I’m not a doctor or a psychologist, but I am pretty sure that this experience is caused by a physical change, not a psychological change.
Guys have been reporting this for at least fifty years. Here is an article from the Berkeley Daily Gazette Feb 15, 1975, which says in part:
My husband agreed to a vasectomy about five years ago. … When he tried to perform sexually he had great difficulty achieving an erection. When he did he was unable to climax. When he discharged semen he would not experience the feeling of a climax. After these problems he started having chronic swelling of his testicles with pain and nausea. He still has this condition.
This is the earliest story I have found documenting a complaint about disappointing climax after vasectomy. The vasectomy was performed 51 years ago.
The comments in this article on wisegeek tell the story pretty well:
Here’s another one on NBC News:
My husband had a vasectomy 13 years ago. Ever since, he claims that his ejaculate is only half what it was and that his orgasms are diminished.
Here’s one from Julian in The Times:
My sex life was very different after my vasectomy, which I had nine years ago. Ejaculation felt different. There was an unpleasant sensation, like a blockage. It felt like a Warner Bros cartoon, with fingers in the end of a shotgun causing the barrels to blow up in the face of the gun-toter
This is from a talk show called The Doctors
First, Dr. Berman lets the cat out of the bag:
Dr. Jennifer Berman, Urologist and Sexual Health Expert:
I’ve heard in my practice that men will say that it’s a diminished sort of sensation, a decrease in the intensity of orgasm … likened to the lack of or decrease seminal fluid that’s being expulsed. So I’ve had men complain that it’s less intense less pleasurable. Certainly not the norm but it’s something that I tell men about before they have vasectomies.
Then, Dr. Spitz attempts to put the cat back into the bag:
Dr. Aaron Spitz, Urologist:
I would say more often what I hear is that it’s a little bit uncomfortable. A little bit of pain. Which is to be expected because when you actually operate on any tissue in the body it actually takes up to 18 months for all those changes to finish. And … we reassure our patients just give it time. If you’re feeling an abnormal sensation after vasectomy and it’s been less than a year, give it time because things do change and get better over time.
I have been collecting these stories for three years, and have coded the “DC = Disappointing Climax” on this timeline. There are 221 examples of “Disappointing Climax” on the list so far, and I know of more that are not on the list yet.
So this is something that some men report.
I don’t know of any positive evidence that this is psychological. Studies of men with vasectomy usually simply fail to detect reports of orgasm problems. It’s not like there is some robust psychological explanation. Rather, the assertion that it is psychological is usually supported by offering the reasoning that there is no known physical explanation. I think this is missing the forest for the trees. The physical explanation is roughly speaking, that the man had surgery on his genitals and it changed something in there that changed the way it feels. That seems pretty straightforward and plausible. The fact that we don’t know all the specific details about the mechanism isn’t really a valid reason to reject this picture.
The fact that 90% or more men report that nothing changed about their orgasm also provides approximately zero evidence that the phenomenon is psychological. You could give penicillin to 5000 men and 4999 of them will report that they feel fine. Only 1 will go into anaphylaxis. That isn’t evidence that the problem is psychological. There is a lot of physical variation from person to person.
There are a lot of changes from vasectomy that could constitute a physical basis for changed orgasm sensation. At least they seem reasonable to me.
- Greater pressure in the epididymis. The epididymis is lined with muscle that contracts during ejaculation to expel sperm. Under pressure, this may feel different, and maybe this explains the lack of sensation that anything is “emptying” because it literally isn’t emptying.
- Vasectomy severs about 50% of the nerves that travel down the spermatic cord. Apparently most men don’t notice, but how can a doctor tell me with straight face that nothing they did could possibly jeopardize sensation? Like, really? Um, cutting nerves can’t alter sensation?
- Reduced semen viscosity. After vasectomy semen is measurably more watery than before. Perhaps it simply feels different travelling through the tubes.
- Prostate change. This is less well documented, but so many men describe prostatitis post-vasectomy. There are other studies that Dr. Tony referred to but I haven’t dug up yet that talk about changes to prostatic secretion behavior.
- Chronic pain and inflammation could inhibit sensation.
- Changes in muscle tone. The bulbospongiosus muscle or other pelvic floor muscles can change their behavior after vasectomy due to pain.
- Retrograde ejaculation. Several guys have reported this after vasectomy.
- Pelvic plexus crosstalk. This nervous plexus is a busy intersection for nerves that control erection and also nerves that are damage during vasectomy. Really, nerves from all over the pelvic floor pass through this zone and can possibly influence each other.
So, yes, I think it is absurd to claim that vasectomy doesn’t change anything that could possibly be perceived as a change in ejaculatory sensation. Funny enough, you can get a urologist to admit that vasectomy causes pain during ejaculation before you can get them to admit that vasectomy reduces pleasure or satisfaction during ejaculation. They know deep down that any risk of this complication is an instant deal breaker for many of their potential customers.
What is a urologist supposed to say? They can’t do anything to fix the problem. Are they supposed to admit that they knew about this and didn’t warn you? Or is it safer to stick with the party line, that they know other urologists will defend, that there is no way to anticipate this sort of thing, and a man who complains about this perhaps has a psychological issue that needs sorting.
So what to do about it? Well I’d say you have two choices.
Choice #1: Mourn the loss of your old orgasm and try to work your way through the grief stages toward acceptance. Your suffering should reduce over time as a result of various factors. For one, sensation may improve for you over time as your body adapts to whatever is going on. For another, your perception that something is missing may diminish over time as you retrain to the new sensation. Finally, you may just not have the psychological response of feeling upset. After all, orgasms are great but there is a lot more to life than orgasms.
Choice #2: Roll the dice on a reversal. Most guys get at least some of their old orgasm back when they get a reversal. Some don’t see any improvement. Some get it all back. It’s a spin of the big wheel and it’s a totally valid and sensible choice in my opinion.
I’m sorry you’re in this boat. I’m in the same boat, as are many of us on this forum. It’s bullshit that urologists don’t warn us about this before giving us this surgery. “It won’t change anything” is simply a lie that they feel safe repeating for as long as enough of them stick to it. I felt like I had stepped through the looking glass when I realized the truth about this. But it was crystal clear from the first time I ejaculated after my vasectomy that something was very different and that I would never have gotten the operation if I had known.