Post Vasectomy Pain Forum

My Story in a Nutshell


#1

Previously healthy 49 year old physician with two children. Following much pressure from spouse, had vasectomy in January 2018. Lots of discomfort during office procedure. No immediate complication post-procedure, but developed burning pain on left side of scrotum, tenderness and soreness on epididymis, and achiness deep in the left testicle that never resolved. Returned to urologist at 1 and 3 months. Unable to exercise with out pain. Could have sex, but generally hurt for about 3 days afterward. Suffered depressed moods. Told by urologist to be patient.

Relationship with wife now different to be sure. Also missed out on cycling with friends which was both a method of exercise, and a large component of my social life. Occasionally, on good days, I still go rock climbing with my kid- but tend to pay for it afterward.

Tried gabapentin, which definitely cut down the pain quite a bit, but could not tolerate due to fogginess and cognitive slowing.

VR in September 2018 with another urologist. More swelling and bruising than first procedure. Pathology sent off that showed sperm granulomas and undissolved sutures. Post-op had painful lump under scrotum at base of penis about the size of a marble. Scar with dysthetic, burning pain along raphe. Marble size mass gradually decreased in size and softened over months. (Topical marijuana cream seemed to help with this). Mass not completely gone yet. No change in burning nor achy pain.

Tried duloxetine. Caused night terrors, night sweats, cognitive slowing, flattening of libido and depression. Still took it for nearly 6 weeks as it helped the pain.

Have had successful genitofemoral nerve blocks x 2 with good results. Relief was 100% on first injection, and 80% on second. Lasted about 8 hours on both occasion. (Lidocaine or bupivacaine only, no steroid)

Now 5 months out from VR considering options. Have started Pelvic PT as well as deep tissue massage of hip flexors (only one session each so far). A little better today(!) One person on this forum suggested stretching out the testes/scrotum which I’ve tried also- as it didn’t hurt. I do think it is SLOWLY getting better, but this trajectory would have me exercising by the time I hit 60.

The alternative that I would consider would be Spermatic Cord Denervation. My urologist gives me a 50% chance of total relief and a 75% chance of partial relief. The left side will hang lower afterward due to denervation of the cremaster. Penis and sexual function should not be affected as this branches off proximal to the spermatic cord. This correlates with the research that I have seen- and can post in the Library section. Spermatic Cord Denervation Articles

My inclination is to give the PT and massage another two months.

Thanks to all that have read this far. You are a great source of comfort and information. I may have posted earlier- if this is a duplicate, please forgive me, I just couldn’t find my own post.


4 months since vasectomy and still with discomfort/pain
#2

Hi @Roy, have you had SA done to see if it was successful? I’m nearly 7 months out of reversal now, and find that NSAIDs help me a lot. They will reduce swelling, and from what I have been reading, they have potential to prevent scarring over.

Maybe don’t rush into another surgery, wait for things to heal properly before deciding your next move.


#3

5 months seemed like a long time…but if you’re still seeing improvement 7 months out that gives me encouragement. I’m headed to the gym now—it’s a “good” day- so I will take some NSAIDS prior.

Regarding the SA- haven’t done it, so I don’t know if the reversal was a success.


#4

Great news your heading to the gym! That is a win in my book. :+1:


#5

Stay positive man. Keep your head up. Give it time with the VR, and remember everyone heals differently… you’ll get there.


#6

I had VR 14 months after vasectomy. I concidered it a failure and 5 months later had Spermatic Cord Denervation both sides, then cryoablation then series of nerve blocks then Botox. I was basically throwing the kitchen sink at it as I was out on disability and had to. Then, 8 weeks after Botox, 10 months after VR, 2 years after the vasectomy, I started to improve and within 6 months was pretty much 100%. I’ve been that way now for 5 years. All I’m saying is keep trying hang in there and keep your sanity and hope as best you can. Jim


#7

Thank you for sharing @Recovered. As a clinician who uses a fair amount of Botox, I am intrigued that it is not offered more often. It is certainly less invasive than other procedures being done. Possible mechanisms include quieting of a spastic pelvic floor or direct inhibition of pain pathways (the later being a less well understood effect of Botox). And, unlike surgery, if it didn’t work, effects would be gone in 3 months. Hmmmm.


#8

I keep in touch with an old member on here from Canada who is being treated by Jarvi. Jarvi is doing a clinical trial with Botox, and the old member is a part of it. Apparently they’re having a lot of success with it. Hopefully that paper will get published soon, which should make the Botox option more available.


#9

Found it on clinical trials.gov. started in 2016. Randomized Control Trial of the Use of Botox to Treat Chronic Scrotal Pain (ROBOT). Points for the acronym even if faked a bit. No results yet.

ROBOT


#10

Botox ablation/blocks for PVPS are available from Sijo Parekattil at the PUR clinic in Clermont Florida. I had one done 1 year ago. The injections focus on the areas around the spermatic cord. Dr. Parekattil will ask you to point to areas where you have pain and uses that as kind of a guide as well on where to focus.

I can’t say that mine had any impact on my pain but it didn’t cause any issues either and was relatively benign at least in my case.

I’m not pushing it either way, just letting guys know it’s available.

I will say that we have had a couple of guys, one named Don a few years back comes to mind, that threw the kitchen sink at their problems with procedures like denervation, cryoablation etc… and the last bullet used, Botox, was the thing that put them in a good place. His name was Don or Don H.

I’m updating this to say I did have it done while in Orlando to watch that qualified for an athletic event over spring break. I did it spontaneously with a turnaround of about 3 days and was able to get scheduled and took an Uber over and got it done and took an Uber back to the hotel. I was great for a day but in about a day and a half when the meds wore off I had some pressure from the bruising that was caused by the injections. It was soreness and pressure but it was not too bad. I was at Disney two days later and walking around without a ton of discomfort. I think if I had never had anything done down there I might have thought it was bad but since I have had much, much worse it was nothing. It wore off in a few days.


#11

Update: week 2 of Pelvic PT and Massage therapy. Sessions themselves fairly unpleasant. Picture myofascial release of tender points in hip flexors and adductors, not relaxation massage. The pelvic PT even worse BUT reduced pain afterward. Last week got too enthusiastic afterwards, went rock climbing and flared things up for 3 days. (I don’t do modified activity well). Today I borrowed a TENs unit from a PT friend and will add that to the mix. Compared to surgery seems low risk.image


#12

There is at least one article supporting this modality.
TENS for Orchalgia 2018. And way more importantly a post from one of our own. Thanks @Ra525! Link to TENS post

I get very temp relief of testicular pain when I press into my lower abdomin so I wondered if a TENS unit on the lower ab could help disrupt the pain. I found a supporting study online. Going to try it next week when I get home.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749563/

And apologies for being repetive…clearly I am a Forum rookie.


#13

Update time: 3 sessions of Pelvic floor PT in. Flares up my symptoms a little, but not giving it up yet.

Re: TENS trial, I started using it on my back. Found it fairly uncomfortable at first but settled in after 30 minutes or so. Still just fairly low intensity, but you can up build a tolerance. No difference so far in the orchalgia. I’m tempted to move electrodes to the painful area.

UFM underwear is helpful- not a celebrity endorsement on my part. Seems like the pain kicks in later on days that I wear them.

The challenge with throwing the kitchen sink at the problem is that I’m not sure what is helping. I’ve become impatient, which seems preferable to being completely discouraged.


#14

What practice are you doing physical therapy with? Did you have it prescribed? If so by who?


#15

Urologist prescribed it…he wanted to try one more thing before proceeding with SCD. In practice, it’s release of pressure points around pelvic floor and inside rectum. It’s pretty awful. Truth is, I do have pelvic floor issues and the therapy does help with that. Muscle tightness and constipation is an issue. It may have even set me up for poor results with the vas but the testicular pain has taken on a life of its own…and so far pelvic floor PT is not touching that.


#16

UpDate: TENS may be helping a little. LOW intensity seems way better for me. Use it at night before sleeping. Eases pain a bit.

Also helpful: topical lidocaine. Applied it before working out on an (upper limb) ergometer. A pain specialist friend also suggested topical cream of lidocaine, clonidine, and neurontin May be beneficial. I’ll see if my doc will prescribe that given that systemic meds have been a wash for me.

Pain always increases during the day…but trying to remain optimistic.


#17

Another update. Considering starting a new thread(again still rather rookie about the forum format). Borrowed TENS unit went back. It provided some nighttime relief but after a week nothing that lasted. I’d consider getting one, but not the $3000 H-Wave.

g helping somewhat but a word of caution:
Lidocaine/Prilocaine cream applied in the AM helped stave off pain for about 5 hours. Stings a little going on. Reapplying helps a little, but by the afternoon really nothing cuts it.

On the recommendation of a pain doc also tried a compounded clonidine/gabapentin cream. Diminished pain slightly BUT there was systemic absorption that came on slowly. I was fatigued at work and fell asleep at the wheel coming home. Nixed that in a hurry.

Got to the rock climbing gym with my kid today. Really limited in what I could do and hurting like hell now. Seriously contemplating denervation still. Just want to get on with life.

Marriage remains on the rocks. Cannot pin it all on the vasectomy, but the anger I feel now is not helping.