Post Vasectomy Pain Forum

Orchiectomy is complete

There is good news and bad news.

Bad news: It’s a very difficult recovery. The incision in the upper groin when you have it done inguinally is excruciating. It’s about 5 inches long and will render every move for at least 2 weeks, excruciating. Full recovery is about 4-6 weeks. You will not be sleeping on your side or walking much. There is a also a lot of post op pain. A hematoma has formed in the scrotum and the scrotal skin is chaffing and peeling. Morning wood is very painful (but I guess it’s good I’m getting healthy erections)

Good news It seems like there’s a high probability it’ll work. I had a nasty case of chronic epididymitis. My pain was very localized to tender spots, making the likelihood of removing the whole thing, good odds. The epididymis is no longer there, I can’t touch it, it’s not causing my pain. It made the likelihood of denervation making it worse higher. The swelling would’ve just been more pissed off. I will report back in another 2 weeks!

More bad news Even if it works I am not home free. My left testicle has some mild/moderate pain first from a varicocele, and then from a failed microsurgery. However it’s significantly less severe than chronic epididymitis. The difference is 3 or 4/10 pain vs 7/10. Denervation and cryo really scare me, and a bilateral orchiectomy Is an absolute last resort (however one I might consider before taking on one of the two surgeries above). So we’re doing Botox in about 6 weeks. I am banking a lot on either hitting the lotto, or having a cumulative effect of 2-3 shots that brings the pain from 3/10 to 1 or 0 where it will stay. Dr P said some men get relief for up to 2 years, as the nerve is turned off not to send pain signals. But average duration is 3 months.

3 week update.

I am cautiously optimistic that I will be able to call this surgery successful. I consider myself 50% recovered from it, and that is consistent with the varicocele surgery I had in April which was about a 6 week recovery.

I did develop a minor infection in the incision (my own fault). I am treating it with Keflex. I still have some moderate swelling in the scrotum, but it is dissolving.

There is a HUGE sense of relief that the epididymis that is causing pain is no longer there. In fact, it seems to have relieved some of the pressure on the other testicle which is naturally hanging a bit more freely. I am still going back to Dr P in 3 weeks for a Botox in my remaining nut, in hopes it will calm the nerves, relaxing the cremaster reflex, and we will have a 1-2 jackpot for my bilateral pain.

Again, I am cautiously optimistic and will provide another update in 3 weeks after Botox and 6 weeks post op.

Guys, I can’t stress this enough. Swelling when it comes to chronic epididymitis is a huge determinative factor when it comes to surgery. It’s universally agreed here that epididymectomy has bad outcomes and a lot of men get worse. Denervation is more controversial. But if you have swelling and do denervation, the swelling will not go away. Dr P explained this. You are hoping to turn the nerves off, but you will always have discomfort associated with the swelling. And you run the risk of the nerves getting a LOT angrier if you do denervation and leave the swollen pissed off tissues there. In fact, it’s almost a guarantee in the acute phase after surgery.

For this reason I think orchiectomy, despite how counter intuitive it is, is a no brainer if it’s unilateral. If it’s bilateral I can understand the hesitation, but I feel zero hormonal changes with one thus far.

On the other hand, if you have no swelling, and the pain comes and goes, removing the testicle doesn’t many much sense at all and denervation from an experienced pro like Dr P may make more sense, as he tries to target the nerves giving you referred pain.

Good afternoon, I wish you a speedy recovery and resolution of all your pains. Can you please tell me, did you have pain in two testicles at once, was the pain in the tail of the epididymis, below the testicle? How much antibiotic did you take (one or more), did you take NSAIDs, amitriptyline, lyrics? Did the ultrasound show anything at all, for example cysts, varicocele? Did you feel the thickening of the epididymis only during manual examination? My situation is as follows, there is a cyst of 4-5 mm in the head of the left testicle, there was inflammation of the left epididymis in 2018-2019. , treated then for a long time, I already wanted to do denervation, but then I drank amitriptyline, lyrics, celebrex, levofloxacin again and it got better, so I lived until 2021, and it so happened that in August, after the first vaccination of modernity, pains started again from the left side, prescribed antibiotics and NSAIDs, again there were waves, sometimes better, sometimes worse. But since September 30, the right testicle suddenly began to hurt sharply (it never hurt at all), the temperature was one day 37, at first it hurt completely, now the pain has shifted to the very bottom of the testicle, as I understand it, the tail of the epididymis. By ultrasound, I did 10 times during this time: in the head of the left appendage of the cyst - 4 mm, as well as varicocele, the right testicle, according to the ultrasound, everything is fine, the only thing in the place where the pain is, is there a scrotal pearl - 5 mm, which moves? !? (like, it cannot cause pain). Those. 13 days have passed since I am now treating the right testicle, 7 days have been injected with ceftriaxone, now I am taking doxycycline + NSAIDs. The pains do not go away, I am very afraid of these pains. Also, it seems that the prostate has increased - 43 cm. I have a big panic and have already been prescribed by the doctor, amitriptyline and lyrics, but have not yet taken it. Actually, I was planning to go to the doctor and consider the issue of the left testicle - a possible resection of the cyst + denervation, and then the right testicle began to hurt.

I had pain in both testicles, but one significantly more than the other. 7/10 on the right with significant swelling, 3/10 on the left without swelling but a tight cremastic muslce. I removed my right testicle 3 weeks ago.

I took Doxycyline for 10 days and then 3 weeks with zero effect. I took Cipro for 3 days and had a severe adverse reaction to the drug which involved multiple tendon ruptures and surgeries. I would urge anyone to never take Cipro or Levofloxacin and to fire any doctor who downplays the risks of these drugs, because they are a quack who shouldn’t be practicing medicine. They’ve been well known for 15 years. You run a risk of permanent disability to possibly resolve your testicle pain that is worrying but not dangerous. I am now allergic to NSAIDs as well thanks to Cipro.

I did not take amiltriptyline. I am not a believer in taking medications “off label” where a doctor is essentially throwing pills at you that are designed for something else. To me, that is lazy medicine and throwing shit at a wall hoping something sticks. It’s easy to just write prescriptions for the purposes of fast appointments. I did try gabapentin for a very short while (same family as Lyrica), it did zero, and I knew it would. Because when you have swelling that is a soft tissue problem, not a nerve problem. All these medications have side effects that are common and are no cakewalk, and doctors routinely ignore this and then gaslight the patient for having the side effects.

I felt thickening in the cord and tail of the epididymis. The entire epi was extremely sensitive to touch. I could not sit in a chair for a full year.

My ultrasounds were actually normal and even upon removing my testicle the surgeon could see no clear pathology at all.

So you have pain both sides? Which side has the cyst? I would personally opt for a cyst removal/drainage and varicolectomy and see if that helps before opting for denervation. Denervation is an absolute last resort, as is orchiectomy, though I would argue denervation comes with considerably more risk of getting worse. However a cyst removal and varicocele removal is a relatively simple surgery done by an experienced urologist. Maybe you could try that first and if it doesn’t work consider more radical options.

I know nothing about the normal size of the prostate. That’s something a pelvic PT may help with.

Thanks for the answer, how do you feel now? When there were both testicles, lately, sperm was leaking or shooting, and there were pain during ejaculation?

I didn’t have any pain during ejaculation or any penis pain at all. I am still very much in the acute phase of this surgery after 3 weeks. Lots of swelling and hematoma. Dr P said it would be like this for a month to 6 weeks

Good afternoon, I wish you a speedy recovery and a pain-free life. If you don’t mind, I will periodically write to find out how you are doing. I have one more question, why was it suggested to immediately remove the testicle, and not, for example, denervation?

Well shit. The infection started to rapidly spread and I had to have surgery to drain the abscess. Now I have a hole in my upper groin 4 cm deep that I have to stuff with gauze daily and taking IV antibiotics from home. Fun times. Will take up to 2 months to close. However don’t let this discourage you from getting an orchiectomy. This is in the incision and probably has to do with my personal hygiene post op, not showering or changing sheets enough, or touching the wound. I think the surgery worked in terms of pain reduction in the scrotum. Will update again after infections and wound closure is dealt with.

Denervation was offered to me but I had a serious case of chronic epididymitis. Lots of swelling in the cord and epi. I would highly recommend against denervation if you have swelling. Swelling is a soft tissue problem, the kind of pain that is noticeable when you touch it - denervation is a surgery targeted at nerve pain, the kind of pain that comes and goes, moves around, etc.

Doctor said denervation would not reduce swelling, it’s an attempt to turn off the nerves, but I would always have the discomfort associated with the swelling. And given the stories I’ve read here about denervation making men worse, I decided to take the entire thing out instead, and I’m glad I did. I’ve not seen any cases where orchiectomy made somebody significantly worse.

Hi this is interesting to read especially the info about the swelling. I lost my right testicle from a cancer misdiagnosis and suffer from very bad swelling and inflammation in my epididymis and top section of my surviving testicle.

I have had cord blocks and my cremaster muscle cut to try and resolve the “tightness” and swelling but unfortunately it made little difference, in fact it made me slightly worse.

From your discussions with Dr P would you say the only hope for me is to have an orchidectomy then? This would mean losing my only testicle which I am slowly coming to terms with, I’m 36 now and have suffered for 7 years since I lost my right testicle from that unfortunate cancer misdiagnosis

I’m at the stage where I honestly don’t think denervation is going to work, the injections did nothing and I don’t see how denervation is going to stop the inflammation. I have 2 small cysts in the exact spot where the pain comes from and actually think cutting them out or aspirating them would be better than denervation but obviously every doctor I’ve spoken to, including Dr P have said this isn’t an option and will only make things worse… well my pain only appeared once these cysts did so maybe my case is the exception! Anyway let me know what you think,

Thanks

Paul

Hey Paul. Sorry to hear you’re going through this. In your case, from what I have gathered over several hours talking to Dr P, none of these surgeries are a solution for chronic inflammation. I’m afraid if the antibiotics/NSAIDs/papaya seed routine doesn’t work, there isn’t much that can be done. These surgeries are all experimental and come with their own risks. Denervation is an attempt to turn the light switch out, but it’s not going to shrink your epi back to it’s normal size. And denervation comes with considerable risk of things getting worse. We’re in a similar spot, both having one testicle with the prospect of losing the other. I’m not at that point yet, but can’t honestly say what I would do. I don’t want to be infertile and deal with the hormonal changes and the shame of being castrated, but the prospect of denervation scares the shit out of me. I don’t think I could go through with it. It is indeed a grieving process to come to terms with the loss of one, much less both testicles, before the age of 35 (I’m only 32). One thing I am going to try at least 2 Botox injections. Dr P wrote a paper that described anywhere from 56-72% of men get 3-6 months of relief. A few guys on this forum say it was the difference maker. Some men hit the jackpot and get relief for 2 years and come down and visit him when they need a top up. Some men get a cumulative effect from a 2nd and 3rd shot to where, by the final shot, the pain is bearable going forward. Botox will relax the scrotum and I find epididymitis to be less intense when things are relaxed. This is a low risk, conservative measure you can try. I haven’t heard anyone getting worse from it.

There is also cryo, but Dr P explains this creates significant scarring that makes denervation impossible later, and orchiectomy a more difficult surgery. I wouldn’t even entertain epididymectomy.

If I were you, I would push for more of an explanation on why the removal of those two cysts would make you worse. I would take the risk of getting those drained before denervation or removal of my one remaining testicle.

But honestly, when you’re dealing with this for long enough, and suicidal thoughts are creeping it, one will do literally anything for pain relief. You CAN live a normal, dignified life with no testicles. Several men here can attest to that. You can get erections and ejaculate semen. We can freeze sperm if we want more children, and take shots. Can even get prosthetics put in for appearance. It would take time, but if we get our lives back, it might be worth it.

It sounds like we have very similar symptoms. Mine is always worse in mornings when my bowels start moving which causes retraction and my scrotum to “tighten” up. Then the pain and swelling starts. If I get into a hot bath then it usually subsides or once I’ve emptied my bowels around an hour or so later my scrotum will relax. I told all of this to Dr P over video call and he offered me botox and denervation but I live in the UK so am seeing a very good urologist who actually took it upon himself to go to the US and was trained by Dr P in the latest techniques.

He has also said I could do with botox but can’t actually find anyone here in the UK to inject my scrotum, there must be somewhere. I even had my cremaster muscle cut last year to stop the retraction and it has helped about 20% but I still get the pain and inflammation and Dr P said they leave the cremaster cut when doing denervation so I’ve pretty much had that done without the nerves being cut lol.

Have you tried Tadalafil? I began taking it about 6 months ago and it increases blood flow to the genitals and I’ve found it helps the scrotum relax more. You can take it every day, only need 5mg before bed.

I am actually starting TRT (with HCG) next week and my fiancée and I are trying for a baby. I am giving myself another 3 years of this sh*t until I’m 40 then I’m done and will be at the end game of this disease… ie - denervation, cyst removal and then orchidectomy in that order. I’ll be on TRT anyway so who cares. The hardest part will be mental but I already lost one testicle and spent 7 years with pain in the other one so if I can survive that I think I can survive losing the other one. I am thinking about prosthetics too but my advice is to get as small as possible. I had one for a few weeks after my orchidectomy when they misdiagnosed me with cancer and the put in a medium sized one which was way too big, it chafed my leg and I couldn’t sleep on my front cos it felt like I was laying on a tennis ball.

This is a longterm horrible chronic disease which I have been ashamed and embarrassed about for too long. Its not our fault we’re like this…. Just like women with ovarian cysts or endometriosis, chronic scrotal pain needs more support and research but ultimately I am slowly coming to terms with losing both testicles if it means living a normal life again.

Hi, Paul
I have read a couple of your post on this forum and I think we are in similar position, except mine hasn’t lasted for so long (yet).

I’m 33. I had a left side orchidectomy in June this year because ultrasound showed some suspicious lesions on that testicle and it was an undescended testicle which was surgically fixed when i was about 5 years old so it was more prone to cancer. Luckily, it turned out it wasn’t cancer, but some benign stuff (I forgot the name) that mimics cancer on US. Biopsy also showed that the testicle was pretty much damaged and non functional (probably due to its undescended status) so the loss hasn’t effected me so much mentally since I have been practically living with one healthy testicle (which produces enough testosterone and sperm) my entire life and the left one could only cause trouble.

I healed pretty fast after surgery and didn’t have any complications except my left side groin is still pretty much numb below the wound due to cut nerves. I feel no pain at all on that side. But some time short after surgery I started to feel tightness in my right groin and remaining testicle. It’s worse at exercise and arousal. After some search I have identified this as an overactive cremaster muscle. It’s not as painful as it is annoying. Only time I sometimes feel pain is during night/morining erections, which sometimes wake me up, but then the the pain is gone almost instantly - weird. I feel like it is limiting my activities since I avoid stuff that makes it tighter. Before the surgery I sometimes had groin cramps during orgasms but that would only last for few seconds and would go away completely soon thereafter. But now the feeling is not that intense, but it’s much more consistent.

Did your troubles also begin after orchidecotmy? Could the trauma of that procedure (in my case also obviously cut left nerve, since I am numb there) have somehow “jumped” over to the other side and freaked out muscles and nerves there so they became more active? I know human body can be a strange system.

From what I have read you have been dealing with this for a very long time now and have tried numerous remedies. Have you had any relief whatsoever? Also is inflammation you feel connected to the issue? (I don’t feel any inflammation and had 2 ultrasounds done after surgery which were both clear, they ruled out hernia as well)

I have been in this situation for “only” few months now and I am very hesitant to undergo more surgeries since I have a feeling cutting there would only complicate things further and make them worse. The only thing I would be willing to try, if things don’t get better with time, is botox injections but this is probably a science fiction for doctors in my country. (How does that even work btw.? Do they inject your groin or scrotum?)

I am also counting on improving my overall health position since I have been a complete slop for some time now. I am almost 30 kg overweight and have a terrible posture since I sit to much (have a desk job). I was also prone to depression and anxiety even prior to this problem and it definitely hasn’t made it better. I should be exercising regularly but as I said the tightness in my groin is not helping me with that since I have a feeling I am going to damage something down there and it’s my only testicle. And I must lose my habit of constantly snacking which I have no excuse for.

Anyway, hope you find your solution soon.

Hi Hector,

Really appreciate your reply and yes it definitely seems we have similar symptoms. First the cremaster muscle - I also did research on this and was convinced this was my problem and took the gamble last year to have it cut. Unfortunately it hasn’t resolved my pain or inflammation but has reduced the pulling and tightness by around 20%. The bad news is when I’m not having a flare up the testicle hangs far lower than before and in an almost horizontal position which and it feels more prone to torsion (that could just be me being paranoid though).

My symptoms were there before my orchidectomy but slowly got worse afterwards. I have a very complicated history where in 2005 I had severe orchitis from a mononucleosis infection and ever since then I had recurring pain but nothing too serious until they took my right testicle away.

My current situation is bad but not completely hopeless. I am starting TRT next week, my testosterone has been low for years and I owe it to myself to get that sorted, have to turn it into a positive somehow and if TRT can improve my mood and well being by 20% then it’s definitely worth it. You never know it might calm the pain and inflammation down (unlikely though!)

I am under the care of a very good urologist in the UK who actually went to see Dr P to get trained on denervation. He has suggested I have botox into the scrotal nerves to stop it retracting but guess what…… he can’t do it because he’s not qualified and can’t find anyone in the UK who can! Gotta wait on that one or get my own botox and try myself lol.

If the botox fails then he has offered to do denervation surgery but I have to say I don’t think it will work. My problem is 80% inflammation and 20% pain so I have no idea how cutting the nerves is going to stop the inflammation. When I ask all they say is that “pain and inflammation go hand in hand.”

In regards to finding stuff that works… so far gluten free diet and laxatives or psyllium husk to keep the bowels moving has helped a lot. My flare ups are triggered by bowel movements and if I’m constipated I can spend hours or even days with a full blown swollen testicle. Medication wise I have tried everything but the only thing that has helped me is Tadalafil (cialis) 5mg every, or every other night. Hot baths also help relax the muscles and reduce tightness of the scrotum but we don’t always have access to a bath do we. I also found that deep squats at the gym can really stretch out the muscles down there and I usually feel slightly better the following day.

There is a good chance that losing a testicle does cause chronic pain in the other one. I’ve spoken to dozens of urologists over the years and also guys in similar situations to ours who lose a testicle then develop pain in the other one. An NHS urologist even told me she sees it all the time, it’s normal and to get on with my life… eventhough it was the god damn NHS that misdiagnosed me in the first place!

One last note is that I would avoid surgery if possible, I was fairly stable mentally before having my cremaster cut and now I feel like I have a dead weight hanging there and have swayed more into considering a 2nd orchidectomy now but only after I have kids. Before this surgery I was 100% against orchidectomy but now the testicle feels damaged or tarnished I keep thinking about getting it removed. Saying that though if I can keep it I will but I’m not giving it another 3 years until I’m 40 then I will be reclaiming back my life on way or another

Thanks

Paul

1 Like

Thanks for the fast reply. Much appreciated. I have been searching trough several online forums and you have the most similar symptoms to mine I have found yet. That is orchiectomy + pulling feeling on other side afterwards. I guess I am lucky that inflammation has spared me (for now at least). It seems in my case that nothing is wrong with testicle per se and the problems are solely with the muscle(s) and possibly nerves. I don’t think my right testis had much “rearranging” to do after orchiectomy as it is case in most other cases since the lefty was pretty much dead already. (it was also almost half the size of the normal right one). But the operation itself could trigger some unknown reactions on the other side.
I have mentioned this to my general doctor and urologist and they have absolutely no clue what could be wrong. I live in a small country of Slovenia that has good general healthcare for common problems, but once you fall into the “niche problem” you are on your own. The only thing I have found they do for this kind of problem here is orchiopexy where they cut your cremaster muscle and fix your testis in scrotum with stiches. But that sounds like way too much can go wrong for my only testicle and from what I have read from guys online all these operations can cause pain where there prior was none. It’s used to “fix” retractile testicles, but mine wasn’t like this before. (can it become all of the sudden?).
So I agree with you and for now I am skipping that. I’ve read about botox as a efficient relaxant for muscles (at least temporary), but if you can’t find a doctor to do that in UK, there is no way I am going to find one here.
By reading all the horror stories here and on other forums I am thankful that at least I am (mostly) pain free at least when I am not doing anything. But as soon as I am physically active that pulling/crampy feeling creeps in and I have to stop it, so long term it’s not a viable way of living. Not to mention my sex life is currently non existing since I am single and I don’t want to date with all these issues.
For now, my hope is this will go away on its own with time and with my healthier way of living. I’ll try some of the dietary tips, thanks. If not, I’ll consider other options.
After all these years of suffering you deserve some resolution of you problems and I hope you can avoid losing the other guy as well. Good luck with the TRT treatment and baby-making as well!

1 Like

Hi CB89, I’ve had left and right testicle pain for 15 years, the right testicle being the worse. 11 months ago I had a simple orchiectomy right side, I went into the surgery blind without knowing enough about orchiectomy surgery, and my urologists did not give me any options or inform me of the differences between the two surgeries.

It seems both surgeries do carry similar recovery times, I like you was rendered useless on every move for at least 3 weeks. Forget about getting comfy in bed at night or during the day for that matter, laying down was impossible. My post op pain didn’t start for a few days after surgery, but it lasted months, I was getting some very wired pains, but thankfully no pain from the incision, no swelling or bruising. I guess one main difference between the two surgeries is the chance of a hernia developing at a later date from having a radical, something to do with the incision site and muscle being cut, this was only something I read.

My first surgeon who was going to perform my orchi said to me that he wanted to remove my cord to better address the pain element, he said pain can come from the cord so it’s best to ligate the cord high, but sadly I was transferred to a different hospital due to a backlog of patients. This meant I had a different surgeon perform my surgery and he obviously didn’t know my case, and I stupidly put my trust in him. I am now currently waiting for a review.

Like you, the pain from the head and tail of my epi has gone, but instead I still have pain from the remainder of my cord which is still hanging in my scrotum, I can still feel my cord in my scrotum getting aggravated from wearing jeans and trousers. All my surgeon had to do is follow the first surgeon diagnoses, which was to remove my cord out from my scrotum and stop my scrotum being the trigger point. It’s obvious the more of the cord that is removed, the better it is to address the pain pathway. The shorter the cable makes for shorter wires and less current.

I recently had a bilateral cord block which took all my pain away (both sides), these past few weeks have been fantastic, I feel like I nearly have my life back, but now the blocks are wearing off and pain is returning.

Both my left and right testicles have been painful for years, they both got diagnosed with varicoceles and epidydimal cysts, the right testicle being the most painful, hence the orchiectomy. But now my remaining left nut is kicking off a lot more, I guess it’s now free to party as much as it likes, it’s the only painful testicle left.

I’m ready for part 3 of my journey, either cord, testicle or scrotum removed, I’ve had enough of being messed about. The fact that my cord blocks worked is a massive plus point, at least they now know where my pain is coming from.

All the best, keep us updated.

Hey Chip. My deepest sympathies that you have lived with this hell for 15 years. One year was more than enough for me to go for a unilateral orchiectomy on the worse of the two testicles. People look at me like I’m crazy, but I would’ve done it at 3 months honestly, as this is simply not living. But I was forced to jump through all the hoops - antibiotics (which had long term disabling consequences in the form of Cipro), pelvic floor PT, and going through the process of sorting through 3 garbage urologists before finding Dr P, then his rather long process to get the procedure scheduled (4 visits required)

Just like you, it seems my other testicle has already “kicked up”, as you put it. Which is worth noting for all of you using my orchiectomy testimony for your own case. I would still say it “worked” to remove the pain of the testicle that was removed - I don’t have any phantom pain on that side. But it’s a real possibility the other testicle would be affected. I had 3/10 pain on my “good” side going into that surgery, and now I’d call it a 5 when I palpate the head of the epididymis. Now, on ultrasound, my remaining testicle shows epididymitis and it didn’t before on prior ultrasounds.

Chip, I am going to do Botox in another month or two. Have you done this yet? 70% of men getting medium term relief is promising. If it brings the pain from a 5 to a 2, and I can just go get the shot 3x a year, I’ll live with it. It’s my last conservative option before trying some really radical things I hoped it wouldn’t come to. I consider bilateral orchiectomy the absolute last resort. Removing one is no big deal, removing both is a huge deal. I’m now leaning towards possibly putting my trust in Dr P to try denervation and cryo before the final removal. Despite being scared to death, I do believe he’s the best in the world and he doesn’t give up on patients. But I fear those two surgeries creating unintended consequences and making things worse in nearby nerves, rendering an orchiectomy useless by that point anyway. Who could forget poor Jesse’s story?