement and can be read several ways. The authors give their opinion that the men were not given a warning beforehand that adequately prepared them for their experience post-vasectomy. That could still be safely said today, 36 years later.

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It seems that the lack of long term follow ups with a large sample of their patients is where a lot of the oversight could be coming from.

Yeah, it is beyond me how they can be confidant in inferring such success rates in such small sample sizes. I understand it is not feasiable to contact thousands of people years after the fact, but some form of effort should be made.

In the military, there is a high turn over rate so I could see long term PVPS onset not being recorded by their military medical records if they separated prior to onset.

I’m just shocked that PVPS didn’t even warrant a comment in their article.

Right.

If a urologist says their patients don’t get PVPS I always want to ask them how they know that?

For example, are they calling their patients a year after the surgery and asking them how they are doing?

Or is this like a “well I never heard anything so…”

The fact that you don’t find something means a lot less if you put no effort into looking.

I have seen other studies conducted by urologists, guru vasectomists, and so on that were just as corrupted. They used the same exact tactics to come up with their conclusions and/or final numbers.

Many peer reviewed vasectomy studies are a joke. I’m going to guess there are far more corrupted studies than we are aware of.

Would you believe that some of the so called best of the best pvps urologists in north america that have a chair at the pvps round table site such statistics and studies as reference? Lol! Certainly they are aware of how such studies were conducted.

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The general surgeon that did my vasectomy said that he’s never had someone come back in for pain. I don’t know the sample size he’s working with, but given that I was one of 5 guys getting a vasectomy the morning of my surgery, I suspect it is large enough to find that claim suspect. I haven’t been back to see them because I was referred to a urologist, but I fully intend to follow up with him to see if he has updated his figures. If they still want to give a bogus level of safety they can, but it’ll be on their conscious and a lie.

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Lol! Certainly you do not believe him. Not funny. Liar liar pants on fire.

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If these studies were capable of measuring PVPS, then I would expect there to be more consistency. They would all cluster around the actual frequency.

You would read something that sounded like “We randomly sampled from 16,000 guys, and based on the responses to surveys we estimate that 160 of them that had pain at the 1 year mark. We were able to speak with 2 guys that got a reversal and 1 guy that got a denervation… etc.”

And out of those 16,000 guys our study was sensitive enough to estimate that 100 of them reported sexual dysfunction. We think it is psychological because when we try to come up with a physical mechanism for causing that we can’t think of anything. But it might well be Freudian or something.

But so frequently what you get is more like:

Conclusions:
Our study supports our going-in position that we should keep on doing vasectomies. Pretty much nobody had any problems that we were not capable of ignoring.

At the time I was shocked and thought, “wow, I guess I am in the lucky 1%” but now I suspect it was a blatant lie. They acted like people go back in for injuries related to not following post op care and getting hemotoma, ect but not just PVPS type pain.

I didn’t feel bad at all after my surgery and I recal someone else was writhing in pain, so I wonder how they turned out.

And meanwhile, while all these so called peer reviewed studies, journals, and so on are being published - we still have have this.

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The general surgeon that did my vasectomy said that he’s never had someone come back in for pain.

So, what, like he never has a patient come back for anything? Or patients that come back are coming back for something other than pain?

Reading between the lines, what probably happens is that when patients call back with pain, he doesn’t invite them over for an exam. He has the nurse advise the patient over the phone. Take Advil. Be patient. This stuff takes time. Could take a full year to settle down. You don’t need to come back unless you have an infection or a hematoma and it doesn’t sound like either of those are happening. Maybe call us back if it hasn’t settled down by this time next year…

When patients do show up with pain during an exam, he doesn’t think there is any reason to assume it might be the vasectomy that is to blame. The path of least resistance is to see what you expect to see.

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Yeah, he fondled me a little and said it seems your testicles and epididimes are inflamed. No one ever comes back in for pain so I doubt you have Post Vasectomy pain (I bought it up first). There’s no way your in that 1/1000, well I can’t say no way… We treat epididimitits with ibuprofen so take 800mg 3 times a way for a week and gave me a referral to a urologist. As far as they’re concerned at this point I haven’t contacted them back so they probably check me off as another success case as far as they know for now.

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Unless your general surgeon has only done a handful of vasectomys, he definitely lied to you. His statement makes absolutely no sense.

People call back, people come back, countless people are prescribed prescription meds post vasectomy, and statistics worldwide suggest otherwise.

Don’t feel bad - The urologist that did my vasectomy told me I was his first in well over 1000.

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I’ve said elsewhere that I sent my urologist an email and she prescribed Neurontin, no questions asked, no exam necessary. Almost like it wasn’t her first rodeo.

Another little memory from the pre-op counselling is she mentioned in an offhand way that she used to do single midline access but switched to bilateral because it caused less problems. Dummy that I was I didn’t demand to know on the spot what problems she was referring to.

Second urologist admitted at first that my pain was probably due to the vasectomy based on the timeline, but then after I got a cord block and it had minimal benefit guess what? He got really skeptical about whether it was the vasectomy after all and proposed imaging (cat or mri I don’t recall) to get to the bottom of the mystery.

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Based on the assembly line going on that morning, I doubt he was being sincere. Probably trying to placebo me in case it was in my head or temporary. I think he could tell I was on the verge of a mental breakdown having just had my groin possibly screwed up for life. I saw him 2 weeks after my vasectomy. Would have been nice to have heard about that “1/000” risk ahead of time. All he told me was some people regret not being able to have kids later.

It’s a military hospital so they’re not getting anything out of it money wise as far as I know. So I don’t know why they would be lying about it unless they are just sadists and get their kicks snipping dudes all day.

Probably trying to placebo me in case it was in my head or temporary.

I think this is a part of what is going on. They figure that it is good bedside manner to sugar coat this issue, because the reality is so upsetting that it has the potential to jeopardize their patient’s recovery. The more they think psychology can influence healing, the more motive they have to hide what they really think.

I’ve heard that 50 years ago, when they didn’t have anything they could give to cancer patients, they would sometimes simply not inform the patient that they had cancer. They figured the truth would do more harm than good. Personally I don’t want to live in that paternalistic world.

Edit: can you honestly imagine your surgeon telling the next guy who comes in for a consultation:

“Look, I gotta level with you. Most of the time this surgery goes well, but I just had a guy who is considering a reversal now because he is really unhappy with how his vasectomy feels. So you should know that can happen.”

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I suppose it’s a fine line to walk. In some ways that truth might cause unnecessary stress if they were on their way to recovery, but at the same time they owe their patients the truth; it is not up to them to decide who gets the hard truth and who gets to suffer with false hope. I don’t want my dr to lie to me about my possible PVPS or cancer anymore than I want cosmologists to lie about the possible, inevitable heat death of the universe, whether or not the idea is comforting.

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Looking back at my follow up for pain at 2 weeks, it was pretty ridiculous. Doctor had me come in during lunch when they were closed, he knew I could barely walk after speaking to me on the phone, probably didn’t want other patients to see me limping around.

Asked me to lay on the table, didn’t really even touch, no exam, on my back balls had pretty much fallen in between my legs, no way in hell he would have known anything, said yup no infection you’re good, if you had a infection the skin would be a different colour and your scrotum wouldn’t be baggy like this while he pinched and pulled my ball sack so fucking hard I nearly jumped off the table, said it would look like a bulb if there were a issue. My wife piped in and said umm, sorry to say his balls are very swollen even if they aren’t infected. He actually asked my wife how she would know that, my wife and I kind of looked at each other in disbelief totally puzzled.

I didn’t know I was there for him to just do a quick visual and confirm no infection, I told him my testicles were swollen and sore on the phone, I wasn’t Talking infection.

I got up from the table, he said you’re only two weeks in, that’s nothing, it’s common to feel like this for 3 months, you’re only a small way on your healing journey. Take double the ibuprofen I gave you and lay down for as long as you can, take hot baths. I was kinda puzzled as his web site states 3 days and back in business but couldn’t even be bothered at this point.

I got a really sketchy vibe from him, rushed me out, patted me on the back. I left and knew I would never speak to him again.

I would imagine if you give the impression that there is no way that you can help someone and act like a complete a hole, people won’t come back to you, they’ll go somewhere else that will take them seriously, this is what I did. I mean I’m not going to go back and argue with the guy, on top of that he hurt me pretty badly, good way to get people out of your hair, not to mention, you never have to admit that there was a issue with one of your patients.

Next day went to my regular gp, he confirms swollen epididymis.

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The guy I saw was much more friendly and reassuring about it, if only faulsly so, but I fully intend on giving them regular updates so that they can’t say they didn’t know.