Some years ago, I was told by a urologist that with most men after a vasectomy, sperm production declines in the testicles, as they respond to the pressure from the epididymis which become congested after the surgery. “Some congestion is normal and expected,” is what he told me. But the amount of the congestion, and how much resulting discomfort develops varies widely from person to person. Which is why urologists will always push back on reports of pain, and they will always advise patients to take a wait & see approach. Because the chances are high that any “discomfort,” will fade with the passage of time, and even if the pain doesn’t subside completely, it will diminish to the point where it isn’t an issue in daily life. Humans have an immense capacity to adapt to changes, even unwelcome changes may fade over time in importance. Most men are reluctant to have anyone poking around at their genitals, and if there is a twinge now and then that can be subdued with an aspirin, then that is a more welcome alternative versus going to a see a cryptic, rude, brusque and disbelieving urologist.
According to the urologist I spoke to, most men do not notice the congestion, and in those that do, the congestion subsides (somewhat–never entirely) over a period of time from anywhere from six months to two years.
“Blowouts,” caused by the congestion are common, which is where a tube in the epididymis breaks, and there is corresponding inflammation as the body reacts to the sperm being exposed to the bloodstream. The body seals over the blowouts with scar tissue, which gradually cause the epididymis to become deformed and filled with blockages–which is why a vasectomy reversal may not be successful, especially for a reversal that is attempted many years after the vasectomy. Because, as time passes, the damage increases. Many men do not notice blowouts. The epididymis never dissolve the sperm cells all at once, at any given point in time, there are many fragments and they do form a sort of “sludge,” for a lack of a better word.
I am apparently one of the unlucky few that do notice blowouts. And my urologist’s suggestion was to take some aspirin when one occurs and to treat it as a headache.
I think it is entirely possible for pain to be referred upwards, I have noticed when I have a “blowout,” I’ll often have a sharp pain in the flank on the side of the testicle where a blowout is happening.
I don’t know if having a reversal would always have much of an impact on the volume of the ejaculate. The sperms cells themselves represent a small part of the ejaculate. In some men, perhaps they did produce a larger than average volume of sperms cells, so those men might notice a lower volume.
The volume of ejaculate varies, depending on a lot of different circumstances. A lower volume of ejaculate could have more to do with how you’re feeling. If you’re in pain during sexual activity, or even anxious that you’re going to feel a spike of pain when you reach the point of ejaculation, then it seems reasonable to conclude that your sexual response and reflexes will be dampened somewhat. For myself, the quality of an orgasm is not tied to the volume of the ejaculate. I have noticed that ejaculation never results in the “empty,” or satiated feeling afterwards. But, I’ve become used to that. For now, it is, what it is.
I think you would be better served with following the suggested pain management. More surgery means more trauma, more opportunities for nerve damage. So, in my opinion, the less invasive procedures are used, the better. Understand that a reversal, depending on much accumulated damage there is within the epididymis, may, or may not, relieve symptoms of congestion. Meaning that yes, while you may once again have sperm present in the ejaculate, you may still have a certain amount of congestion.
For those considering a vasectomy, I think there needs to be a more cautious approach. If you’re really in tune with your body’s systems, and if your testicles and the structures around them seem to be a bit more sensitive than what might be expected, then maybe a vasectomy isn’t for you.
Of course, along with that are other considerations involving your partner which I won’t go into here. Suffice it to say that everything in life is a tradeoff. And yes, there usually is a catch. If something sounds too good to be true, it usually is.