Post Vasectomy Pain Forum

PVP after 1 week - now 2,5 months in

Hello. My first post here.

I am a doctor myself, though not a urologist.45 years old, no previous medical history. English isn’t my first language.

Had a vasectomy 2,5 months ago. I was worried about pvps before the procedure, but was eventually convinced by the surgeon that it was nothing to worry about. Asked him directly what the risk was, but he shrugged it of with a short “extremely rare”.

About a week after the surgery I developed extreme pressure pain in both testicles, constant 10/10, didn’t sleep for 3 nights. Eventually I had to be drugged away on tramadol for several ways just to cope. The pain was so intense I had to take sick leave from work for over a month. I eventually got so stressed out from pain and sleep-deprivation, the idea that I would never get rid of the pain, and the despair from realizing the surgeon lied to me, that I developed quite serious suicidal thoughts. Got an emergency admission to a psychiatric ward, stayed there for almost two weeks. Getting regular meals, sleep, and anti-psycotic drugs helped, and I was nearly pain free when released.

Now I am back in work, and the pain is somewhat bearable, but far from optimal. I use paracetamol 1gx4, an NSAID, some anti-psycotic for sleep, and 50 mg tramadol every other day. I’ve had two different urologists look at me, but the rule-of-thumb in my country seems to be that nothing surgically can be done for me.

I’ve noticed that the pain lessens the further time has passed since an ejaculation, but if I feel almost pain-free and try to have sex, ejaculation causes a sharp pain in both epididymus’ followed by quite increased pain the next days. I’ve had a few days with almost no pain, but the days after sex it’s back up to 4-5/10, with short higher spikes.

Don’t know what to do. Would like to hear advice from others. Would a sex-free month or two be of any use, in the long term? How long should I wait before considering a reversal or anything else surgically? I have a feeling based on the way my symptoms have been, that I have a blocked or burst epididymus on both sides, and if I get a reversal it would have to be with a surgeon experienced in microsurgically vasoepidydimostomy. And if so, does anyone know of a capable surgeon based i northern Europe?

Hi stk

Where in Scandinavia are you located?

My best bet would be the urologist who “did me”. I remember when asking him about PvP he answered that it was a complication, which was on his mind.

He was at the time (January 2020) employed at Sydvestjydsk sygehus http://svs.dk/wm417943

Hi Rune.

I doubt it’s the same surgeon. Both myself and the surgeon is located a bit further north, across Skagerrak. I have spoken to several Scandinavian surgeons over the last months, and I find they have mostly the same mindset - they know pvp is a complication, but don’t like to talk/think about it.

Hi stk

No you are right, it is unlikely it is the same. Please excuse if I am unclear, English isn’t my first language either. Anyway, my point was that when I asked my urologist about PvP he became stern, and stressed that it is a serious complication.

He informed me, that upwards of 15 % of men will experience lasting pain/discomfort, that treatment of PvP is complex and that the treatments which are available doesn’t always produce the desired outcome. I can even read this in my journal.

Anyways, he is my best (if not only) bet, if you are looking for a urologist in Northen Europe who takes this condition serious. His name is Christian Maker and last I knew, he was employed at the hospital I linked to.

Hi Rune.
Thank you for your reply. This surgeon - does he do any reconstructive or pain-relief microsurgery himself, or is he just “interested” in PvP?

Hi stk

I must admit I do not know, if he does any treatment or reconstructive surgery himself. But would expect that he would be able evaluate and refer you to a treatment.

But again, this is based on the 15 minuttes of pre-op interview I had with him. However, my experience was very different from what you and many others describe - Christian was honost to me about the risks. That alone tells me, that he knows more about PvP than many other urologists.

I have a more cynical view. I believe that most urologists are at least somewhat aware of the risks of PvP. But - vasectomy is the #1 procedure for urologists who want to make a lot of money - fast. And as long as the general concensus in the urological community is that PvP is “rare”, they have the excuse they need to keep on making money by cutting spermatic cords.

I really hope you are wrong - yet, I have no clue how much a surgeon/urologist makes from a vasectomi here in Denmark.

However, I have a general expectation that any physician would want the best for his/hers patients.

I know something about it. I know people who work in private surgical clinics. They have informed me that vasectomy is by far the most profitable procedure for both surgeon and clinic. There simply isn’t anything else that comes close in terms of $/hour, for a private urologist.

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I tend to completely agree with you. No doubt vasectomy is a cash cow here in the states and elsewhere in the world. My insurance covered half of the procedure itself and our half was around 500 bucks.

I wasn’t able to find any statistics on the average salary of a urologist that doesn’t perform vasectomys vs a urologist that performs vasectomys. I didn’t come up with any statistics regarding those who work in a government system vs those who work private either.

Urologists that perform vasectomy reversals, fertility, etc, up their annual income vs those that don’t. Other urological surgeries, etc.

I used to think the capitalist medical system here in the states was the biggest part of the over selling vasectomys without a proper warning problem - and I still do in some ways. Money ties into it anyway. But, the procedure gets sold the same way in other countries around the world that have government healthcare systems. In many cases, those countries are fully aware of the risks as per their own government websites.

Hmmm - so what’s going on? Why is this happening? The powers that be are fully aware of the risks involved with vasectomys. I’m pretty certain that I know what is going on.

Here’s a couple links that shed some light on the average salary of a urologist.

https://www.salary.com/research/salary/alternate/urologist-salary

I believe that since urologists worldwide “agree” that vasectomy is “safe enough”, it causes a kind of herd mentality. Nobody wants to be the one who breaks out and speaks up about it. I have that distinct impression after having spoken with a number of urologists these last months. The one who did my surgery was mostly interested that I shouldn’t speak of it to anyone else. I visited a general surgeon at the hospital, who was frank about the risks (1-3% risk of pvp was his estimate), and I later heard that he had been reprimanded for saying this. I visited another urologist, who in his written report stated that I’ve had an “uncomplicated vasectomy”, and that there now is “no obvious cause for chronic pain”

As I see it, the big issue with pvp is that is is a condition that is exclusively caused by urologists, and it is also “treated” or at least assessed by urologists. That way they can keep the “truth” about pvp within their own ranks, since no other medical speciality has authority to say otherwise. And they have a very good financial reason to do so. I know this sound like a conspiracy theory, but it does make some sort of sense.

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I hear you brother. What I think boils down to what the majority of people would probably consider a conspiracy theory. Sometimes the truth is stranger than fiction.

The thing that infuriates me the most, is that in my country there is a specific law - just for sterilization - that states in very specific terms that all patients who has a vasectomy (or the female version) should be given information about the risks, medical effects of the surgery, etc. All private clinics here seem to interpret that in a way, that as long as there is a few words about “very few get lasting tenderness” they’re in the ok. I would interpret that as they should specify that a nasty, untreatable pain condition will occur in 1 in 20 men, according to the latest research. Do you have such a specific law in the states? I’m trying to think of a strategy of how to present this to the media, but I’m still not sure how.

To the best of my knowledge, there is no such law in the states.

To the best of my knowledge, the states is also one of two countries that allows advertising prescription meds on TV.

To the best of my knowledge, medicine in the states operates in accordance with what it can legally get away with.

The sale of pharmaceuticals here in the states does require a default FAQ sheet, FAQ label, etc, by law. That includes women’s birth control. But as you can imagine, pharmaceutical companies will only tell you what they have to. Nothing more, nothing less.

Vasectomys and/or surgical procedures in the states falls under completely different guidelines.

Our legal system is rather screwed up here in the states too. Many people refer to countless lawyers as liars.

BTW, I posted a wrong link earlier. I edited it a minute ago. Odd how the second link I mistakenly previously posted didn’t mention that urologists are the fourth highest paid physicians in the states.

So, I guess it’s “your” fault. :smiley: Urologists over here see that they get away with it in the states, and copy their behaviour. I will find a way to argue that urologists here can’t do that, since we have a law and the rest of the world don’t. Vasectomy costs about $600 here. Docs here don’t have the same salaries as across the Atlantic. Thanks for your replies.

Yeah, unfortunately, I suppose so. I have heard the terminology “the client assumes many of the risks” here in the states and elsewhere.

I have heard many stories from people here in the states that said the only thing they were told about vasectomy beforehand was that it was a low risk procedure - period. Other people get told about some very basic stuff - risk of infection, bleeding, etc. Some get told more than that - infection, bleeding, congestion, epididymitis, sperm granuloma, and recanalization. Some places in the states may warn the man about pvps, but it seems to be quite rare. In many cases - in short, the risk of and/or the severity of PVPS is downplayed. I have heard all kinds of things - including urologists telling men that they will just need a reversal if it happens.

Who knows about this stuff?

Apparently, in the states, a urologists can legally tell/sell a man whatever they want. The doctors, surgeons, practitioners, etc, seem to have the upper hand by default. You would have to prove they did something wrong during the procedure, and that’s going to be very difficult.

Here in the states, there is one final nail the unsuspecting populas have waiting for them prior to the procedure. Initial here here and here, and print your name below that. Like many consent user agreements, the majority of people have no idea what they just legally agreed to.

I live in a neighboring country, and here, the overarching state health care actually pays for a vasectomy - even if then performed in a private practices, as was in my case - but completely fails to provide adequate pre-surgery information. I was not even given a written consent form that said ANYTHING about post-op complications, I did sign a form, but no mentioning of ANYTHING. All I got was on the day of the surgery some bla-bla from the urologist that in very seldom cases there could be long-term pain. Stupid and trusting as I was, I did not think about it. And then I learned that I cannot even sue a particular doctor or particular hospital for malpractice in this country; all I can do is file a general complaint against the state health care system - well, wish me good luck, I will need it…

While we have this exact text in the law - run through google translate:

“A person who has requested or applied for sterilization must be given information by the doctor or tribunal about the nature, risk and medical effects of the procedure, and in the case of other ways of preventing pregnancy. The doctor performing the procedure must make sure in advance that such information has been provided.”

But still we get the same crap of “low risk” as anyone else.

Hey @stk

I totally agree with you and Ringo. I think many members of this forum will agree as well. I believe vasectomies are a billion dollar business in the US. There is a great deal of denial and also ignorance.

With regards to your symptoms, my observation has been that people in their late thirties and older have stronger bouts of pain and take longer to recover. Since your pain is pretty close to your vasectomy, it is likely congestion. As you probably know, antibodies to sperm take months to develop. One urologist told me it could take up to 2 years. I remember seeing a study on it.

Some of us here (in the same age group as you), saw improvements after 10 months. For me, the pain gradually reduced over a period of 2 months after I hit 10 months. If your pain is tolerable for now, then waiting till your 1 year anniversary might not be a bad idea (before pursuing surgical interventions).

In the meantime, have you tried papaya seed powder ? See if that provides some temporary relief, for me I saw some improvement after 2 weeks. While I did not try it longer than that, others here saw improvements after 3 months, I think. Avoiding foods high in Omega-3 especially Chia, helped me…Fish is ok though. Papaya seed is a blood thinner though, so you have to be careful with interactions with any other medication you are on.

Thanks. Haven’t tried papaya seeds yet, I’ve ordered a few different brands, hopefully they should arrive next week. I’m pretty sure my symptoms are mostly if not all because of congestion. Pain has been reasonably tolerable these last days. I believe that is mostly because of abscence of sex, which is not where I want it to be but is how it is. I have really high hopes on the papaya thing though. I don’t use medications that should interact with it.

Why did you stop with papaya after only two weeks?