Post Vasectomy Pain Forum

Pathology and treatment examples

Another article for information I found helpful with detailed analysis.

Read the above article a lot. But it misses some things, ie. the sympathetic system’s role in pain.

I’m firmly coming around to believing that a lot of us are suffering from a form of CRPS. It doesn’t present like classic CRPS.

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Interesting. Perhaps you would have a different opinion and/or point of view if you had a different experience with your initial vasectomy. IMHO, it’s all to common for people to come up with theories that are moreless based on their personal experience with just about anything - including vasectomies, vasectomy pain, reversal pain, and so on.

I’m neither agreeing nor disagreeing with your hypothesis, but I figured I’d add some links for those who don’t know the definitions of…

Let’s not forget that there are other VIPs of sorts that think many of us are suffering from some sort of nerve degeneration. There are others that think some of us may have a genetic abnormally, or something along those lines.

I’ve always said that I think there’s a bunch of ways to end up with pain post vasectomy, and I am sticking with that educated assessment.

There’s a bunch of ways for men that never had a vasectomy to end up in a similar situation. While these situations are different, much if it leads to the same place.

I have come to the conclusion if this shit happened to women it would be fixed immediately

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I supposed most have read the same articles found on the web, and I was grateful to find one that appeared comprehensive.

I’m not trying to suggest I’ve found the holy grail or anything like that. I just know that the pain from multiple procedures to try and correct my initial pain led to long term chronic pain and I instantly began to connect with many of the men on this message board who are suffering from similar ailments after one or more surgeries. Let’s face it, you don’t end up here and stay here if one of the fixes such as denervation, reversal or epi removal worked for you. If you are a chronic pain patient whose pain is not localized to one specific site, or is showing signs of pain that quite frankly doesn’t make sense, I think you should investigate the stuff I’m talking about. Let me give an example. I always felt that deep dull ache was due to my epi. Well, stupidly, I had it removed. Not only did I get new pain, but I still had that deep dull ache. Hindsight being what it is, you could palpate the epi and it was fine, it just felt like the pain was there. After my sympathetic nerve blocks, the dull ache went away. I had all the peripheral nerves blocked first with no help. So, would denervation have helped me even though I felt my pain was localized to one specific spot? Even though I felt my pain hadn’t centralized like so many, it turns out it did. I wish I had been able to turn off the pain pathway sooner as I believe that the amount of time I spent in pain led to a condition that I will have to live with and deal with for the rest of my life. My first pain management doctor was close, he was just blocking the wrong sympathetic nerves (impar ganglion, no innervation to the testes/spermatic cord).

One common theme on this board is how the pain has spread. This is classic of CRPS. The past several months, I’ve delved into the anatomy and the pathophysiology of chronic pain (journal articles, textbooks, 200 page in depth exploration of the role of dorsal root ganglion stimulators, beyond just wikipedia). It is all in the nerves because that is how pain is transmitted. By now we all know you have four sensory nerves that supply some form of innervation to the area: GF, IH, IL and pudendal (last branch) as well as the sympathetic nerves, not something mentioned much in the urology journal articles. We know the embryologic origin of the nerves, the fact they may cross innervate and the fact that there is high variability in this area in nerve distribution.

As I contemplated a dorsal root ganglion stimulator, I found one if it’s greatest success areas is in groin and testicular pain. This is what led me to focus more on sympathetically mediated pain pathways getting away from just the four main peripheral nerves. I’ve had great discussions with my pain management doctor (Harvard trained in surgery, anesthesia and a fellowship in pain). There are three major pathways for sympathetically mediated pain. Superior hypogastric plexus, inferior hypogastric plexus and renal/intermesenteric plexus. (I’m at work and don’t have all of my journal articles on hand). The superior hypogastric plexus is the most commonly one blocked for chronic testicular pain yet only one person has ever mentioned it on this board as a treament offered to him @raising4girls. For some reason, I just don’t see the connection being made between PVPS and this particular treatment in the urology world.

Anyways, typing this all at work so it is coming out a little garbled but I think you get what I am getting at. I’m not talking to those with idiopathic scrotal pain who never had scrotal surgery. I think even PVPS is a bit too specific but it makes sense since that is a super common surgery to have there. What I think is that there is a tendency for urologic surgery in that area to lead to long term chronic pain and due to the nature of the nerves and the complex physical and psychological role that these structures play in a man’s life, this pain has a higher tendency to become life altering after the initial insult has healed. It is proven in many areas that long term chronic pain is conducted via sympathetic pathways.

https://www.tandfonline.com/doi/abs/10.1080/0963828021000007950

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I like it.

Thanks for elaborating.

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This is the exact information I’ve been searching for, in order to make the most educated decision on my next step. Thank you.

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I figured I’d add a little bit here for those who are unaware of what PVPS is and then some.

I really did like your previous write up @Reversalpain. I may not agree nor disagree with everything, but it definitely sounds possible. To me, your theory definitely sounds like it could fit into the PVPS world. I don’t think most people understand that PVPS is a syndrome - and/or what a syndrome really is.

The PVPS terminology reaches far and wide because it is a syndrome. Wikipedia doesn’t say that PVPS applies to men that had a vasectomy or a vasectomy reversal, but I certainly think it does.

Final thoughts…

For the record, I am not a huge fan of Wikipedia. It really depends on the subject matter. But, I do find it to be fairly decent for the most part.

I do think the PVPS Wikipedia page needs some work, but it’s constantly evolving, being updated, etc. It does leave room for more content, further exploration, further elaboration, and so on. It’s see also section certainly needs an update, among other things, other areas, etc.

I wanted everyone to know that I like to use Wikipedia as a baseline for a lot of things, discussions, etc. By no means do I think Wikipedia is the end all be all.