Post Vasectomy Pain Forum

Misinformation from medical authorities

Today i visited a uro dr. in a high class private hospital. We discussed about orchiectomy. İ asked about the pain in the lefty ball. He said " its nerves are different and no pain is possible". İ said “it started to enlarge and it creates pain”. He said it does not enlarge…wow…
İf i do a quick search it is not the case…the remaning started to enlarge and its outer envelope May create pain.
Also he said during ejaculation no pain is possible in spermatic cord…
So he is a uro dr and i am not. But he doesnt know results of orchiectomy.

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Wow that’s some tough resistance. Looks like he is either not listening to you or thinks you are on drugs or something. This is crazy!!

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I am still completely blown away by the OP article and by the one I posted. The more I think about it the more upset I get about it. It’s not the one in one million pvps statistic that really gets me - it’s all of it.

There are way to many memes and inaccurate statements in both articles - especially in the OP. Perhaps some idiot that has an agenda wrote both articles, but the one I posted has quotes from a supposed leading authority within the CC.

Quote-

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

What a misleading and disturbing statement. I can only hope his words were twisted out of context, or a good portion of his statement was ommited prior to publishing the article I posted. Such statements simply do not allign with the data within the Wikipedia article below.

A couple of relevant contradictory studies in regard to the statements in the OP (thank you OP where relevant).

No change in semen volume?

We have contradictory data at our fingertips that suggest 10% less semen volume post vasectomy.

More data with relevant contradictory findings below…

I could go on and on picking the CC’s literature and statements apart with fact based data, but I simply don’t have the time at the moment.

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Looks like they have removed the offending text from the webpage.

The text now reads:

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.

So I’m not actually sure that this is an improvement, now that I think about it. We’ve gone from having a reference to “post-vasectomy pain syndrome” with an incorrect incidence (1: 1,000,000) to deleting any mention of PVPS and telling readers that “It is not clear whether vasectomy increases this risk of testicular pain.” So they have left it by saying that the incidence could be (0:1,000,000) for all they know.

I’ll give them the benefit of the doubt here and assume that they just took down the false statement while they are figuring out what to say instead. Meanwhile, here some suggested text:

Pain: Any procedure can affect nerves and there can be residual pain. The testicles are sensitive organs, so pain can occur in men whether they have had vasectomy or not. Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. (From AUA)

Of if they want to do even better, they could say:

Pain: Any procedure can affect nerves and there can be residual pain. The testicles are sensitive organs, so pain can occur in men whether they have had vasectomy or not. Post-vasectomy scrotal pain syndrome is a scrotal pain syndrome that follows vasectomy. Post-vasectomy scrotal pain syndrome is often associated with negative cognitive, behavioural, sexual or emotional consequences, as well as with symptoms suggestive of lower urinary tract and sexual dysfunction. Post-vasectomy pain may be as frequent as 1% following vasectomy, possibly more frequent. The mechanisms are poorly understood and for that reason it is considered a special form of scrotal pain syndrome. (From EAU)

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That’s a whole lot more accurate than the majority of the leading medical institutions and solo practitioners worldwide would want anyone to know about beforehand. Disclosing all that would be bad for business, bad for the agenda, etc.

The outcomes of related studies, validated data, and so on, have been known about for decades, yet vasectomies are still being perpetuated with unicorns, rainbows, pictures of smiling happy couples, misleading statements, manipulative factoids, and so on.

IMO, it’s definitely not an improvement. How can one of the leading medical institutions in the US be having so much trouble deciding (correcting) what is going to be disclosed as “truth” on their website? I can only imagine what people are being told in person at their pre vas consultations at the CC. What’s so hard about simply siting the AUA’s definition of pvps and their statistics? Do they disagree with the AUA’s definition, statistics, and guidelines? FFS, what’s the problem here?

After that, you have to ask yourself, why do the accepted pvps statistics in the UK, Canada, the US, and elsewhere vary so much? How is that even possible? Do these countries medical analytical systems vary that widely? I doubt it. I’d guess there is some other sleight of the hand going on within such discrepancies.

For the time being, that’s all we can do. I don’t expect much to change myself. Whatever they are going to do, it will likely align with other leading medical institutions in the US such as the Mayo clinic, and so on.

Here is the relevant section from UpToDate:

Post-vasectomy pain syndrome — Post-vasectomy pain syndrome is distinct from postprocedure pain; however, there is some controversy regarding its definition and therefore prevalence 54. Historically, rates for post-vasectomy pain syndrome have been reported as very low (<1 percent). However, surveys have found that the incidence of “troublesome” post-vasectomy pain is reported by approximately 15 percent of men, with pain severe enough to impact quality of life in 2 percent; survey respondents, however, may not have been representative of all post-vasectomy men. 55,56,57,58

You can see that here, too, they seem to be having clarity problems, to put it generously. Or alternatively, granting the minimum credence in PVPS that they can get away with without printing things that are demonstrably false. I think it was Victor that got them to revise their numbers in 2013

But what is this?

Historically, rates for post-vasectomy pain syndrome have been reported as very low (<1 percent).

Reported by whom? Reported based on what? What studies are these reports anchored to? Why is UpToDate citing what amounts to nothing more than a rumor here as interesting or relevant? Or if this is UpToDate correcting the record, again thanks to Victor why don’t they state that plainly?

Historically, rates for post-vasectomy pain syndrome have been erroneously reported as very low (<1 percent), a number which cannot be found in any reputable studies of the incidence of PVPS.

Instead, they dignify the false rumor and anchor to it as the venerable traditional wisdom, rather than as the proven bullshit that mainly provides evidence that urologists trusting their recollection of how many men phoned back and said their balls still hurt years later and they hold the urologist personally responsible cannot be relied upon to deliver accurate incidence statistics.

Then they take a half-hearted stab at answering the question before basically throwing their hands up like Clevland Clinic and saying “But we haven’t really bothered doing the science properly so who knows? Can we stop talking about this yet?”

survey respondents, however, may not have been representative of all post-vasectomy men

Well golly guys, I guess science is too hard to do and we just can’t know anything then. Especially when we don’t want to know.

Meanwhile, Austin Auyeung at Royal College of Surgeons in Ireland is showing UpToDate how science is done and coming up with an incidence of 5%

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More like, especially when we don’t want you to know. They definitely know.

There are to many politics within modern medicine, including vasectomies, and the majority of people in this world seem completely unaware of any of it. There isn’t anything random or accidental about any of this political vasectomy stuff.

Campbell and Walsh, UpToDate, Wikipedia, this entity, that entity, the other entity, and so on. What a mess. Please get it together people.

Don’t forget that it’s far more profitable to treat pain patients indefinitely rather than telling them about the cure. The most inexpensive cure for vasectomy related complications is not having a vasectomy in the first place. Countless entities profit directly and indirectly from vasectomy pain, pvps, side effects, psychological, and so on.

I am completely up to speed with Victor’s contributions many years ago, but I am not sure how it really effected things in the big picture. I know what was supposed to take place, but did it? Have the textbooks really changed? Did it have a positive effect regarding awareness? Did it have a positive effect on society? I’m going to guess it amounted to a stalemate within the big picture, but IDK for sure.

Others have reached out to entities such as UpToDate and tauted some sort of victory afterwards. I’m still waiting.

The AUA’s guidelines on vasectomy are weak and their last update was in 2015. They aren’t in a hurry to do anything.

https://www.auanet.org/guidelines/vasectomy-guideline

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I know, I’m hemorrhaging money cause of this.

Here’s another medical authority that is shy about bringing up the whole “chronic daily scrotal pain” topic:

Complications of vasectomy include

  • Hematoma (≤ 5%)

  • Sperm granulomas (inflammatory responses to sperm leakage)

  • Spontaneous reanastomosis, which usually occurs shortly after the procedure

https://www.merckmanuals.com/en-pr/professional/gynecology-and-obstetrics/family-planning/permanent-contraception

This is from the Merck Manual.

Note that PVPS occurs at least as often as hematoma. Both are called out in the AUA guidelines as items that should be communicated to men considering a vasectomy. One made the list, one didn’t. What is the difference between hematoma and PVPS that can account for how they are treated differently here? :thinking:

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