Post Vasectomy Pain Forum

Ilioinguinal nerve block made pain worse

I had a ultrasound guided pulse radio-frequency nerve block to the Ilioinguinal nerve 5 weeks ago, the procedure has made my pain worse.

The pain got worse during the procedure, by the time the doc had finished I had tremendous aching/pain in my testicle and down leg, this hasn’t got any better, and it has been 5 weeks now.

When I lay down the pain goes after a few hours, but as soon as I’m up and dressed walking around the pain starts.

Should I be worried?

Has anyone had a similar experience with nerve blocks?

Did you have same pains before the procedure?

Yes, exactly the same pain.

Have you had reversal? I had same pains all the way down to my foot, and still get them once or twice a month on and off, but improving now.

Update. The post nerve block pain seems to be subsiding, I just hope it continues.

One other thing I have noticed since having the pulse RF block done, I’m having trouble ejaculating, I’ve lost feeling.

The wife was worn out as it’s taking me over an hour to do the business, it’s been like this since the nerve block. Lol

I didn’t know the Ilioinguinal nerve gets used during ejaculation, I thought that sensation would go through the spermatic cord nerves???

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Glad to hear the pain is subsiding. My best guess is that they found the culprit, and the assault from the pulsed RFA (reportedly safe…I had it twice) aggravated a already angry nerve. I think the ablation takes time, not an on/off switch.

An hour? I’ve had difficulties on the other end of the spectrum since my vas and subsequent reversal that I’ve attributed to either (a) my damaged GF or (b) mental anxiety surrounding my sack from the PVP trauma.

Good luck! I’m a fan of therapies that use needles over scalpels and hope you and others can report good results like me (though my pRFA wasn’t the winner for me, the cord block with botox was).

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What does all this mean???

My pain is always located at top of right testicle (it’s the trigger point), the pain goes down my right leg and into my foot. I had the ilioinguinal RF nerve block which seriously aggravated the original pain in all thee places, testicle, leg and foot. The nerve block made my pain ten times worse, so what does that mean exactly?

I was thinking… the nerve block didn’t go anywhere near my testicle, but instead the ilioinguinal nerve got injected which seriously aggravated it. This must mean the ilioinguinal nerve was sending pain to my testicle, leg and foot, where usually my testicle is the trigger point which sends pain to my leg and foot, I’m so confused???

If my testicle is at fault and sending pain signals up a nerve, such as the ilioinguinal nerve, then it would make sense.

But if my testicle is not at fault, and instead there is a nerve such as the ilioinguinal nerve malfunctioning or being compressed somewhere, it’s obviously sending pain signals to my testicle, leg and foot.

Solution 1: If the ilioinguinal nerve is cut, this would turn off the pain signals to testicle, leg and foot.

Solution 2: If testicle is removed (the trigger point), this would switch of the pain signals. When I wear jeans, trousers or Chinos I wont get pain because the trigger point is no longer there to be triggered.

Important question: How many nerves are there that can send pain signals to and from the testicle, leg and foot?

I hope all this makes sense, or do I sound crazy?

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I think you’re thinking along the right lines, but my first advice would be to hold off on removing the testicle.

I’m a novice on this, and you might want to check in the choohoo or aschiro on this forum. They’ve done WAY more nerve research on this than me.

I believe that once a peripheral nerve is damaged as possibly happened to your ilioinguinal during your vas (and my GF during my vas), that can cause pain everywhere. Peripheral nerve specialists like Dellon and Williams in Baltimore might be able to explain. I’d suggest arranging a paid-for call with Williams. Great guy and very helpful. I talked with him twice and then saw him. Well worth the trip.

Your situation sounds similar to mine, though I never had leg pain. My pain eminated from the left epi and radiated up the inguinal canal. I seriously thought about epi removal since it was “obviously” painful. It still hurts at times. But, through GF blocks and cord blocks, the pain in the epi went away. I believe the epi is NOT my problem, but the epi is feeling it because the GF innervates the epi. In my case, I believe the GF nerve is damaged and any organ pain is just referred.

You might have the same situation. Perhaps the testicle FEELS the pain but is not the source. PERHAPS the II/IH is damaged. That can send pain everywhere. Like you, at my worst, I couldn’t wear jeans, but I’m sitting here right now in a pair of fairly tight Eddie Bauer jeans with no issues all because I was able to calm down the GF.

With pain traveling like yours, I’d really try to get in touch with Dr. Eric Williams in Baltimore just to have him diagnose your situation. He MIGHT tell you the problem isn’t the nerves but IS the testicle itself. I’d sure want to know because I had a nut removed.

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Hi @raising4girls please correct if wrong, but you have not had any surgery, correct, but got relief on the GF by repeated injections, most notably Botox in the end? How many Botox injections did you get and what spacing was in between, when was your last one and is the effect lasting in your case? I guess Dr P referred to you as the only patient where this is the case when I spoke to him a couple of weeks ago. I am very much interested myself to try Botox for nerve pain relief, probably it’s the GF as in your case. And where exactly did you get the Botox injected? The one possibility in Europe I have is injection of it into the inguinal canal, where they also test numbed the individual nerves (II and GF). And last but not least, since I posted on the Metformin thread recently, was that never something you considered / tried after @MikeO 's very positive experience? These 2 avenues seem to be my way forward with my (nerve) pain.

Hi Juno. Well, technically, I HAVE had surgery. My vas was in March 2005, and my pain started October 2005. I ended up with reversal surgery in June 2006. Back then, they tried Neurontin (gabapentin) and a GF block but the results weren’t sufficient. Cord denervation was brand new then, I think only Dr. Levine in Chicago was doing it, so I opted for reversal. Pain free by November/December 2006.

Interestingly, he found I was leaking from both vas tips. We both agreed reversal was going to be beneficial post-op even before the pain went away based on that.

That lasted nearly 10 years other than a 5-6 month relapse starting late 2008 running through early 2009. That relapse, though, convinced me I was dealing with nerve pain because my SAs were pretty good, in the 50-100MM range. Never regretted reversal though because it fixed the leaking which, I THINK (but cannot prove) was causing autoimmune problems (T = 300, PSA = 4.2). That bout was conquered with gabapentin and celebrex.

The longest bout began April 2016. I came VERY close to cord denervation, then I later came VERY close to having laproscopic GF neurectomy. I was leaning toward Dr. P. over Dr. Shoskes at home at the Cleveland Clinic for denervation, but never actually scheduled it. I had cord blocks with botox in June and October 2018. By November, the pain started dropping, enough to convince me I was a candidate for cord denervation, but not yet enough to call myself recovered.

I kept going forward with the general surgeon (who offers neurectomy) because it had been determined I also had a hernia. I wanted to know if that needed repair. If it did, I figured neurectomy was the way to go since he could fix the hernia at the same time.

He ordered a dynamic ultrasound to examine the hernia. He suggested having the radiologist do a GF block at the same time to confirm one last time that the GF was my issue. I thought it’d be just an anesthetic, but while on the table, the radiologist asked if I wanted him to included a steroid. I said “sure, why not” to get that steroid superimposed on what Dr. P. had given me. Pretty sure that injection knocked out the last remnant of pain, dropping me from 2-3 most times to 0-1 most times.

Long story, I know.

My sense is that my reversal was necessary not for congestion (since I was leaking, I wasn’t congsted) but to stop the autoimmune response. PSA and T have started correcting right away and are quite good (PSA 0.8, T 650-750). Dr. P. suggested that the reversal gave me a “mini denervation” by removing scar tissue. That makes sense to me. I

So, based on my own personal experience, I’m a fan of injections.

I never tried Metformin but on @MikeO’s experience, if I relapse again, I’d give it a shot.


Does anyone know what nerve’s go to the epididymis?

Right from day one my pain started at the head of the epi, this has never changed, it has always been the trigger point.

I just gave myself an examination, and the head of my epi is so tender and very painful when I touch it, this has always been the same.

I wanted to see if the pain location would move if I rotated my testicle, so I gently rotated/turned my testicle 90 degrees so the head of the epi was facing towards my inner thigh. I then touched lightly on the head of the epi through the skin on the scrotum and straightaway I got instant pain which also shot down my leg.

This must mean my epi is the problem, the trigger point moved round as I gently turned my testicle 90 degrees, as soon as I touch the epi head I get shooting pain, this then leaves me with chronic ache/pain for minutes/hours until it settles down.

What nerve would be involved that sends pain when the head of the epi is touched?

Why did the pulse RF block make my pain worst, as I’m sure the ilioinguinal nerve does not connect to the epi, it doesn’t run through the spermatic cord?

Are there any doctors on here?

Woke up this morning with no pain, had a bowel movement and the pain started???

If I didn’t have a bowel movement, or if I didn’t get dressed, I would not get any pain???

I just don’t get it???

Hey raising4girls. So you had success with botox? I found Don’s old posts and he did great with it. Can you tell me more about your experience?

I have bilateral testicular pain (not from vasectomy). I am considering

R-orchiectomy, L-Botox
Or both sides botox

Right side is worse and has swelling, that’s why we’re considering going nuclear. Left pain started with a varicocele and did not improve after varicoclectomy. Now have moderate pain at the site of the cut.

Sure. Back 2016-18, I was working with local pain management getting II/IH, GF, and pudendal blocks for my relapse of PVP. Found out about Dr. P. on this forum who, ironically, had done his fellowship under the guy who’d done my reversal in 2006. So, in mid 2017, I went to Orlando and got his “mega” cord block but without botox. It helped a lot, but only lasted 3-4 months.

Local pain management’s approaches weren’t helping much through late 2017-18, so in mid-2018, I went back to Orlando. This time we tried the concoction with botox added. Cost me about $1,000 out of pocket. It helped within a few days, but not enough, so I went back 3 months later for a 2nd dosing, and that did the job.

For me, after 30 months of pain, the added botox was able to knock it down and out. Still doing well about 3 years later.

@raising4girls Have any of your surgeons talked about cutting nerves, have they ever mentioned about neuralgia of the scrotal skin?

The pudendal, ilioinguinal, genitofemoral etc?

I spoke and met with two peripheral nerve surgeons, neither a urologist. One was Dr. Eric Williams at the Dellon Institute in Baltimore. He’s technically a plastic surgeon. His solution was a triple neurectomy which I strongly considered until I learned that I’d have to have a separate surgeon repair a small hernia on my left (paiin) side. While Dr. Williams is clearly capable, he’s not licensed to do hernia repair. So, after seeing him, I met with Dr. David Krpata at home at the Cleveland Clinic. His recommended solution was to repair the hernia and laproscopically remove (resect) the GF nerve, not a triple neurectomy.

In the end, Dr. P.'s injection cocktail with botox got me back to pain-free most days with some occasional twinges, about what I was prior to 2016, so I was avoid to avoid the neurectomy vs. cord denervation decision.

I myself would have a triple neurectomy tomorrow, I will try anything.

I’m fed up of not being able to wear clothes, it’s getting ridiculous now.

I hear ya. If you go down the neurectomy path, be sure to get a top peripheral nerve surgeon. Also, I learned that some prefer triple neurectomy simple because they fear nicking the II/IH on the way to the GF. I NEVER got any pain relief from them numbing the II/IH but almost always got relief when they numbed the GF, so I and just about every doc I worked with concluded the GF was my singular problem.

I didn’t want to have the II/IH resected out of convenience for the surgeon if I could find one who’d go after just the GF. I found that here at home but, thankfully, ended up cancelling the surgery.

@raising4girls We share many of the same symptoms. Were yours strictly pain based or did you have other issues? I have the sensation that my testicle isn’t seated correctly along with a swollen “vein” type thing that probably isn’t a varicocele as I already had a varicocelectomy on that side. I’m still trying to sort out if nerve treatment or reversal will do anything to relieve that.

Pain was what drove me to seek treatment, but I did learn that I had an elevated PSA and greatly reduced free testosterone level during my initial course of treatment back in early 2006.