Post Vasectomy Pain Forum

My Story After 6 Months - Still Improving

Today is the six month anniversary of my vasectomy and I figured it was about time I write something up about my experience to add to the incredible amount of data on this forum. Hopefully this will help someone.

Had a scalpel vasectomy on 3/29/2019 at Mass General Hospital in Boston. I needed to get extra shots of lidocaine on both sides as I could feel the incisions being made - but that was handled quickly and I really didn’t think much of it. Surgery seemed fine after that.

Recovery for the first 9 days after surgery seemed fairly normal and I was feeling good. All of that changed after ejaculating on the 9th day. For the next few days, I felt increasing discomfort in my scrotum, to the point where I went back to the urologist that performed the vasectomy. Urologist shrugged it off after a physical examination lasting a few seconds and told me to take Motrin. Pain actually subsided a little, but then a few days later I developed a surface infection at the left incision site. Took Keflex for a week and that cleared it up.

For the next month and a half (0.5 to 2 months after vas), I would have periods of increased pain lasting a couple days at a time. It would feel like tremendous pressure/aching pain in my testicle/epididymis. After a couple days it would calm down but I still wouldn’t feel normal as there was this almost constant tension-like feeling and I wasn’t able to relax. Over this time, my anxiety really spiked. There were some really scary moments. I didn’t know what was happening to me and my urologist was no help. Other than this forum, there was also seemingly nothing out there that could help me understand what I was feeling. But with the help of this forum, I got to the point where I knew I had to get my anxiety in check - which I’ll talk about more later below.

After 2 months, things started to change. The pressure/aching pain in the testicles/epididymis that I had been getting four a couple days at a time went away. That was a huge relief, but the constant tension-like feeling was still there and I started developing nerve pain. A mild-burning sensation around the scrotum, electric shock (zingers) randomly throughout the pelvic region, legs/feet, abdomen. Sounds bad, but this was actually more tolerable than the testicle pain. And I would have some days where it really wasn’t that bad at all. One weekend when I was feeling well I decided to go for a run (first time since surgery) - only a couple miles at a slow pace. I actually felt fine during the run but the next day the nerve pain really kicked up again - with the zingers happening more frequently for the next couple weeks before dying down again.

Over the past few months, I’ve seen slow and gradual improvements. Certainly not linear, there are ups and downs, but I can confidently say I am in a much better place today than I was 3-4 months ago. I’m still left with what I believe to be nerve issues - mainly a burning/stinging feeling around the sit bones, perineum, and scrotum, particularly when sitting on a hard surface. I still get occasional zingers if I do something that makes the nerves unhappy. But I’m still working on things and seeing improvements.

So what have I done?

Two months post-vasectomy I started a few things:

  1. Diet - Started eating more fruits and vegetables, less saturated fat and processed foods - basically a Mediterranean Diet. And made sure I didn’t over eat. This helped a lot and very quickly. I’m 5’11 and I went from 175 pounds to 150 pounds in a month. My digestion improved and I felt like I had more energy. And I think this must have helped reduced inflammation.

  2. Anxiety - started working to get my anxiety in check. This started by going to the Benson Henry Mind Body Institute - which is connected to Mass General Hospital. The founder, Herbert Benson, is known for coining the term “Relaxation Response” and was sort of a pioneer in trying to understand the mind-body connection and the harmful effects of stress. I’ve been going to regular appointments here, where we work on meditation and other strategies for trying to deal with stress better and trigger the “Relaxation Response” so that the body can heal. I’ve found it helpful to work one-on-one with someone, but these are things that anyone can do on there own. Benson’s book from the '70s, The Relaxation Response, is an easy read and a good place to start. Some of the meditation apps like Calm, also cover a lot of the same themes. It takes time and hard work, but I feel that it has helped me immensely.

I’m also starting to explore cognitive behavioral therapy and imagine that I will start seeing a therapist at some point in the future. This whole experience has had a profound impact on me, and while I’m definitely dealing with stress and anxiety better than I used to, it is something that I need to continue to work on, not only for dealing with the post-vasectomy pain, but also for the general stressors of life - i.e. work, family, etc. While my pain really isn’t that bad anymore, I still feel it every day to some extent, and it occupies my thoughts far too much even when I don’t feel anything. I believe this will get better with time, particularly if I continue to see improvements with the pain, but I’m thinking therapy could be beneficial for me as well.

I also went on an anti-depressant about 3 months ago. I’m taking 10mg of Lexapro a day. I believe this has helped as well and luckily I haven’t felt any side effects. I’m planning to stay on this for the rest of the year, as I don’t want to risk coming off just yet, but I’m hoping that in other 3 months the pain will be even better (gone?) and everything else I’ve been working on will allow me to come off of it. I’m not a big medication person and I was resistant to going on it, but right now, I feel it was the right decision for me.

  1. Heat - I’ve been taking hot baths almost every night for the past 4 months. I feel that this helps loosen things up and improves blood flow to the pelvic area. It’s also a calming experience and fits in with all the other things I’m doing to deal with anxiety. The past few weeks I’ve also started sitting on a heating pad. Not sure why I didn’t think to try this sooner, but I think it is helping - particularly in the 1-2 days after pelvic floor physical therapy.

  2. Pelvic Floor Physical Therapy - I’ve gone to six sessions so far and will definitely be continuing. It’s really the first person in a medical field that I’ve seen/talked to that has any understanding of what I’ve been going through. That alone is beneficial to me. But I’ve learned a lot through this so far and right now feel like this is the best means for me to get back to normal - perhaps with some complimentary work. My PFPT thinks that the pudendal nerve is likely the may cause of my issues. The tissues around the nerve are restricted and I have difficulty relaxing my pelvic floor. My understanding is that this could be causing the pudendal nerve to fire and also that it is restricting blood flow to the area causing the nerves to remain unhappy. Therapy sessions include both external and internal work, some of which is rather unpleasant, but I do feel like it is helping me to relax so that I don’t feel so tense in the pelvic area. The first few times I went, I actually had increased pain for a couple of days after, likely the work fired up the nerves, but then it would subside. I haven’t experienced this the past few weeks as I’ve started using the heating pad after sessions and I’m generally feeling better and better. But it is another thing that makes me realize just how integral stress and anxiety are in this whole process. I’m now able to feel that my entire pelvic area tightens up when I’m stressed and I’m working on consciously trying to relax it and drop my pelvic floor. I should also note that I have been doing pelvic floor stretches (mentioned elsewhere on this forum) to relax the area regularly for the last 4-5 months. Even early on this provided me with some short term relief. Probably should have started pelvic floor physical therapy even sooner, but my urologist, a second urologist, and my PCP all told me that it is primarily for women and that it probably wouldn’t do anything for me - yet another thing that fueled my anxiety and anger around this issue.

  3. Exercise - I’m not able to do intense exercise still, but fairly early on I started making sure I was going on regular walks and getting at least 10,000 steps a day. Perhaps I’ll try a run again sometime soon, but I’ve been reluctant to try it again after the experience I mentioned earlier.

Yoga has been very helpful. I started off mainly going to yin yoga and restorative yoga classes - fairly gentle stuff where poses are held for long periods of time. This has been good for stretching as well as with meditation. I’ve also recently started going to some basic/gentle vinyasa classes. These are more of a workout and I’m thinking of slowly working these vinyasa classes into my routine more, as I really want to find some things to get my heart rate up again and work on strength.

  1. Supplements - I’m currently taking Omega 3 Fish Oil (high in EPA), Nerve Shield, and Zyflamend. Hard to say if these are doing anything, but they are low risk and as long as I feel like I’m still feeling improvements I will likely continue taking them. I did try Papaya Seed Powder for awhile just to see if it would do anything. At times I do feel like my epis (particularly on the right) are really large, but I can’t say that I’ve really had much of the congestion like pain that people talk about on here. The papaya seed powder didn’t seem do anything for me, so I’m off of it now.

  2. Underwear - I spent way to much time thinking about what underwear to wear. I tried UFM and UA boxerjocks which are both talked about on here and did feel like they were better than what I had been doing before - regular boxer briefs - but they started to give me problems over time and I went back to regular boxer briefs. Then about a month and a half ago I tried briefs and have switched to those exclusively. Not sure why it took me so long to try briefs, but I’m glad I did.

I think that covers most of what I’ve done the past six months. I’m not back to normal, but my pain is very minimal. It is still bothersome, however, because I can’t say that I’ve had a full day of not feeling anything. But it does seem to be getting weaker and weaker and I’m noticing more moments of not feeling anything. I plan to continue doing pelvic floor physical therapy and I may end up getting a pudendal nerve block at some point. My PFPT has talked to me about trying that along with seeing another urologist that knows something about pelvic pain. I’ve been reluctant to see a new urologist because the two that I have seen were worse than useless - they probably caused me to become more anxious and it seems nearly impossible to find one that admits to having any experience with this. I haven’t been to pain management yet, but I’m probably a little more willing to try that now for the nerve block since it’s clearer to me than ever before that the pudendal nerve has got to be the source of some, if not all, of my problems. I just don’t want to do anything that makes this worse since the pain isn’t that bad and I feel like I’m still seeing improvements.

Sorry for the long post - but I hope this helps someone like a lot of what I have read on here from others has helped me. And if I can answer any questions to help others, I’m happy to do so.

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Today marks seven months since my vas so I figured I would provide an update. Will try to do this on a monthly basis to help me keep track of things and provide more data to this community.

First off, I still feel like I’m improving. It is slow and I definitely have some down days where I question that, but overall looking back at the last month I believe it was a better month than the previous month. I’m fortunate in that my pain isn’t all that bad. This makes the improvements difficult to measure, but it certainly seems to me that I’m experiencing more and more periods of no pain.

Sitting for long periods of time or on hard surfaces as well as stress, still seem to be the two biggest triggers for me. I’m doing more and more to modify my behavior to try to prevent myself from even beginning to experience the pain, with the hope being that I can stop that pain feedback loop.

I also saw a new urologist last week that has a lot of experience with pelvic pain. First urologist that I’ve seen that actually seemed like they had some level of intellectual curiosity in my condition and showed interest in helping. She has referred me to a pain management doctor that also has a lot of experience with pelvic pain and I have an appointment with her in December. She has also referred me to a neurologist - although the earliest I could get in with him was next July. And along with that I’m having some tests done - an autonomic (tilt-table) test in January and a skin biopsy in February. Theses tests are related to potentially diagnosing small fiber neuropathy (SFPN).

I’m still thinking that my main issue is that I angered the pudendal nerve in the initial months after the vasectomy for a host of different reasons (i.e. pain, inflamation, stress & anxiety, pre-existing musculoskeletal issues, etc.) and it is just taking a long time for it to calm down - or at least that is my hope. But there are times where I’m questioning where I’m also feeling some pain in the cord-area that might not be the pudendal nerve - it is very difficult to pinpoint as I typically only feel that when walking around and definitely not all the time either - but it could just be the parts of the scrotum innervated by the pudendal nerve.

But the zingers that I sometime get through the legs or into my abdomen are a little more of a wildcard and seemed to cause the urologist a bit more of a concern. For example, a few weeks ago I was at my son’s curriculum night at school and sat in a tiny wood chair meant for a 4 year for about an hour. I knew it would give me problems, but stupidly did it anyway, and I was experiencing zinging electric shock pains throughout my right leg for the next ~18 hours (anywhere from a 3-4 a minute to a couple an hour). It died down after that, but I think these zinging pains that I can sometimes get are why the urologist thought it might be good for me to see a neurologist, as those are obviously not the pudendal nerve.

Would be curious if anyone has any experiences with the tests I mentioned above. At seven months post-vas now, I’m willing to explore these options (i.e. pain management, neurology), but since the pain isn’t that bad I still want to be relatively cautious as I don’t want to make it worse. And if I still feel like I’m improving each month, then I’m happy.

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Today marks 8 months since my vas so I’m checking in for another update. I think the pudendal nerve issues I’ve been dealing with have continued to improve. The pelvic floor physical therapy, stretching, heat, meditation and most everything else I talked about above now have me at a point where I feel that I can fairly consistently relax the pelvic floor.

I did develop a hemorrhoid almost a month ago that I was dealing with for a couple of weeks. Had never had one of these before - yet another new fun experience. Luckily it wasn’t too bad and in someways it may have even helped me focus more deeply on relaxing the pelvic floor so that I wouldn’t make that worse. But because of that, I feel that my pelvic floor is in the best shape it has been in post-vas.

The pudendal nerve pain has also improved. I even had to fly from Boston to LA and back a couple weeks ago and made it through the flights without too much trouble. I’m using seat cushions wherever I can (brought one with me for the flights) and it is helping. I hardly ever getting pain around the sit bones anymore and not even getting much in the perineum. The scrotum is the one area where I’ve got sustained issues. In fact, now that the pudendal nerve pain has subsided as much as it has, I’m really starting to wonder if some of my issues are related to nerves along the spermatic cord.

It does seem like there is a lot of hard stuff inside my scrotum. This includes hard small spherical structures around where I believe the vas was cut (maybe the clips or granulomas?) and then really hard tubes traveling down from there to the testicles (presumably the spermatic cord or vas). The area where the vas connects to the epis seems enlarged - as do the epis at times. And I’ve actually felt that aching “kicked in the balls” type feeling a few times in the past few days. It hasn’t been much, but I haven’t really felt that since the first couple of months post-vas so it is a bit scary. At this point, it’s only been when my PT was working on it with direct pressure or if I make a wrong movement that puts pressure on the area, but it is something that I will definitely be monitoring. I haven’t been as good with my diet lately, so maybe it’s just inflammation pick up again, who knows.

In summary, it’s been a bit of a mixed bag this month. But I’m generally still feeling good about my prospects even if it is such a slow recovery. I’m really happy about how the pudendal nerve issues seem to be improving. Yes, it doesn’t seem like the pudendal nerve is my only issue, but I’m really just now at the beginning of trying to figure out what those other issues are exactly. Hopefully with time, I can figure out how to get improvements in these other areas too.

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Thank you for your reports, bos80!

Two days ago marked nine months since my vasectomy. I’m feeling fairly confident that the last month has brought continued improvements. As I’ve said before, my pain levels have been generally fairly low which can make it difficult to measure improvements, but I feel that I have been pain free an increasing percentage of the time. In fact, the past two weeks or so have been notably good. This could be tied to a generally slower schedule over the holidays, meaning less stress and greater relaxation.

I had an appointment with a pain management doc on Dec. 19th who has expertise with pelvic pain. We talked about a number of different options. She wrote scripts for a lidocaine ointment that I can rub onto the scrotum/perineum or any area where there is pain as well as baclofen which I can take as a suppository. I’ve tried the lidocaine ointment a few times, but not sure it’s really doing much. I haven’t started the baclofen yet, but will considering doing so in the new year. The improvement I’ve been seeing lately might have me hold off on taking it until a point in time where I have an uptick in pain. But those upticks in pain are always connected with feeling tense in the pelvic area, so in theory it makes sense to me that a muscle relaxer like baclofen could help.

We also talked about a pudendal nerve block. She seemed on the fence as to whether or not one truly made sense for me given my generally low level of pain. I mentioned that I’d seen stories of these nerves blocks helping a lot for some people, while in others they’ve been complete disasters - perhaps making it worse. Her feeling was that the complete disasters are most likely due to relatively inexperienced practitioners administering the blocks. She apparently does a lot of pudendal nerve blocks - had done 6 already that day by the time I saw her at 2pm - so seemed confident that I wouldn’t have a truly awful experience. Yet at the same time, she said that a flare will happen 30-50% of the time that could last about a week. Hard for me to reconcile that in my head. Will continue to give this thought, but since I’m seeing continued improvements, particularly in the areas that would seem to be tied to the pudendal nerve, I feel like a pudendal nerve block is not a high priority for me right now. But she put in the order for one, so I can schedule it at anytime if I choose to do so.

She also referred me to a pain psychologist that I will see in February, which I think will be good given the psychological impact this whole experience has had on me.

In the next month, I hope to get my diet back on track and hopefully work in some more aerobic exercise. I’m generally feeling fairly positive about things, although I think it’s likely that I will be dealing with this stuff for awhile longer given my pace of recovery. But as long as I’m moving in the right direction, I’m happy. And given my low level of pain, I still think dealing with this relatively conservatively makes the most sense for the time being.

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I did 3 months of cognitive behavioral therapy January-March last year. I found it really helpful for stress.

@NorthernFellow CBT is actually on my list of things to do. I’m in the process of trying to find a regular therapist that I can go to - not the easiest thing in my area as most don’t have any availability for new patients. But I have been doing an online CBT program set up through my PCP’s office and the work that I was going with the Benson-Henry Institute has some overlap. Overall, I’m dealing with stress and anxiety so much better than I did in the first few months, but I think there is still more work to do.

I feel like my stress level is like a “volume” control on my whole nervous system. If I’m feeling stress from anything - could be work or watching a sporting event - my whole nervous system feels like it gets hyper active and any discomfort or unnatural feeling gets amplified. When I calm down I can generally get back to feeling pain free.