Post Vasectomy Pain Forum

Post vasectomy pain, 3 months, worried about chronic pain, investigating surgical options

Hmm, that’s quite a high dose. Bear in mind that lyrica/pregabalin is roughly 6 times more potent than gabapentin. Hence a tablet is 50mg vs 300mg for gabapentin.
About 4-6 months after my vasectomy I was on up to 2400mg gabapentin but in the end I realized the effect was rather small.
And at that dose most of the drug is cleared before having a real effect. In the other hand pregabalin is more fat soluble and there more likely to have a linear increase in effect with increasing dose.
I GP prescribed the up to 2400 mg/day but I have later talked to experts in neuropathic pain who were hesitant to go to that dose…
I hope your pain levels will start decreasing.

1 Like

My hint will be look at pain management if u have pvps the a small opportunity that can help if u have pvpd what I have it’s very long winded feel free to ask me what I’m on

A quick update 7 months post vas:
I am still on Tramadol and Lyrica (Pregabalin), started to reduce it, am halfway through with it and taking 2 x 50 mg Tramadol and 2 x 150 Lyrica these days. I have tried some other drugs, exchanging Tramadol for Tapentadol (making things worse for me, especially emotionally), trying TCA (Nortryptylin), Cymbalta, etc. I also have a 1:1 solution THC:CBD but haven’t tried that yet. Weaning off on Tramadol and Lyrica to current levels gave me very strong withdrawal symptoms, that hit me totally unprepared. I am currently trying - again - Nortryptylin, am at 30 mg, no impact really. I have been doing pelvic floor exercises, no big relief, even though I like to think they help. Doing mindfulness exercises & meditation - no help (but I am not very good at it). Have done 5 sessions of acupuncture this week - no change. I am heavily thinking about surgical options right now. I noticed I have an itching sensation on my epi; not sure what if anything it means. I don’t think I have congestion, I believe not a lot here have true congestion problems, I think it’s all nerve related. Have been taking Papaya seed - no relief; actually I believe it did give me heart race, so I stopped it for some time, and heart race stopped. Am taking it now again, but as before - no impact. I am currently wondering about the following: if I don’t ejaculate in a long time, as I did in the first few weeks to approx. 4 months post vas (perhaps once a week), I got pain sitting “deep”, hard to locate, maybe where the prostate is. A MRI actually showed it could be prostatitis. Then, when I started to ejaculate more often (3-4 times a week), this went away, but then I get sore in my testicles. Does anyone have experienced something similar?

Who’s here on long-term Tramadol, Lyrica, Nortriptyline?
I am interested of course how it messes with you if you take it for years.

Wow I’m on morphine gabapentine paracetamol tramadol tens machine see other replays in my name get off the tapentadol if u can try acupuncture and tens machine tho that’s my advice . A good hobby for when ur home. Ops can nerve devregation ,nerve removal ,ocoloptamy ,rejoining nerve tissue and Reversal also ask for Botox trials in us shows it helps with none complications vesctomy for 3 to 6 months directly into scrotum sack tho again just what I see on my twitter and Xbox pages I’m on Reddit here and NHS choices too

It’s almost 10 months post vasectomy, and my situation has not improved at all.
I have visited different urologists, some self-proclaimed experts who admit PVPS exists, and also some pain management doctors, collected a few ideas and diagnoses (“genital neuralgia” and “PVPS”), but honestly, I have no frigging clue what to do next. So far, time hasn’t been on my side, so I consider I have 3 options right now:

  1. continue, wait & see. Hasn’t been successful so far, maybe there is still hope. I have been on Tramadol retard for like 8 months, currently 100 mg per day. Also taking Pregabalin, 300 mg per day. Used to take 200 mg Tramadol, 450-600 mg Pregabalin, reduced to 100 / 300. Slight increase in pain, but not a lot. Am currently trying to wean off on Tramadol, am at 75 mg per day, pain spikes.
    I did try also Nortriptylin, Duloxetine, and Valium, all gave little to no measurable relief. I have a 1:1 solution of THC and CBD which I have not tried yet.

My resume:
Tramadol seems to help me, Pregabalin (Lyrica) does not.
Does this mean, I do NOT have nerve pain?

  1. interventional pain therapy, Botox or RF ablation or the like:
    I have consulted with a few doctors, but am not convinced by anyone. No one can really tell how destructive the methods are and if they will make it worse / impossible for later surgery. Looking at PUR clinic’s guidelines, they seem to have their own thought about that.
    https://www.purclinic.com/testicular-pain/testicular-pain-treatment/
    “We tend to try denervation prior to botox or micro-cryoablation, since these ablative techniques may create some scarring around the cord that makes future denervation more challenging”.
    I will consult with Dr P soon and raise these questions.

I had a GF block in the inguinal canal, but the doc said, he also numbed II and IH, so I am not sure how good the doc was (I guess you can pick one of the nerves, he showed me the GF, but then does it mean the bupovacaine just numbs all of them?) or how stupid I am, because during the treatment he said “GF only” but the report states all three nerves. Anyways, I walked in with mild pain, maybe a 2, and walked out pain-free, except for the back of the testicles, which he attributed to the pudendal nerve (also causing anal and perineal pain and pain at the tip of the penis). I liked that doc, because he seemed to know about these nerves, but then he is only offering Botox injections, but no RF ablation. He works together with a peripheral nerve surgeon - well, no surprise, the surgeon recommended surgery, but he never followed up on me and my equations, so also not a very trustworthy option for now.

Questions here:
Since the block worked, does it mean I have “nerve pain”?
Why would a successful GF / II / IH block rule out “congestion pain”
Should a block not per se also help with congestion pain, since that pain is also send back to the brain via the very same nerves? Am I not getting something basic here???

I am still puzzling over the two main components of pain that are used for explanation:

  1. congestion pain
  2. nerve pain

Can anyone describe what 1) and 2) would typically feel like?

  1. follow-up surgery:
    This is my fall back option; I am not really keen right now on having another surgery, don’t even know, which one (reversal, denervation of the spermatic cord, neurectomy, ???).

I am going through hell right now. As I am an anxious person by nature, I am very agitated these days, possibly also depressed, and have a very hard time coping with all this shit, especially as I do not know what to do, and going off Tramadol seems to cause the pain to spike, so I might just keep taking it for now. I also have much stronger episodes of palpitations, heartbeat irregularities, etc. over the last months, and during a routine ECG in a hospital for the first time ever a sinus arrhythmia was recorded. I attribute it to stress and anxiety, but I also think it could be related to Papaya seed. I am off it for 2 weeks, no issues since then, but pain has increased. So, at least this is under control right now.
And, because it’s so much fun, I got an anal thrombosis because of occasional constipation caused by, well you know it, Tramadol. I watch my nutrition carefully, even take Mg, but still suffer from constipation. My whole life right now feels like breaking and falling apart, the health part, the relationship part, and work.

Could it be, that besides going off Tramadol (100 to 75 mg is not a huge reduction), actually not taking papaya seed is making the difference pain wise? And would that make me more of a candidate for the “congestion pain” category and less of neuropathic pain?

My baseline pain is a kicked in the balls-feeling.
I do feel a lot more pain in the testicles after ejaculations.

Also, with now taking less Tramadol and no Papaya seed powder, I feel the pain much sharper in the testicles, whereas with 200 mg Tramadol or 100 mg Tramadol & Papaya, it felt much more like prostatitis. I do not feel sharp stinging pain, I feel OK with my legs, etc, no numbness. So I wonder if it really is nerve pain that I am having.

I guess I am wishing it is congestion pain and could jump to reversal as the go-to solution. I want an easy fix of all this and my old life back. As mentioned earlier, I am not good at coping, I don’t want to accept my current life.

Anyone wants to comment ?

I had my consultation with Dr P. He strongly interpreted my increased pain after ejaculations to lean more towards reversal than denervation. He would not recommend any type of ablation as they are all destructive, except Botox, leading to tissue damage and scarring. For targeted denervation, he would aim at 2-3 nerve branches, for cry-ablation that number goes up to 8-10. Cryo-ablation is less damaging than RFA (don’t know about pulsed RFA). He talked about denervation being a low-invasive low-risk surgery based on his experience, as others have noted before, but the forum seems to be anti-denervation. For reversal, he quotes success rates up to 95% including a psycho-social component, 70-80% without. He gives a 1-5% scarring chance each given year after the reversal.
Based on this conversation, I tend to favor reversal - again - as I intuitively did already immediately post-vas. I tend to not pursue any form of nerve blocks and ablative methods right now.
The question I am asking myself is: How invasive is reversal really (how much new damage and scarring can happen) vs. “putting things back together”, as all of us like to simplify. Dr P did seem to acknowledge autoimmune problems, but I felt he did not really buy into it but is maybe more of the opinion that the psychological component of “putting things back” plays a greater role for men than the flowing aspect. I think he believes that removing scar tissue, clips, etc. gives the most benefit. I read from others that he said he would not believe in congestion pain. Now this is contradicting my experience with him as he picked intensified pain after ejaculations as an indictor for reversal.
I don’t know what to do. One thing we both agreed on was weaning off on all medication to see how bad my pain is. I am currently on 40 mg Tramadol, 2 more weeks to go down to 0, and then I will start reducing Pregabalin, currently 300 mg, over some weeks. I hope to be med-free in 2 months and then will consult with him again.
Good luck to all of you.

1 Like

Yes, there does seem to be a contradiction there. He’s flat out told me several times that congested epis themselves do not cause pain. If true, then why the pain after ejaculation and why buy into reversal.

I know that Dr. P. did his fellowship under Dr. Thomas who did my reversal at the Cleveland Clinic. Dr. Thomas was a BIG believer that pain after ejaculation indicated reversal as a solution. Maybe Dr. P. is just going back to his trainer’s opinion.

Regardless, if ejaculation gets your pain going or makes it worse, I think I’d start with reversal.

Just to keep this updated; for now, I got rid of the sinus arrhythmia, even without beta blocker. I found this possible links to Tramadol and other opioids:

Tramadol is an opioid and also acts as both a serotonin and norepinephrine reuptake inhibitor. Tramadol at analgesic doses has a low risk for cardiovascular adverse effects. However, tramadol administration can lead to serotonin syndrome, which can lead to cardiac arrhythmia. Cardiac side effects may range from agitation and palpitations to rhythm abnormalities, conduction defects, and cardiac arrest.

https://www.ncbi.nlm.nih.gov/m/pubmed/30071529/

On consistent basis without heart problems. I attribute this to absence of Tramadol.
I reduced it to 0 at no increase in pain; on the contrary, it seemed to have made me feel better overall.
Reducing Pregabalin has turned out more difficult. I planned to wean off in steps of 50 mg per week, coming off 300 mg. I had to stay at 250 for a months because my pain spiked.
So, Tramadol seems to have not helped lately while Pregabalin does (which is the opposite of what I thought was the case at the beginning) - I conclude this points to nerve pain rather than congestion.
I’m on vacation right now, exercising for the first time since the vasectomy. Went hiking, some 60 km and 3500 m height difference last week. Needless to say I’m totally out of shape - but it felt great. However, after day 3 or 4, the steep descends claimed their tribute, and pain spiked for a few days, and I was resting. I was simultaneously reducing Pregabalin, am now at 200 mg.
I will have diagnostic blocks of the GF and II/IH nerves next week, and pending on results plan to consult with peripheral nerve / hernia surgeons familiar with (triple) neurectomies.
I kind of hope it will turn out it’s only the GF and not the II/IH, as right now I would favor GF neurectomy over reversal.
Will keep this post updated.

1 Like

I had my II/IH blocks left and right today, and while they were lasting (some 5 hours), I thought I did not feel a lot of difference.
Unfortunately, I have less pain in the mornings, so I might have started out with a 3-4. I tried everything upfront today and yesterday to make it worse, including jumping, running, ejaculating and not taking Pregabalin in the morning. The doc injected somewhere close to the hips (sorry for my poor knowledge of anatomy), where only II and IH are present (the GF comes in lower). He said it’s very hard to separate II from IH, so I don’t have their individual responses.
Interestingly, on the left side, I could feel my pubic area numb and large parts of my upper thigh on the outer and central parts of the quadriceps femoris muscle were numb, while on the right it was only the pubic area. The scrotum was not numb.
Throughout the day, I thought there is no difference - the same burning pain inside the testicles. Then, I might have made a mistake by ejaculating 2 times just about when the anesthetics was supposed to stop being active. Then the pain spiked - so I am asking myself now was it AFTER the injection had already stopped working or WHILE it was still working - I think the former, but can’t tell for sure. I should have just waited. Now, a few hours later, the whole area hurts more, I guess it’s due to the injection.

A few comments from the doc in general:

  • he said repeated injections of anesthetics and steroids used to be done in the past but proved to be of little benefit, as the steroids can actually destroy tissue
  • he also said that Botox seems to become the new standard, though large clinical studies are yet to be conducted
  • he would not recommend any surgery unless the pain is in the 6-7 range which is not the case in my case

I will get the GF numbed left and right tomorrow and I really hope this will knock out the pain.

So, here I am, still asking myself the very same questions (wait it out? try meds I haven’t tried before? inject Botox or do some other form of ablation? surgery? Which one?). My thinking lately and strategy is:

  1. get of Pregabalin, establish pain baseline; this will take a few more weeks
  2. get the GF tested (tomorrow) but with the mixed results of today, I am not sure I really gain anything at this stage - I might have to re-do it once I am off all meds
  3. try Botox injection to get at least some pain reduction or pain free for some time
  4. I have not found anyone doing comparable “mega blocks” as Dr P does, so this is no option at this stage
  5. I have not yet found someone to do pulsed RF or cryo ablation
  6. Unless it is clearly and only the GF, I will not attempt any GF neurectomy
  7. MSCD is maybe an option vs. 6)
  8. I was leaning towards reversal - my simple brain tells me to go in and clean up the mess that is causing the pain by a “mini-denervation” - then I don’t care whether it’s GF or II, and get the added benefit of established flow and minimized long term impact of autoimmune issues (in case they are really important for me - idk)

Now one can ask why reversal and not MSCD, if I am suffering from nerve pain - I don’t know. It just seems reversal produces by and large less unfavorable outcomes than MSCD.

I had a block of the II/IH in 2016 and then twice in 2018 (separated by a few hours to doublecheck). Never felt a lick of difference with a block of the II and IH, like you.

Every block of the GF, however, has delivered some or a lot of pain relief. So, definitely go through the with block of the GF if you’ve come this far.

I had my GF blocked left and right yesterday in the morning. I started with maybe a 3-4 pain.

The doc said the pubic area and the scrotum should get numbed.

However, it was only the pubic area that got numb on both sides, and the deep burning sensation was basically the same. In the 3-4 hours these blocks lasted, my sensation went between “no change” and “maybe some 50% reduction” back and forth. At the best moments, I had felt a tickling sensation that was actually somewhat arousing. It felt nice. Once the anesthetics stopped acting, the pain went back to normal 4-5 for that time of the day (early afternoon). In the evening, it was quite painful, today, one day later, it is a little better.

I had high hopes after the II/IH blocks - which already gave some mixed results - that the GF blocks would significantly (!) reduce the pain. However, the results are more than mixed. I hoped for clarity but I got some confusing results which don’t really help me right now.

My thoughts & conclusions are:

  1. Could it be the doc did not hit the nerves properly?
    As both sides felt similar, I cannot see how he would have missed both. So I give it a fairly low probability, but I might re-do the blocks with a different doc. Though I like the general comments of this doc, I kind of don’t trust him after these inconclusive results - maybe not for his fault, but that’s just how I react to docs these days (little to no trust).

  2. Could it be the blocks did not work because of pain centralization?
    Idk. This is the toughest one to assess.
    In April, I got only the GF left numbed. Pain went from fairly low 2-3 to maybe a 1-2, but not everywhere (not deep inside - around prostate - and not at lower end of testicles).
    I hope that’s not the case, but I don’t know how to prove or disprove this theory.
    Again, might want to get another set of blocks from a different doc.

  3. Could it be that part of the pain was actually blocked during the GF blocks, but the remainder comes from the pudendal nerve?
    This doc and one other pain doc last year thought that some of my symptoms / pain locations I ve had over time (anus, perineal area, prostate, lower end of testicles, tip of penis) would indicate that.
    I am thinking about getting also the pudendal nerve blocked.

After this, I am again hesitant towards reversal - why should it help if neither the II nor the GF are clearly responding to the blocks? Same applies for MSCD. Or do I not have neuropathic pain after all? F*** I don’t know.

On a side note: I noticed that frequent ejaculations - while increasing pain - are helping with the feeling of orgasm and also the viscosity of the ejaculate. Both appear to approach pre-vas state.

A few comments from the doc in general (updated from yesterday’s notes):

  • he said repeated injections of anesthetics and steroids used to be done in the past but proved to be of little benefit, as the steroids can actually destroy tissue
  • he also said that Botox seems to become the new standard, though large clinical studies (placebo-controlled double blind) are still missing; it’s repeated anecdotal evidence. Also, the pain level over a few cycles of injections appears to come down after each injection. He furthermore said there is basically no damage done when injecting Botox, and that it takes some 3-5 weeks before it starts to work (when injected into the scar); the subcutaneous injections in the skin of the scrotum also done would provide some more immediate relieve.
  • he would recommend 3-4 repeated diagnostic blocks before attempting any surgery
  • he would not recommend any surgery unless the pain is in the 6-7 range, which is not the case in my case

As next steps, he would recommend Botox injections and possibly look into neuromodulation / ganglion stimulation. I guess that’s what people refer to as dorsal root ganglion (DRG).

2 Likes