Post Vasectomy Pain Forum

Inguinal Pain is back. What is it?


#1

Ok, so I haven’t posted regularly for the last several years. February will be 5 years since my Vas and about 3.5 since my reversal.

Initially, after the Vas, I had some super sharp inguinal pain. It would flare when doing normal activity – coughing, laughing, yelling loud. Generally when I was standing up… and if I would bear down to project, it would ignite. And once it did, I had to go sit down for a while for it to calm down. This was a problem for a couple months – which is a problem since I work for a church and part of my job is leading the music each week. Singing would trigger it.

I completely stopped physical activity in that post-vas season of life… and it eventually went away. In fact, all has been ok on that front for the last few years. Every now and and again, I’ve felt it briefly, but never consistently or very bad since then.

However, over the past year, I have been slowly getting into the best shape of my adult life. I’ve avoided ab workouts to avoid this pain, but I’ve done lots of upper body work and slowly added in jogging and now even some leg presses, leg extensions, pullups, etc.

Well, the pain is back. It almost feels like a pulled muscle, right in my belt line at the inguinal canal on my right side. I’m sure it is right around that “inguinal ring”. It can happen when I’m stretching for something while pushing off my right leg… or even just when talking loudly while standing up. Sometimes even some mild gas can cause it to hurt right there. However if I compress my right leg enough (i.e. - put my right foot up on a chair while I’m standing up, sit down, etc.)… I can make it stop. And if I sit down for a little while, it goes away (until I do enough activity to aggravate it again).

To me, it sounds like some sort of hernia… but I know that can be a rabbit hole. Any advice on where to start with this? Which kind of doctor should I go see?

In the meantime, I’m going to stop the leg exercises to see if that helps.

Thoughts?


#2

I had same pain and was diagnosed with small inguinal hernia, but haven’t done anything with it, as this pain coincided with vasectomy. Had reversal around 5 months ago, and this particular pain stopped.

Maybe try NSAIDs to start with, see if imflammation is causing it?


#3

@kevinb

Kevin, glad you’re back and good to hear you’re doing seemingly better. I’ve got the same pain and have since the vas. Ironically, I saw someone Christmas Eve who took an ultrasound and was convinced I had some kind of muscular issue down there. He felt like he could see some chronic edema at the public tubercle attachment and proposed a tear in the conjoint tendon. This is basically a “sports hernia” which isn’t a “true hernia” by definition. He ordered an MRI with a special pelvic protocol which I had done last week.

Fast forward to today, just received the results. It didn’t show a dang thing. I’m convinced, after this MRI AND working with multiple PT’s, that it’s the ilioinguinal nerve acting up. In your case, this would make sense as it helps provide innervation to the transverse abdominis and internal obliques. Personally, I’ve gone on to develop right leg weakness, back pain, and the same inguinal pain. It’s particularly worse during sit-ups or rotation like playing golf. How it’s managed to take out my leg is beyond me but I do know that my adductors are tight and weak, especially the pectineus.

Do you feel like your reversal was a success, how has it helped you, what symptoms did it improve, would you do it again?


#4

Man, hate to hear that. So frustrating that they couldn’t see anything. I feel like I saw someone on here say something about a dynamic sonogram or something to see little hernias, maybe? You’re right though. I fear that it may be more of a nerve. I’ve also lost weight over the course of the year and wonder if being thinner somehow exposes that nerve more?

I’m not sure about reversal. I’d say I’ve improved some since. Not sure how much attribute to the reversal and how to just time.

I’m not having back issue so much, but I will say that even though I’ve tried to get back to jogging, my knees can’t handle it very well anymore. I feel like several of years of changing the way I walk and sit (to protect the groin), has done something to my hips/legs/knees to make those joints not work as well. I’ve thought about asking a PT about this, but haven’t done it yet.


#5

Interesting. Ya my knees are crap, or should I say knee. Everything is right sided, right knee, hip, right side low back, right side upper back…and this is after the initial injury/damage on the right side during the vas. My left side is perfect. Tough to consider a systemic cause with the unilateral nature of my troubles. To me it’s rather obvious what’s going on. But…can’t crack the code and fix it. My pilates/yoga experiment starts next month.


#6

Hi @kevinb, do you get this pain daily, or is it intermittent? Have you got any other aches apart for this? Thanks


#7

Kevin, your situation sounds remarkably similar to mine, and I’ve got a bunch of new news. My vas was 03/2005, reversed in 06/2006 for pain. I was pain-free 'til 04/2016 except for a 6-month relapse 2008-2009.

My 2nd relapse started in April, 2016 and is nearing 3 years, but I am getting better. It all started after my first bike ride of 2016. Same pain pattern as 10-11 years prior.

For 2-1/2 years, I saw 3 uros plus Pain Mgt. I was getting some short relief from various injections, the most from Dr. P. at the PUR. The Pain Mgt. pudendal injections helped with perineal pain but not much with scrotal and pubic region. I decided to try a different approach and saw Dr. Williams at the Dellon Institute. Under US, he DID find a small hernia and advised me to get examined here at home in Cleveland. As a plastic surgeon, Dr. Williams doesn’t do hernia repair, so if I was to work with him, he’d have to have a colleague repair my hernia (which is VERY close to the GF nerve, I saw).

Finally got to the right guys at the Cleveland Clinic. On 12/31/18, They did a Dynamic US which showed the hernia and a fatty deposit (lipoma) that COULD be pressing on the nerve. At the same time, they did a GF block with anesthesia and a steroid. As background, I had a botox and steroid injection with Dr. P. on 10/11/18.

So you know, at least 7 different doctors have checked me for a hernia since 2016 and not one found it manually. It’s apparently small, but in just the right (wrong) spot to potentially be a problem.

My best guess is that first bike ride of 2016 re-injured the GF which had a history of injury plus hurt the ab wall. As background, I had bilateral hernia repair in 1973 when I was 8.

I had already been doing 50% better since Dr. P.'s injection in October and am now 80-90% better since the follow up block at the Cle Clinic. Almost pain-free and pain-free some of the time, barely noticeable most of the time and far better from the hornet stinging pain I’ve been feeling.

I’m tentatively scheduled for hernia repair and laproscopic resection of the GF nerve at the same time in April. If this relief lasts, I’ll probably cancel, but I’m confident they found the culprit.

I don’t mean to make this about me. My point is to be persistent and don’t let anyone cut you again 'til you have confidence you’ve found the pain generator and have confidence that the surgery will repair/solve the problem. Had I jumped into SCD, that might’ve solved the scrotal problem but could easily make the hernia worse.


#8

Thanks for the replies, fellas.

@SomeGreyBIoke… I have some general testicular tenderness and some minor abdominal soreness that comes and goes. It’s very liveable, though, and is probably more aggravated by exercise that engages my core. The debilitating pain is the sharp inguinal pain. It isn’t constant… but seems to be getting more frequent and seems to come on after extended periods of being on feet, plus talking loudly, coughing, singing, etc.

@raising4girls… your progression is super interesting to me. I’m very interested to see how your hernia repair and GF nerve resection(???) goes. I’d be curious about two things:
– where did the idea for the GF nerve resection come from? i don’t think I’ve heard of that before.
– where exactly is your pain from the hernia? is it in the inguinal area? Did you do the GF block in that same area?

Thanks again.


#9

So I went to a sports hernia specialist here in Houston. After a brief manual exam, he was confident he could feel a torn muscle (similar to a sports hernia). He said this was likely pressing the nerve.

He wants to do surgery to stitch the muscle back together. And he said he also will cut the nerve there. This guy does the same surgery for the Houston Texans NFL team. So he’s a top notch surgeon.

Anyone have thoughts/suggestions on this? Currently planning on the surgery next week.


#10

This is interesting and I have not heard this before. I’m curious if he recommended a 3T MRI or something to confirm his diagnosis of tore muscle. Which nerve does he plan to cut and what is he going to do with cut ends?


#11

Hey Kevin good to see you again although you being here means that you are having issues. The fact you have been away is actually the best sign that you have, for the most part, dealt with your issues successfully and graduated from this hellhole, lol. I am very stoked to hear you are working out and getting in shape.

I guess other than this setback you have been having a pretty good post reversal life?

One thing about surgeons, and the good ones will tell you this, they cut for a living. It’s one of those “When all you have in your toolbelt is a hammer, everything looks like a nail”. I am not saying don’t do it but I would proceed with caution on the sports hernia thing.

If you are saying beltline that’s pretty high up. How long ago did it start and do you remember doing anything that might have triggered this?


#12

@kevinb

This is an interesting situation. I’m probably repeating myself but I recently found myself in a similar circumstance. My uro sent me to a sports medicine doc in Boulder, CO who specializes in athletic pubalgia and similar pelvic issues. Since most of my pain is pubic bone and there are 5-6 muscle attachments in this area it made sense. After his ultrasound, he was convinced he’d found something. However, my 3T MRI at the Champions Center with a special “pelvic protocol” designed specifically for this type of procedure was negative and now I can’t get the doc to call me back. I’m not really sure what to think. His ultrasound pic was pretty convincing that there was a problem but miraculously the MRI didn’t show anything.

I’d be hesitant to think your guy can magically feel it. I’m not sure that a thing. Maybe I’m wrong but I’ve had three pelvic PT’s all over my inguinal canal and all I ever here from them is overtght muscles.

Definitely keep us posted on this.


#13

@kevinb, the timing is strange. One item to consider would be an L1 radiculopathy. Consider seeing a physiatrist for electrodiagnostic testing. It may be a wash, or you may avoid an unnecessary surgery.


#14

@raising4girls
Is your hernia considered a sports hernia or other type? I didnt realize the huge difference until I read @Choohooo post yesterday and did some research.


#15

Mine is a small, run-of-the-mill inguinal hernia. It’s down very low in the groin almost exactly where they’d do an incision for SCD. It’s very close, too, to the GF nerve which is why I’m leaning against SCD. All they’d do is make the abdominal wall weaker. The hernia today doesn’t require surgical repair, but it’s presents a complication for surgery regarding the scrotal pain.


#16

@kevinb

Finally was able to speak with the docs assistant about my MRI. Apparently, the MRI confirms what he saw in the ultrasound and I indeed has a legitimate issue down there. According to my doc, radiologists aren’t really trained in these types of issues and often overlook things that are clear as day.

Final diagnosis is abnormal thickening of the conjoint tendon, which is a class sign of athletic pubalgia. As mentioned earlier, this can affect the adductors and is likely a cause of my pelvic floor pain and right leg instability as it can put pressure on each of the nerves responsible for these muscles, including the obturator nerve which typically isn’t considered in the post vas world.

Doc said for this issue surgery isn’t typically an option and recommends PRP injections first. I don’t want to cut unnecessarily but I have a hard time accepting that there’s NOTHING that can be done.

Anyhow…that’s my follow up. The plot thickens (no pun intended…ok maybe just a little bit).


#17

@Choohooo
I am following this closely. Does the Dr. believe this could cause the back pain and neck pain and other body pains on the right side? I have a lot of the same issues and not getting anywhere with local doctors besides try reversal.


#18

@Ben

That’s a good question. Personally, I say ABSOLUTELY. However, you’d be hard pressed to find a PHYSICIAN who understands functional anatomy and physiology well enough to answer this question. Ive since reached out to my orthopedic friend and general surgeon/hernia repair friend and both admitted they’re familiar with it but understand very little. It’s best answered by a physical therapist and a good one should be able to connect the dots. I strongly believe in the connection because I’ve had to go through it. If your core takes are a hit, there will be a ripple felt throughout the rest of your body. Thats essentially what’s happened to me. My occipital neuralgia is getting increasingly worse and my PT can fix it with neck stretches and dry needling therapy. She claims my C2/C3 are no longer moving separately due to muscle tightness and tension which in turn tugs on the nerve in an unnatural way. Everything on the right side of my spine is tight from my low back to my neck because my abs aren’t doing their job 100% like they are supposed to.

I found this today while researching. “In about one third of cases, the patient recalls a sudden ‘tearing’ sensation at the time of initial symptom onset.” I lifted my 8 lb infant daughter 36 hours post vas and it felt just like a torn muscle at the pubic bone. It’s important to note that I haven’t had the typical nerve pains of others on here. However, my pelvic floor has taken a huge blow and I went on to develop consistent bouts of pudendal neuralgia at month 4-5 that still haunts me today.

“Most cases show localised tender hypoechoic thickening of the conjoint tendon at or just above the pubic crest on real-time ultrasound interrogation.” This is precisely what I have, diagnosed via ultrasound and MRI.

It’s equally important to know how this involves the abdominal muscles. I have pain that moves from pubic bone (initial site of injury), to inguinal canal, then up to mid abs on the right side. I’ve lost a significant amount of abdominal strength in the area and at month 1 post vas I was no longer able to do more than 5-6 sit-ups (down from 60-70 two months prior). It’s also well known to involve the adductors, particularly the adductor longus, which plays a huge part in leg, hip and knee function – something I have really struggled with. In fact, i had my pectineus and adductor longus dry needled last week due to weakness and over tightness. Hip issues are common as well as testicular pain.

Connecting this to the vas? I’m not really sure. Perhaps surgical damage weakens muscular support and puts people at risk for this type of injury. Realistically, I struggle to see how 8 lbs could injure me without some kind of predisposition, especially considering how soon it happened after the vas. However, I play a ton of golf. In my prime I was spending 5-6 hours/week on the driving range. It’s not crazy to the think that maybe I was on the brink of it happening from chronic overuse and this episode was the final straw.

At just 2 months shy of the 4 year mark since my vasectomy, I never imagined I’d be this close to explaining ALL my problems considering how extensive it seemed to be. Having solved all of my systemic dysfunction, this feels like the missing component that ties in the pelvic and my constant inguinal pains. It’s almost surreal and brings a little closure to a hellish injury and thousands upon thousands of hours of research on the internet.


#19

This checks a lot of the boxes for me and sounds similar.

I have tightness from my low back to neck also and just starting to feel headaches on occasion all on the right side. I have minimal ball pain except some minor pains upper right ball on occasion. I have some inner right groin pain similar to what you describe but hardly noticeable unless I really think about it.

I lifted a water bottle to fill a water cooler a week after my VAS and often wonder if I did something at that time to tear a muscle or further make a injury worse from the VAS.

I have the same thoughts and was playing a lot of golf prior to my VAS. Hours at the range and playing 3-4 times a week. I was having some upper abdominal issues several months prior to the VAS that subsided. I thought this was due to a tear or something from golf at the time but it went away and was out of my mind by the time I did the VAS. Could be related but I don’t know?

I pray this is the answer and hope you find relief. It must feel great to have a possible definitive answer after 4 years backed by ultra sound and MRI. I feel I have something similar based on your symptoms and my symptoms being so similar. I think you are on to something and I plan to pursue looking into a possible sports hernia myself.

I would also like to add I always get relief from nerve blocks specifically with steroids for 1-2 weeks after. In addition I had 3-4 months of relief after PRF no ablation Illioinguinal nerve which helped with groin and lower back pain. At that point I started exercising again and playing some golf.

I found this case study on Radiofrequency denervation of the inguinal ligament for the treatment of ‘Sportsman’s Hernia’: a pilot study which specifically talks about both options, Nerve Blocks and PRF and potential relief which matches what I was having. The results suggest that symptoms are related to tendon inflammation and ilioinguinal nerve compression and can be relieved by PRF which is another option to look at if you identify this as the main issue. Keep me posted on your journey and options. In the little research I have done it doesn’t sound like there are many doctors in the U.S. that treat this specifically.


#20

Just to add to this thread. I finally was able to get a MRI with sports hernia protocol and the findings were right labrum tear and adductor strain with myotendinous edema but no undermining tear. So I have some definite issues that need addressed but not sure if this is the source of my pain. My pain started a week after vasectomy so did I have predisposed issue that surfaced after Vas, did I injure myself after vas, or is this something that needs addressed but not my pain source. It could be a lot of things all in one and this is some of the issue. I also realize the MRI does not pick up a lot of issues and requires a skill to read so I plan to get some additional opinions. I keep learning more and more and will keep digging. In the meantime I will start therapy with a sports medicine specialist and prescription anti inflammatory.