Post Vasectomy Pain Forum

Journal in 2001 gives some legal advice to doctors who do vasectomy

https://pmj.bmj.com/content/77/912/656

Published in “Postgraduate Medical Journal”

October 2001

Review of the complications and medicolegal implications of vasectomy

problems relating to vasectomy are the main cause of claims against GPs for medical negligence related to minor surgery.

Litigation against secondary care practitioners, mainly urologists and general surgeons undertaking vasectomy in the hospital setting or in private practice, is also highly prevalent.

The problem of chronic testicular pain after vasectomy has become increasingly recognised and is common enough to mention during counselling. It is certainly the subject of litigation and a difficult clinical problem to investigate and treat. Painful and clinically tender post-vasectomy nodules can be excised and epididymectomy to include the lower vas segment may be successful if the pain persists. Orchidectomy should only be a very last resort. If this course is pursued the patient may well then present with pain in the other testicle.

Choe and Kirkemo found post-vasectomy scrotal pain to be the commonest late complication in 34 out of 182 patients (18.7%), which adversely affected the quality of life in four (2.2%). Thirteen men (9.3%) were dissatisfied with the decision to undergo vasectomy and 10 of these listed chronic scrotal pain as the reason. McMahonet al are clear in their advice regarding chronic testicular pain: “Those performing a vasectomy are under an obligation to ensure that patients requesting the operation are aware of the risk, albeit with the reassurance that in the majority of cases the pain is comparatively mild and only rarely requires further medical or surgical intervention”.

We agree that the evidence is such that men should be warned about the small possibility of chronic testicular pain after vasectomy and that this is sometimes difficult to treat successfully. Referral to a pain clinic for management may be necessary when it occurs.

Why are doctors sued post-vasectomy?

Doctors are sued after vasectomy for several reasons:

  1. Failure of the operation to render a man sterile resulting in an unwanted pregnancy.
  2. Significant postoperative haematoma formation +/- infection requiring operative intervention.
  3. Chronic scrotal pain sometimes requiring further surgery which is not always successful.
  4. Atrophy or loss of a testicle following 2 and sometimes 3.
  5. Failure to inform the patient of a positive postoperative semen sample.

Conclusion

For the majority of men, with a low risk of complications, vasectomy is an acceptable and effective method of permanent contraception. For the unfortunate few, however, in whom the operation fails to render them sterile or who have significant postoperative complications, litigation is an increasingly popular method of obtaining compensation and causing considerable distress to the unfortunate doctor concerned. Much of this distress is avoidable by good communication, accurate and comprehensive note keeping, and a sound surgical technique.

Note the “distress” in the last sentence refers to the distress the doctor experiences when they are sued by the patient who was not adequately warned and had a bad outcome.

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Yes, how awful the “unfortunate doctor” might be put through “distress” due to the horrible outcomes of his own actions, the ramifications and likelihood of which he underplays to his unsuspecting victims. You hate to see the unending suffering of many patients over the years ever come back in any instance to briefly inconvenience a doctor and result in any kind of financial consideration for the person suffering 24/7. It’s like having to take the time to clean blood off the bumper of your Lexus after running over a man on your way to perform surgery when you’d just gotten it waxed. What an inconvenience!

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I am convinced that there is a systematic underselling of the risks of complications with vasectomy by urologists and media. We are told that 1 in a 1000 will have issues, but the real number is probably closer to 1 in 10. Any other VOLUNTARY procedure with such a high risk of complications would be discontinued. I think the silence around this is due in large part to reluctance to talk publicly about testicular pain :confounded:

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I totally agree with you but how do we get men to break the silence. It took me a long time to speak out about it and was shut down by my G P

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My heart bleeds for them

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how do we get men to break the silence

The fact that victims of PVPS do not speak up about it is definitely a huge part of the problem. One way grievances like this seem to get corrected is when the victims take the initiative and make enough noise to bring attention to the issue. But what man wants the spotlight of attention shining on their PVPS?

Another way these issues get attention is when there is some company that has a solution to sell. Then suddenly you see commercials with chipper people who finally have their ulcerative colitis under control by taking a profit-generating pill. But so far, there is no pill for this.

I don’t think we can promote suing doctors as a way to get the word out. It’s too expensive and painful. And when you inevitably lose the lawsuit it sends everyone the wrong message anyway.

Word of mouth clearly can’t get the job done, or it would have already. Word of mouth has been failing to spread awareness for more than 50 years. Men are inoculated against word of mouth stories by vasectomy promoters who jeer at all the “myths” and second hand stories that are just made up nonsense by religious fanatics or ignorant people who think vasectomy means castration or that nothing will come out when you ejaculate. I’m aware how painfully close to home those two concerns – which are presented as ridiculous manifestations of shocking ignorance – hit for some of the men on this forum.

My guess is that websites like dontfixit, painaftervasectomy, the yahoo forum and this forum have done more than any other effort to raise awareness of this issue. I try to spread awareness on social media like twitter, reddit and in comment sections of youtube and articles.

Another idea I had, would be to encourage men to file a formal complaint to the relevant oversight agency. For example, the state medical board, the Joint Commission, the GMC etc. We could see this as the bare minimum duty that men with PVPS have to other men so that at least a complaint is lodged somewhere. Somewhere other than with the doctor who performed the surgery and who has an obvious conflict of interest. And this would not take a lot of effort or bring a lot of unwanted public attention to the man’s plight.

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The problem is that majority of men haven’t got any perceiveable issues and they spread thier stories via word of mouth too. I know 2 people from my surrounding who had it done >10 years ago, and are very please with it. I tried to warn men on FB forums, but for every 1 of my negative or cautious post, there were at least 5-10 positive ones, so go figure. In my opinion, the only drop in vasectomy we will see will be when a contraceptive pill targeting men will reach the market.

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Yeah, it’s sort of like coronavirus that way I guess. For every person who goes into respiratory arrest and dies you can find 99 people who recover without a problem.

It would be pretty recognizably obscene if doctors were out there giving the impression that coronavirus is not dangerous and the stories you hear about people dying are just myths.

But my goal isn’t to decrease the number of vasectomies that are performed. That may indeed be unrealistic, as men will willingly roll the dice because of the success stories they have heard. My goal is to help the conversation and expectations about vasectomy be realistic so that men and their partners can be informed, and men who get PVPS can have their experience validated and not be made to feel crazy. For reversal surgery to be recognized as a valid treatment option that can be covered by health insurance where that makes sense. And for alternatives to get developed once people see that the status quo is not satisfactory.

That said, you do see vasectomy rates falling in the UK, and it seems plausible that the numbers that are being distributed to men by the NHS (e.g. 10% chronic pain) have to be a driving factor.

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Yep, I can see how useful that can be, instead of being told that it’s all in your head and just get on with it. TBH, now I had it done, I’d say that a reversal is another roll of the dice, comparable situation to the vasectomy itself. Saying that, I healed relatively well after my reversal, but in the midst of a horrible setback, and my sanity is being tested daily at the moment.

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Ethan I love the work you do digging up these studies. But man everytime I see another one with shockingly high rates of bad outcomes I go blind with rage.

I’m no lawyer but I have to wonder if a class action lawsuit would be a better avenue. But there’s no one device or pharmaceutical maker that’s an obvious target. Maybe against the national urological association. Their own guidelines state 1-2% for pvps, yet I never got that number in my consultation or literature. My urologist was in the writing panel BTW.

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My doctor explicitly told me that there was a chance of chronic discomfort. She described it as mild and occasional, and not worth seeking additional treatment for. She said that the odds of this happening were 1 in 2000.

So… yeah. I’ve been on an anger-fueled research bender for more than 2 years now, starting with my medium post https://medium.com/@agent_scruples/vasectomy-pamphlet-analysis-21a52932b0cf

This is the other line that really jumped off the page for me in the topic article here:

problems relating to vasectomy are the main cause of claims against GPs for medical negligence related to minor surgery.

They know. It isn’t written down a lot of places, but they have to know that if you are a GP facing a lawsuit for a minor surgery, it’s probably for a vasectomy that you did. I realize that most of these are probably for unwanted babies, but I’d like to know the ratio.

Meanwhile, the Cleveland clinic statement is still up:

A very small percentage of men (approximately 1 in 1,000,000) might develop post-vasectomy pain syndrome, which means pain that lasts past three months. Some of these men decide to have the vasectomy reversed. (Link)

Ok, so “some” of the 50 men who developed PVPS in the last 50 years have sought a reversal. So that’s, what, like 25 men who have ever had a reversal for PVPS.

Those 50 guys must be very, very busy serving lawsuits.

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Maybe off topic, but does anyone have an overview how many law suits were attempted, in the US, in the UK, elsewhere? And are there only negative outcomes?
I am contemplating filing a complaint at the national health care provider in my country.

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If you’re feeling sleepy after lunch and need another dose of pissed off, check out the chart I just posted:

Based on that meta-analysis, PVPS is 100 times more likely than my urologist told me. So much for informed consent. :roll_eyes:

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The OP study is an excellent dig Ethan. I have never seen that one before. I’d give you ten likes if I could, lol.

Well done :star:

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I am considering giving a one star review to the urologist who performed my vasectomy on ratemyMD - purely for the uninformed consent. Like many or all of you I was told complications were ‘one in a thousand’ and that if there were any that they could be easily addressed. Also that I was unlikely to suffer negative outcomes, as I had a ‘positive outlook on life’.

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I’m imagining that exchange with the urologist…

Urologist: You are unlikely to suffer negative outcomes as you have a very positive outlook on life. I’ve dealt with a lot of these PVPS guys now, and I’ve noticed that most of them are what I would call “bitter and pessimistic” types.

Regrets2: Ohh

Urologist: So I think you don’t have anything to worry about.

Regrets2: Well that’s a relief!

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So spot on its scary.

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Oh sh@#$&-t!!! More angry than ever.

I was far more optimistic before I had constant stabbing pain in my left nut…go figure.

I have seen this thought process come up on here many times and I wonder if it actually holds any merit.

Do men and women in the UK really get the official 10% statistics in all of their pre vasectomy consultations? Is it mandatory? Or is it like the US, Canada, and elsewhere where the powers that be do not require vasectomists to give people an official warning beforehand? I am going to guess the latter, but IDK for sure. How many people would actually be wary enough to go to the NHS, AUA, CUA, etc, website to get the official statistics beforehand? I’m going to guess hardly anyone.

Might want to look into the current birth rate statistics in the UK as well. That could be the driving factor as to why vasectomies are supposedly “down”, and/or it could be part of why the NHS (UK) is more outspoken about pvp/s - siting the highest official statistics.

Just some thoughts.