Post Vasectomy Pain Forum

Misinformation from medical authorities

I post reviews of public statements about vasectomy over at www.reddit.com/r/postvasectomy

Today I saw an update to the Cleveland Clinic article that got my attention, and I wanted to quote sections of it here:

What are the risks of a vasectomy?
Complications such as inflammation (swelling), bleeding, or infection may occur, but they are relatively uncommon and not serious. Minor risks include:

  • Pain: Any procedure can affect nerves and, rarely, there can be residual pain. The testicles are sensitive organs, so pain can occur in men whether they have had vasectomy or not. It is not clear whether vasectomy increases this risk of testicular pain. 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.
  • Sperm granuloma: A hard, sometimes painful lump about the size of a pea may form as a result of sperm leaking from the cut vas deferens. The lump is not dangerous and is almost always absorbed by the body. Scrotal support and mild pain relievers (like Acetaminophen) can help relieve symptoms.
  • Congestion (in the scrotum): A sense of pressure caused by sperm in the testes, epididymis (the structure that stores sperm), and lower vas deferens may cause discomfort for 2 to 12 weeks after a vasectomy. Like a granuloma, congestion usually resolves itself over time.

The risks of vasectomy must be weighed against other options, including the chance of another pregnancy if you do not have the vasectomy.

Will I have any unwanted “side effects” after a vasectomy?
This usually means:

  • Will I produce less testosterone?
  • Will I still want to have sex?
  • Will I produce (and ejaculate) less semen?
  • Will my semen be different?
  • Will my partner be able to tell the difference after a vasectomy?

Basically, the answer to these questions is no! Vasectomy does not affect testosterone production or release. (Testosterone is the male hormone that is responsible for a man’s sex drive, facial hair, deep voice and other masculine traits.)

Vasectomy does not affect sexuality in a negative way. Erections, climaxes, and the amount of ejaculate remain the same. The only difference is that your semen will no longer contain sperm. Often, men who have had the procedure find that sex with their partners is more spontaneous and enjoyable because they no longer have to worry about pregnancy or interrupting things to apply contraception.

Last reviewed by a Cleveland Clinic medical professional on 03/04/2020.

https://my.clevelandclinic.org/health/treatments/4423-vasectomy-sterilization/risks--benefits

So the real howler that I saw here was this one:

The testicles are sensitive organs, so pain can occur in men whether they have had vasectomy or not. It is not clear whether vasectomy increases this risk of testicular pain. 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.

This struck me as an absolutely infuriating betrayal. First of all about 50 million men have gotten a vasectomy and if only 1 in a million get PVPS, that means that there are only 50 men who have ever gotten PVPS.

Fifty men.

There are at least a thousand guys who have created accounts on just this website. I have a spreadsheet with about 6,000 links to content online with guys describing long term post vasectomy pain. Just as an amateur, doing this in my spare time as a sick hobby, I have read and coded the stories of more than 700 individual men. I can point to specific stories online of men who had PVPS and sought surgery to remedy it, including:

  • 127 who got a reversal
  • 20 who got an epididymectomy
  • 13 who got denervation
  • 13 who got orchiectomy

That’s 173 guys who had PVPS bad enough to go back under the knife again. And I have found others that are not in those number yet.

Here are 45 reversals just in one link

For the Cleveland Clinic to imply that this problem is 1 in a million is such a massive lie. I also notice they want to suggest that men are mis-attributing their ordinary testicular pain to their recent vasectomy, which is not the true cause. “The testicles are sensitive organs, so pain can occur in men whether they have had vasectomy or not. Hell, practically anything can make your testicles hurt. But not surgery obviously.” Well citation needed, guys. I want to see what study they are basing this frankly extremely offensive statement on, because it smells suspiciously as though they pulled it straight out of their ass. I can directly point to enough online users to bring that number down to 1 in 80,000. And what fraction of the men with PVPS do you suppose I have found? What fraction post online? In English? It would be completely reasonable to expect that for every 1 guy who posts about this publicly online, 99 did not. That will bring the number down to 1 in 800. I expect the true number to be more like 1 in 80, which would be consistent with AUA guidelines.

And don’t worry, guys:

Vasectomy does not affect sexuality in a negative way. Erections, climaxes, and the amount of ejaculate remain the same. The only difference is that your semen will no longer contain sperm.

We should all find this to be deeply unacceptable. I don’t know what doctor reviewed this statement for accuracy yesterday, but they are clearly completely unqualified for the job.

5 Likes

I have read and posted to this site another rather disturbing article that involved the Cleveland Clinic department of urology. In the article below, one of the top dogs that gets mentioned here fairly regularly is interviewed about how many men in the US get a reversal at some point after vasectomy. In that article, there is no mention of pvps, pain guys, reversal for pain, etc, etc.

Whatever is going on in that article, some things seem to have been intentionally left out by someone who is definitely in the know about such things :roll_eyes:

I don’t believe his “rough” statistics either. I’ve seen otherwise in the past, and it was considerably more than that.

1 Like

The ending of that article gives you a little hint:

“Uh … no,” he said with a laugh as his wife listened a few feet away. “No, I will not do another vasectomy.”

This answer just begs for the follow-up question: Why?

Why is this man, who previously thought that getting a vasectomy was a good way to prevent unwanted pregnancy, now saying that he wouldn’t do it again?

1 Like

I’m lost for words. This article makes me in equal measures angry and upset.

2 Likes

Disappointing and a bit surprising but, then again, maybe I shouldn’t be surprised.

Ironically, Dr. Sabanegh (former fertility section leader) is now President of the entire Main Campus, basically one of the top ranked guys in the state’s largest, non-government employer.

I don’t think the article featuring him is concerning. The article’s purpose was to highlight men having reversals to have children, so raising the pain issue could be considered off-topic. And, perhaps he did mention it, but the author (from that “great” news source, MSNBC, may have edit that out, we don’t know).

The article cited by Ethan is highly concerning. I’m going to try to find time to send letters to Drs. Sabanegh, Shoskes, and even Parekatill (who did his fellowship there) to get them to be more “fair and balanced.” I will cite Sabanegh’s predecessor, Dr. Thomas, who told me he had been treating two new pain patients every month for many, many years. I will also remind them of some of the comments my Pain Mgt. doc at the Cleveland Clinic made.

Maybe @mklamut79 and @Cartman will join me in a pressure campaign.

I firmly believe members here are the tip of the iceberg. I think most men with PVPS don’t end up finding us but are stuck in the medical quagmire.

What’s interesting here is that, all in all, I’m a fan of the CC guys. Thomas was phenomenal. Sabanegh was great with me, very professional and compassionate. Saw him 3-4 times and recovered without needing anything more than meds from him. Shoskes isn’t the warmest guy compared to the other two. I think he’s just a bright, introvert. I do think he’s competent. Pain Mgt. there is pretty darn good, especially at main campus. All totaled, they’ve helped me whereas the local yocals at Southwest Urology (attached to Cleveland’s University Hospital #2 system) kicked me to the curb once I showed up with pain.

1 Like

I’m been radio silent for awhile here but this popped up and made me wonder what was going on.
Sad to see the same bullshit is still being slung around.

What do we do? I have no idea. I would love for things to change but unless someone has a shit ton of money to start a campaign or unless someone famous comes forward things won’t change.

1 Like

Nope, we don’t know, and people that read that article certainly didn’t learn about a lot of things. The vast majority of the readers of that article are likely as ignorant as we were. Their take on the article is likely - reversal is all about making baby’s :heart:

Nope, sorry, reversal is not all about making baby’s, being a dad again, etc. There’s certainly way more reasons as to why men seek reversal than being a dad again :roll_eyes:

I read articles like the one I posted, and I’m like, what’s the point of such a titled article, let alone siting statistics, if you don’t cover the majority of reasons why men have reversals, the rationale, etc? I thought the article fell way short myself.

I commented on the quote below a while back, and still think it’s misleading. The statement comes from a top dog. Certainly it must be 100% truth right?

Over time, too much pressure in a purposely plugged epididymis can cause a rupture, forming a secondary — albeit non-painful — blockage, Sabanegh.

What about this one? I suppose it’s a matter of opinion, but I was like, I can certainly think of other non related very sad stories.

Some lost children to illness or accidents — “truly, the saddest stories,” Sabanegh said.

Yeah, this one… He never elaborated, or that part got left out too :roll_eyes:

But after that, will Perk undergo a second snip job?

“Uh … no,” he said with a laugh as his wife listened a few feet away. “No, I will not do another vasectomy.”

Whatever the case, I found Ethan’s article far more disturbing. The two articles are not even comparable. But, unfortunately, both articles involve the Cleveland Clinic.

1 in 1,000,000… Lol!

1 Like

Note the definition of PVPS provided here. “pain that lasts past three months.” So only 50 guys in the history of vasectomy have had pain lasting more than 3 months. And only “some of these men” went and got a reversal. So how many is that? Like a dozen guys have ever gotten a reversal due to PVPS?

I mean, come on. This is really, really bad communication to be coming out of the Cleveland Clinic. Real numbers for pain at 3 months is probably like 10%, which is around 400,000 men every year.

According to the Cleveland Clinic article in the OP, statistically ~1 man gets pvps in the US every ~2 years :slightly_smiling_face:

2 Likes

Just sent this off to Dr. Shoskes at the Cleveland Clinic. Hope others join me. @mklamut79, with your more recent connections to Sabanegh, I think we need to get access to him. He’s got to know that the 1/1MM number is BS. I’ve been impressed with Sabanegh and think he’d have the website edited if he’s made aware of the error.

Dear Dr. Shoskes and Team - It’s been a while since I last saw Dr. Shoskes, and I wanted to report that my scrotal pain finally went away a little over a year ago following nerve blocks and the amitryptline prescribed by Dr. Shoskes. This was my 3rd and most stubborn bout with post-vasectomy pain since 2005, and I’m SO grateful for the great, inter-disciplinary care provided by the Cleveland Clinic each time. From Dr. Thomas in 2005-06 to Dr. Sabanegh in 2008-09, and Drs. Shoskes and Grimm 2016-2018, I’ve had great caregivers.

The other reason I’m writing is that I’m concerned about a publication on the Cleveland Clinic website and wondered if Dr. Shoskes’ office could point me to the proper channels to discuss. The website cites that approximately 1 in 1,000,000 men develop post-vasectomy pain syndrome. Based on my treatment and anecdotal discussions with Glickman professionals, I believe that number is being understated. Further, my review of various medical publications over the past 20 years cite measured statistics in the 1-2/100 to 6-15/100 range, much higher than 1/1MM.

I’m hoping your office can point me to the source at the Cleveland Clinic to speak with on behalf of the thousands of members of postvasectomypain.org to offer statistically-based proof that the Cleveland Clinic’s website is understating the risks of vasectomy.

Thanks for any direction you can provide and, more importantly, thanks for helping me personally in my battle with PVP.

Scott Holter

2 Likes

It would be great to see the CC correct the 1 in one million statistic, but in all honesty, I found a slew of things about the OP article to be complete brainwashing nonsense.

Agreed, but it’s easier to fight data with data.

1 Like

You’re right, and even if every one of them showed up on this forum, we’d only see one new American member every 2 years, but just watching this forum, I’d guess it’s closer to 1 every week or at least 1 every month.

1 Like

Just sent this off to the Ombudsman at the Cleveland Clinic.

Dear Ombudsman

I’m writing not to complain about services at the Cleveland Clinic but to express concern about inaccurate and misleading statistics published on the Cleveland Clinic’s website about the risks of vasectomy.

I have been treated off-and-on since 2005 at the Cleveland Clinic for Post-Vasectomy Pain. I have nothing but glowing comments to offer about the treatment by numerous physicians since then. In 2005-06, I was treated by Dr. Anthony Thomas and Dr. Negy Mehkail. After the Pain Management injections failed to provide relief, Dr. Thomas provided vasectomy reversal surgery in mid-2006, and I became pain-free within a few months.

I suffered a short relapse in 2008-09 and received the same, wonderful care from Dr. Sabanegh (who had replaced the retired Dr. Thomas). After 6 months of treatment by Dr. Sabanegh, I became pain free again which lasted until April, 2016, when the same scrotal nerves became re-sensitized and painful. Once again, after 10 years of remission, I was back at the Cleveland Clinic. This third, most stubborn bout with PVP lasted 2-1/2 years 'til late 2018, but again, the great inter-disciplinary group of Dr. Shoskes at Glickman, Dr. Grimm in Pain Management, and Dr. Krpata in general surgery were able to get my pain knocked down to virtually nothing. I am so grateful for the continued help from the Cleveland Clinic for treatment for nerves that were damaged during my 2005 vasectomy (not done at the Cleveland Clinic).

I provide this background because I am also an original member of a men’s support group called postvasectomypain.org where we provide support and referrals to thousands of men injured by vasectomy. Several members noticed that the Cleveland Clinic’s website regarding was recently updated, and it now states that “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.”

We know that statement is inaccurate, and I’d be happy to meet with personnel at the Cleveland Clinic to provide researched evidence but, candidly, I don’t think that’s necessary. The physicians I’ve seen at the Cleveland Clinic have all told me directly or, at least anecdotally hinted, that the numbers of men with PVP are far greater than 1 in 1,000,000. Dr. Thomas, for example, specifically told me in 2005-06 that he was seeing 2 new PVP patients PER MONTH, or ~24 per year. If he saw every PVP patient in the US, where 500,000 vasectomies are performed per year, the risk would be 24/500,000 or 1/20,000, and that absurdly assumes no other doctor in the US was treating PVP patients. If just 20 doctors were treating the same number of PVP patients, we could easily estimate the risks at 1/1,000.

While that’s just anecdotal evidence, Dr. Sabanegh himself was co-author of a study that affirms that balpark estimate of 1/1,000 men developing post-vasectomy pain. He’s a link to Dr. Sabanegh’s co-authored research. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2008.07602.x.

I don’t want to speak for Drs. Mekhail, Grimm, or Shoskes, but based on their treatment of me and my discussions with them, I think they’d also agree that the risks of men developing post-vasectomy pain are more like 1-2/100 or 1-2/1,000 and far more than 1/1,000,000.

Lastly, a very recent 2016 study revealed that the incidence of PVP could be as high as 6-15%! Note this line from the publication: The exact incidence of PVPS is unknown but was estimated to be very low (<1%) in the past.4,5,6,7 However surveys in recent years have found that almost 15% of men suffer from PVPS, with 2% of men experiencing pain intense enough to impact their quality of life.8,9 One review reported that 1 in 1000 men who undergo a vasectomy will sustain long-term pain requiring surgical intervention.10. The full publication can be found here. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854072/

Yet another medically-researched publication also puts the risks well above 1/1,000,000 for the development of post-vasectomy pain. https://pdfs.semanticscholar.org/651e/15408724a1c001c1b94c213d51b85fc56f2b.pdf

Please know that I am not writing to complain about the Cleveland Clinic physicians. The pain I suffered in following my vasectomy in 2005 was so excruciating that I don’t think I’m exaggerating when I say the Cleveland Clinic, specifically Drs. Thomas and Mekhail, saved my life. My relapses of pain, albeit a bit less painful, were life-altering, and I received equally wonderful treatment of many Cleveland Clinic physicians. I will be eternally grateful to all of them.

I’m simply writing to help the Cleveland Clinic align its website with the opinions and research, in some cases research done by its own physicians, so that men have a clear and accurate understanding of the risks of vasectomy.

Sincerely,

Scott A. Holter

216-403-6735

3 Likes

Very well worded @raising4girls.

When I went into the urology office for my first urgent visit due to debilitating spasms of pain on day 35 after my original surgery, I remember the doctor telling me there was a 1 in 10,000 chance I was that one guy who would live with chronic pain for the remainder of my life. Where did he get that statistic? He said he had done 4,000 of them and no one had never not recovered. Unfortunately, I took confidence in his words and then was wracked with further spasms of pain in the months to follow until I finally had the surgery reversed 12 days ago.

I met with three different urologists from that office and spoke to one other over the phone at various stages in my journey. Two of the four gave me the same story as the first: “Don’t lose hope; Everyone gets better eventually; We’ve never not had one of our patients recover.“

The fourth never saw me in person. He reviewed my charts prior to taking my call on the weekend and told me I was a “prime candidate for a reversal.” I plan on writing him a letter one day and thanking him for getting my diagnosis right if this all pans out for me in the near future.

I’d be willing to wager my entire 401k balance those first three doctors are still telling folks who suffer pain after their vasectomies, “None of our patients have never not gotten better. Don’t lose hope.” How would they know my story ended with an $8500 bill out of pocket for a reversal surgery? They certainly never called to check in on me after I stopped calling them to complain of my terrible pain. I think they saw me as nothing more than a liability. They certainly did not get into the health care business because they are generally sympathetic people because they, other than the one fine doctor I mentioned, never empathized with me one iota.

2 Likes

I can try and reach out to him, no guarantees. but I will do my best.

mike

Bad timing…they’re a bit pre-occupied now preparing for the shitstorm on the horizon.

2 Likes

agreed, we won’t be attacking our problem anytime soon. busy here at the clinic.

1 Like

My data from doctors in the Austin area:

Dr. Kavousy: “…1-2% develop pain and complications. Considering the number of vasectomies done per year in the US this is still a lot of men”. … “…Overall 6% of men who do vasectomy want a reversal for different reasons…”

Dr. Sandeep Mistry (N Austin): “I do hundreds of vasectomies every year and get 3-4 / year who end up like you”.

These are live doctor :man_health_worker: statements to me. I don’t want to go to a court and put these guys on the spot but definitely CC has a thing or two to fix in their statements.

@Ethan_Scruples great work on your hobby. It helps clarify things to the community. Eventually this collection will be very valuable as you collect more data.

Ali

2 Likes