Post Vasectomy Pain Forum

Inguinal discomfort cured by reversal?

I’m looking pretty far ahead here as I’m going to try some non-invasive treatments before having yet another surgery. But I’ve been thinking lately that my pain and discomfort isn’t solely confined to above where my vas was performed, but that pain is overshadowing other pain on the top and backside of the testicle. I’m wondering if I do indeed have some back pressure and if so, is it possible for it to refer pain upward? One of my major complaints has always been pain, pulling, and sometimes a twitching sensation in the inguinal area.

I’ve had very low ejaculate volume since my vas… Not due to gradual aging like every uro has tried to tell me, it was like a switch was flipped. I’ve read several instances where forum members who’ve had reversal have had drastic. improvement in that department.

I still think nerve damage is a distinct possibility, so I do not want to jump into reversal until I go through the pain management process starting next month. I’d be interested in hearing experiences of fellow members here. I feel my symptoms and experience has been pretty similar to what @raising4girls and @MikeO, would especially appreciate any input from you guys.

Hey Vkarnod,

Take a look at my previous posts to see if you have similar symptoms to mine. Everyone is different and these pains are so hard to pinpoint. Hopefully my experience helps give some insight (or helps weed things out). I feel like Im one of the lucky ones to find pain resolution. There is hope. Good luck.

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I also have discomfort and sometimes pain in the area you describe.

I’ve talked to quite a few guys (when doing ultrasound on them) on where exactly they feel pain, and many say the same as you - the pain is on the back side of their testicles. In many guys, this is where the distal part of the epididumus is - the tail or cauda. This is the part of the epididymus just distal to the vas.

I read somewhere - can’t exactly remember where, but I think it was from one of the links in this paper, that the tail of the epididumus is the part in which most of sperm reapsorbtion occur. I suspect that the “forced reapsorbtion” of all sperm that must occur in the cauda epididymus, can partly explain some of the pain/discomfort in this exact area. I’ve also seen on an number of MRI’s that sperm seems more likely to “sludge” /become thicker - more viscous in the tail than in the head of the epididumus, but don’t yet know how/if that is connected to pain.

In any case, I believe pain in this area may be because the tail of the epididymus is forced to absorb more sperm than it has capacity to do. Just my not-yet matured thoughts on it.

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I’ve been dealing with this for over 4 years and have been so focused on pain/discomfort above the vas site and in the perineum that its overshadowed the pain I have down lower. I guess part of it is that I presumed imagery would pick something up or I’d have swelling if it were an epididymal or back pressure issue. That hasn’t really been the case, although I’ve had increasing discomfort down there, especially when taking a seat and the testicle is lifted in the scrotum.

I’m trying to maintain a calm, methodical approach toward solving this issue, but I’m also completely over it and would love a swift resolution. Unfortunately that’s seldom the case for us.

Copied and pasted from something I wrote earlier about sperm absorption:

Prior to vasectomy, your body has about 40 cm of vas deferens on each side. The epithelial layer of this tube is adapted to confine living sperm and process dead sperm. Just before the vas deferens enters the prostate, it expands to form a reservoir for mature sperm called the “ampulla.” The ampulla is about 2 cm long and about twice the diameter of the vas deferens. The epithelium of the ampulla has deeper and more complex folds, which means lots of surface area for handling the sperm cells that are reaching the end of their lifespan. (Link) Also, prior to vasectomy, almost all men empty their ampulla periodically, by nocturnal emission if not sooner. It would not surprise me if someday we discovered that one reason for nocturnal emission is to clear out the ampulla when the amount of ageing sperm cells there exceeds the capacity for absorption.

After vasectomy, about 2 cm of vas deferens remains on the testicle side, meaning that less than 5% as much epithelial surface area is available for handling sperm. No ampulla reservoir. Ejaculating doesn’t remove any sperm.

Therefore the full burden of handling that sperm falls to the cauda epididymis, distal vas, white blood cells, etc. and as we know they often get overwhelmed resulting in a granuloma. And doctors have the audacity to tell you that your body absorbs the sperm “just like before” the vasectomy. If you removed 95% of your intestine, you would not absorb food “just like before.”

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Strange how some of the referred pain can be worse than the pain at the origin. In bout #1 (2005-06), like you, my inguinal canal pain was brutal. I described it as someone pressing a steel bristle brush into my inguinal canals. In bout #3 (2016-18), like #1, it started in the scrotum, but referred this time to the perineum.

I’m 99% sure I didn’t have congestion. More certain I had nerve damage, impingement, etc. Also granulomas on the vas tips where I was leaking. Did reversal help? Most probably, but not from congestion relief but by preventing further leakage and cleaning out scar tissue that would’ve only increased.

Always hard to say if what worked for me will work for others. And, admittedly, I had a 6-month and a 30-month relapse post-reversal. I think you’re wise to try non-invasive treatments. The problem is that they (combo of medications, PT, injections I assume) take time and most of us hurt so bad we don’t have patience.

If I can put in a plug for supplements, even today where I’m pretty much pain free, I feel a notch up to 1-2 if I stop taking Nerve Shield or Zyflamend. They both took several months to have an impact, but now that I’ve been taking them both for nearly 4 years straight, I see their benefit.

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Similar to @raising4girls, had awful and relentless pains in the inguinal region. Additionally, semen volume went from something that resembled fireman’s hose to 2 miserable drops after vasectomy and next to no orgasms. This somewhat resolved with reversal, no inguinal pain and volume have increased a lot, but am not back to where I were before this whole ordeal.

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The scary part is that even the uros who’ve studied and treated PVPS victims cannot completely explain the mechanisms causing the referred pain. Between 2017 and 2018, I had 3 separate docs affirm a belief that my GF was damaged/aggravated, etc., yet none could explain why my perineum hurt with confidence. One DID speculate that I had pelvic floor tension in response to the scrotal pain, and I’ve bought into that theory but it’s just that, a theory.

Seems like many of us have had a wide array of hard-to-explain symptoms as a result of our vasectomy. Because they can’t explain it, many docs choose to deny the relationship to vasectomy. That’s what makes me appreciate more the humble ones who conclude “yes, there’s a relationship that I can’t explain.” That’s a better answer. It’s also what makes treatment and recommendations here so difficult. I know what worked for me, but Your Mileage May Vary has to be added to just about every statement.

I had all kinds of pain issues, but some of my worst pain was on my left side. The pain would radiate up into my inguinal area. It would cause severe pain to press on my left side inguinal area. I had a left sided sperm granuloma that adhered to the wall of my spermatic cord. Whenever my testicle would contract or raise my pain increased exponentially and it would cause severe lower left back pain and back spasms.

If you have not read through my history and issues you can read it here: https://www.postvasectomypain.org/t/another-personal-journey/4975

I am 2 1/2 weeks post reversal and getting better every day. No left sided pain at all other then some slight tenderness at what I assume is the vas connection site.

Reversal Update thread: https://www.postvasectomypain.org/t/reversal-updates/6081

At times it actually causes relief when I press in this area. Also, when pressing and bearing down, my testicle would actually turn nearly sideways in the scrotum which led me to believe something was twisted or pinched. One Dr suggested that a hernia may be causing this and all my other complaints, but a hernia specialist ruled that out.

If I recall correctly, I first noticed inguinal discomfort a few months after the vas, then constant dull ache in the perineum about a year and a half after the vas. I was diagnosed with prostatitis and put on a month of antibiotics followed by ibuprofen. This seemed to help for about a month, but the pain returned thereafter. Additional rounds of antibiotics didn’t help.

It’s my hope that the vas did something that messed with the pressure in the plumbing and that a reversal would solve all my issues. I fear that it’s more complicated than that and I might instead be dealing with complex nerve issues. I’m considering going to see Dr. P and letting him handle the rest of my care. I’m now on my 8th urologist and I have a referral to a neurologist for nerve blocks and such in a few months. It seems that Dr. P’s an expert in all of the above. Plus, I’m getting to the point where I need to get figured out before everything falls apart. It’s getting tough working and it’s getting more difficult even being functional around the house.

It will get better mate, don’t lose hope

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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.

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I had a phone consult with Dr. P last night. Based on conversation he thinks I may have some preexisting cremaster muscle issues that were aggravated by vasectomy. He mentioned reversal as a course of action as he feels that removing the clips and putting things back they way they were could help. I have a few months before I’d even be ready since my last procedure, so there’s time to think it over and try some other less invasive measures first. He suggested a nerve supplement that I’m trying. I’m also going to talk to him further about injection to relax the cremaster as a first step.

To @Morien60’s point, I do have appointments coming up with a local pain management clinic. I’ll stick with them if there’s improvement. I totally agree with avoiding more surgery if possible.

Dr. P was really great on the phone. I’m confident I’m working with the right person to get this figured out the best I can.

The more I think about my issues the more it makes sense that there may be an issue related to the cremaster muscle. When I was 18 I had a 6 month bout of unexplainable discomfort on the right side after I noticed that my testicle looked out of place in the scrotum and I moved it back to what I thought was the right position. I went to several doctors over that period of time and none could find anything wrong. Thankfully, the discomfort went away on its own and I went on to live the next 20 years normally… Except for periodic bouts of retractile testicle (an issue caused by an overactive cremaster) on that same side, that were slightly uncomfortable to manually correct, but otherwise weren’t a big deal to me.

Now 20 years later I think the vasectomy woke the beast. It’s nearly the same feeling, but with more pain elsewhere and ejaculation issues to boot. It really makes sense to me that botox to relax the muscle may be worth a shot, but I’m not sure how the ejaculation issues fit in the picture. It’d be great if something less invasive than more surgery would fix everything but I’m not so sure.