Post Vasectomy Pain Forum

Reversal for fertility nerve pain

#1

I am here to share my story and get advice, but I come from the complete opposite direction. I had my vas about 8 years ago. Unpleasant surgery, left side felt fine, right side needed more anesthetic but I healed uneventfully.

Time passes, divorce, remarriage and now a vasectomy reversal for fertility reasons. (Discussed IVF but wife wanted me to be put back together). Surgery May 2018 with two urologists working in tandem. Left side felt great, right side felt like I was stitched up by someone with two left hands. Recovery was tough but 6 weeks out doing ok. Then 8 weeks out intense burning pain on right side. Urologist says, surgery a success since SA came back with sperm. Doesn’t think much of my pain, prescribes a course of prednisone which did nothing. NSAID’s don’t help. Pain is worse when sitting and increases during the day. In fact, I wake up and feel fine. By the end of the work day I am at a 7-9/10 for pain. He starts me on Gabapentin 300mg tid and I notice a slight relief. Does an in office ultrasound on a machine from the 70’s, all normal. Tries a spermatic cord block, ie. injects 5 cc marcaine into my sack and of course pain diminishes by about 50%, but that doesn’t surprise me.

I go to my GP, she refers me to hospital urology group. Have doppler ultrasound and they find bilateral varicoceles and some minor fatty tissue on right testicle (they assume prior trauma) and small nodule on right epi they say is commonly seen in men with vasectomy. New urologist also has testosterone and other labs run, finds testosterone is low for man my age trying to conceive. Based upon my symptoms, recommends varicocele embolization and clomid. I should say on physical exam, my testicle, epi and spermatic cord can be palpated etc. with little discomfort. They just feel sore, like they ran a marathon. Look up varicocele pain and I had almost every symptom. At this time, I suspect the nerves are trying to recover but pressure from varicocele is keeping them from doing so.

November 2018, varicocele embolization. Easy procedure and recovery. However, deep dull ache is replaced with an intense burning pain in right testicle 4 days post op. Emergency room, nearing a complete nervous breakdown (suicidal?) Ultrasound, normal, Rx Percocet 7 pills (first narcotic I have taken this entire time). I take 1 that night because. Since I have taken ¼ of a pill as needed. I still have 5 pills left, they are my safety net. Urologist starts me on 50mg clomid 3 times week.

My GP starts me on:

Amitriptyline 10mg daily

Gabapentin 300 mg TID

Klonopin 0.5mg BID (yes, I know all about this and have successfully tapered before)

Klonopin relieves nerve pain, why, who knows but I will take it. Amitriptyline is 3 weeks in on a low dose so jury still out. Gabapentin, helps, but I am thinking of increasing the dose. Have applied menthol, cooling creams to right scrotum which occasionally overwhelms dull ache signals to brain. My only other symptoms is slight weakness in my right thigh and lower back, but that could be job related.

Now 6 weeks post op embolization. I wake up and feel fine. I take my pills, do light cardio, pelvic therapy stretches I’ve garnered from books and internet, cold sitz bath and go to work. Pain increases throughout the day but I can work for the most part. End of day, crash and watch tv with wife in bed. Luckily, she is a homebody but I feel tremendous guilt during our first year of marriage.

Latest SA is good post reversal 50 million/ml with 21% motility.

I don’t suffer like some of you on here, but I am suffering in my own way and I need to get through this for my family’s sake.

My thoughts on my future:

  1. Conservative treatment. Started going to chiropractor, will see acupuncture soon. Nothing invasive until pregnancy at the earliest.
  2. Find the right medicine that gets me through the day. Maybe, the body will adapt to these painful nerve signals and someday I can taper off them. Applied for medical marijuana card at suggestion of my urologist
  3. Repeat ultrasound.
  4. Pain management? Do I want to get into one of those places? Not looking for narcotics, but my GP offered some tramadol which sure would help on those afternoons when the pain starts creeping up. I may take her up on that offer. My urologist says he has someone who is very good with pelvic pain at the hospital.
  5. Consider nerve blocks to definitively find out which nerve is the cause.
  6. Botox?
  7. If varicocele persists, varicocelectomy
  8. SCD? I’d have to be in a really bad place to consider this.
  9. Peripheral nerve ablation
  10. Removal

If you have read this, then I thank you. If you have any comments or suggestions I’m all ears.

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#2

Just curious did they work on both sides at the same time in tandem? You can find a lot of information on this site to help make a decision. Sounds like you have already started with the most logical conservative options.

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#3

Thanks for sharing your story @Reversalpain.

Interesting that it’s the same side with both vasectomy, and reversal that were problematic in one way or another. That leads my mind places, but nowhere for certain.

Interesting that you considered your varicocele embolization procedure completely non event. I felt alright for my first 24 hours afterwards, and over the next 24-48~ hours I gradually felt like someone had beat my entire waistline, and midsection with a tube sock with a bar of soap in it. I got over that over a period of days, and somewhere around 10-14~ days into things, I started having serious problems that got better~ over a period of a year~, but persist to this day which is over 7~ years later. Like you, I wake up pain free everyday.

Hard to say what you should do. Sounds like you’ve done your homework already, and you seem to pretty much know your options.

Your total SA count sounds pretty good, but your motility is poor. Hard to say if you guys will conceive with such low motility. What are your fertility docs saying about that aspect?

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#4

Not sure, I think one did one side and the other did the other side but I’m still awaiting getting my medical notes, that has proven difficult!

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#5

Yeah, not surprising that it was the same side that gave me trouble. Only difference was that as soon as the original vas was done, I had no pain difference between the two sides.

I’ve read you had trouble with your embolization and certainly that weighed on my decision. My procedure was easy and other than a minor bloating feeling I was fine. Now the dull ache changed to a burning pain after the embolization. I’m staying positive that a change means the varicoceles at least played a part in my nerve pain. Also, I was able to treat the burning pain with medications, the dull ache only responded to lying in bed and going to sleep, not a single medication!

My pain six weeks after embolization is at least half what it was before. My urologist said he had a patient similar to me that took several months for pain to go away.

I wonder why my pain increases as the day progresses. Does sitting put pressure on a nerve, blood supply? Is it because I’m getting urine into the vas (yes, my imagination can run a little wild).

As far as fertility, the urologist likes the numbers and thinks with clomid and now the varicocele treated we may see a further jump. Motility percentages are typically lower with reversals, but most important is total motility and I’m at 20 million motile so I’m approaching a good number. Of course ivf doctor says ivf right away even though several months ago when my SA numbers were 5 million/ml with 20% motility he said no. We plan on giving it 6 months and then go for ivf.

Thanks for the prompt responses guys. I’ve learned a lot from this site, probably the most important of which is patience.

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#6

Yea, I hope you get better over time too.

Was your varicocele embolization procedure considered a success far as made it smaller, less blood flow, etc? Mine didn’t change anything, other than made me worse.

It may have taken longer than 10-14 days for things to go haywire for me. There was a short period of time where I was thinking it was likely going to help me, then while at work one day, all hell broke loose. I used to wonder, what the hell happened, but I’m not sure if anything really happened.

Prior to embolization, laying in bed made me feel better. Post embolization, and after all hell broke loose, laying in bed gave me a lot of trouble, specifically if I laid in my right side. Luckily, most of that resolved over much time.

Do you use caffeine, or nicotine regularly? Just curious, because I am fully aware that those two things at minimum can have a negative effect on varicocele, and thus more pain~. Not eating well, eating bad stuff, etc is said to be bad to.

Hard to say why you have problems sitting in regard to your sitting - blood supply question. Your pain may not be related to varicocele, or blood flow. It’s really hard to say one way or another.

I feel best when I stay active, moving, etc. A lot of the time I’m fine standing around, but I definitely have more issues standing around, or even laying more less flat on my back on the couch sometimes. I’ve tried to make a connection that some of what I’m talking about may be related to sympathetic tone, and/or even my a change in my blood as a result of everything from caffeine, nicotine, and even cannabis. Perhaps my issues aren’t purely related to any of them things, but there are times when I’m almost certain there is a connection.

To much fish oil used to cause me a lot of grief too. I no longer take high doses of it to this day. You might experiment with not doing things you suspect thin your blood, or change its consistency.

I dont have major issues sitting in chairs anymore. I used to post vas, and after my first reversal. No significant sitting issues after my second reversal. Sitting issues post embolization again. Like you, or perhaps more so, I am confident that my varicocele plays a major role in my problems. I was a varicocele pain guy at one point pre vas to, so go figure.

Yea, I agree, 20 million motile should do the trick. Hope that works out, I’d hate to hear your suffering was all for nothing.

Tramadol got me through some really hard times for many years, many years ago. It’s not for everyone, but it works wonders for me with minimal side effects, and I didn’t become dependent either. I used to ramp up on it pretty good while at work, and would remain pain free all evening, until the cycle of madness began the next day.

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#7

And if there was anything I left out, ejaculating is my biggest trigger for a major flare up. That’s been part of my trend since my beginning’s.

Not sure if it effects you.

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#8

I’m now 2.5 months out from the embolization. I had two periods where my pain decreased, week 3 after starting 10 mg of amytriptilline (which was 6 weeks post embolization). Then again, about 10 weeks post embolization I had another reduction in pain. So my theory is that I got nerve damage/entrapment from the reversal surgery and it was made worse by a small varicocele that was adjacent to it. Unless, all my symptom relief was just from the drugs but I don’t think that is the case.

So, everyday I tell myself I’m doing better and remind myself if where I’ve been. But I still have a dull ache/sore muscle feeling all day long. It does bother me more as the day progresses. It doesn’t cripple me by days end like it did before the embolization. NSAID’S help at times, but how long can I really take them for? It seems like the right testicle hangs low and pulls on the tissue throughout the day and friction from walking make things worse. Nerve is trapped in scar tissue?

Next week I met with the urologist. Got my testosterone levels back, about 900 so they tripled. I guess that’s good news. My PCP has been prescribing the medications but she honestly admits this is out of her league. I’m going to ask for a referral to pain management. I want to try blocks (not spermatic cord) of the nerves to identify which one is the culprit. If that works I’m seriously interested in RF ablation if the doctor thinks it is a viable option.

Any thoughts? Should I increase medication dosage? PCP doesn’t want to. Should I try another one, cymbalta? Feel like I’m going through this alone with no one in the medical community willing to quarterback this one.

I am happy with my improvement, but my quality of life still suffers some. Thanks guys for listening.

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#9

Supportive underwear really helped me. As soon as I started wearing it, I noticed a big improvement. I also went onto low inflammation diet with supplements after my reversal (~5 months ago) and still am taking NSAIDs.

Other senior members said it takes around a year to fully recover, so hang tight brother

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#10

Thanks for the reply. I’ve done supportive underwear and it made no difference. I wear a fairly supportive athletic breathable one that works well. I’m almost 9 months out from my reversal, and I never had any pain with my vasectomy.

After posting this, I finally put in for a referral to pain management. I’ve toughed it out for so long, taken a grand total of 4 opioid pain pills, but I’m mentally exhausted. It’s not so much the level of pain but the fact that I have never, for a split second, been pain free since last May.

I eat healthy, take my vitamins. I’ve tried supplements like lipoic acid, tumeric etc. Now, I’ve cut it all out except for the pain medications, and haven’t noticed any increase in pain. I think I’m lucky in that my pain is so localized to one area. As bad as I feel, I truly pray for those with multiple issues.

I’ll try to keep people updated and I also put this as a warning that a reversal is not without complications and carefully consider any surgery you may have.

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#11

You had two procedures back to back so you have a tricky situation. I’m sure you have read it can take 12-18 months for nerves to heal and a reversal to completely heal. I have tried the nerve blocks and early on that were helping me more than lately. I have some scheduled next week again. Who did your reversal since you mentioned choose your surgeon wisely?

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#12

My procedures were 6 months apart, not exactly back to back and the embolization is non invasive in my opinion. I gave myself six months from the reversal before I had the varicocele embolization and persisted through each day with all the strength I had. By month six my daily pain level reached a 9 almost every day. Going for the embolization at six months was smart since it has significantly reduced my pain level. Before the embolization I was about to stop working. I can now work.

I’m hoping that some nerve blocks and maybe ablation along with better guidance with medications will allow me to give the nerves more time. Most mention that 12-18 months, not sure what study it comes from or how it applies to someone like me that had no problems before the reversal.

I won’t mention who did my reversal, but my new urologist has been great. I wish I had someone like him do the reversal. Actually, I wish I went straight to IVF. Reversal surgery is much more invasive than a vasectomy so I assume there are higher risks for neuropathic pain, of which I was never told.

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#13

If your going to try blocks I recommend to make sure they are ultrasound guided which are safer and more likely to block the nerve your after. There are a lot of different kind of blocks to try. I lost count on how many I have had but early on they were reducing my pain 75% for 2-3 weeks. I had PRF no ablation which also helped for several months of illioinguinal nerve. I have been concentrating on the illioinguinal nerve but it appears the GF plays a bigger role in my issues and could be a combination of things in my case. I will be blocking both nerves next week with steroids to see the impact. Trust me I get it and was barely making it to work early after my vasectomy when I was blindsided with pain. I had to work a lot from home. I am at the point now where I can make through work a full day with little worry but still in discomfort. Tramadol helps me the most and breaks the pain cycle throughout the day where I’m pain free at times and when laying around at home. I also do a lot of other conservative things such as Pelvic PT, chiro, and other supplements. I am considering reversal and I’m sure a lot of other guys reading these boards are as well. This is the reason I asked about the surgeon so we know of possible bad outcomes from specific surgeons when making our decisions. I agree it would be good for you to find something to help break the pain cycle weather it be a medicine, block, or whatever works. Super hot baths with epsom salt helps me a lot after work to relax through the night and break pain. My issues are different than most with my worst pains in back and neck and minor pains in groin and testicles.

At least with reversal with a highly trained microsurgeon they are using a microscope even though even with that they can’t see the fine nerves. I think we are all lied to a bit with both the vasectomy and reversal.

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#14

Depending on where the one area is you may also want to try a lidocaine patch you can pick up anywhere if you can put it in this area. You may also want to try heat or ice. You can buy the gel packs you can put in microwave and heat up and place on the spot or they can also be put in freezer for cold. They make them small enough you can put in your underwear if your pain is in balls or lower groin. You can find different variations on amazon. These helped a lot early after my vasectomy.

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#15

Just a quick update. The embolization that was performed six months ago gave me some relief, I now only reach a 5/10 instead of a 9, and I have had a couple of stretches with minimal pain.

I went to a pain management doctor and he switched me to Lyrica, tramadol and nortriptyline. After getting through the first two days of Lyrica making me spacy, I got a lot of relief, even a couple of days with no pain. Now, I’ve been on them for a month and the effectiveness seems to be less. The pain management doctor offered to increase the dosage but I’ve decided to try a ganglion impar nerve block, which was his other recommendation. Has anyone had this done? I’ve done some research and found it is useful for pelvic pain but no mention with relation to vasectomy.

The doctor also told me that peripheral nerves can take up to 2 years to heal. He also said that chronic post operative pain from surgery occurs in 30-50% of all surgeries, but surgeons don’t like talking about it.

I’ll report back in several weeks to let everyone know about the nerve block.

Edit: the Lyrica has removed the diffuse tingly pain behind my testicle and now my main pain is feeling like a pulled and contracting muscle along my vas immediately surrounding the reconnection. I assume a nerve is likely trapped amongst all the sutures and scar tissue. The reconnection is very palpable and much thicker than the rest of the vas.

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#16

It took me about 6 years after my reversal to get to a good place. I was 5 years post vasectomy when I got reversed and I was a trainwreck at the time.

I have posted here before about my magic bullet. I took metformin to help shed a few extra pounds last fall and my nerve pain vanished miraculously. I have ditched the double underwear and now where UFM or Mack Weldon boxer briefs and feel fine.

Having gentle support helps me. Not to much not too little.

I wish I had discovered metformin prior to vasectomy reversal as it might have saved me from that ordeal but I think there was so much scar tissue from my vasectomy that reversal may have been the only way to get pain relief.

You of course had a goal->fertility. That’s a good goal and it’s nice you don’t have to question your decision. You knew what you wanted and why you did it.

All I can say is it can take time. Again for me, gentle support, and metformin are the things that help me. The metformin is a weird and unexpected blessing.

Thanks for the update and hope you keep getting better.

I had issues if I did not use support after my reversal but things feel pretty good now even if I am free-balling for short spells (even if my nuts hand a bit higher, lol).

Hang in there. It can get better.

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#17

Quick update.

Went on vacation and didn’t bring enough Lyrica. The diffuse pain that I’ve had a hard time describing turned in to a very localized pain directly at the vas reconnection. The smallest touch of the reconnection and I had a sharp stabbing pain. When I got more Lyrica, the pain diminished and became more diffuse. You could touch the reconnection without any pain. So, I’m convinced I have a nerve trapped in the scar tissue that forms from the reversal surgery.

I just had my ganglion impar nerve block one hour ago. I feel some relief from the anesthetic. Hopefully when the steroid kicks in I’ll get some lasting relief. It was a super quick procedure. Little discussion of it on here so I’ll report back.

After all this, I’m wondering if the pain persists, do I have the reversal cut out? Seems crazy, but I never had a problem with my vasectomy. I’m going to try and give it 2 years as the pain management doctor suggested. I’m about to reach my one year anniversary next month.

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#18

I never got any sustained relief that outweighed the symptoms of the anticonvulsants Gabapentin and Lyrica.

It took about 5 3/4 years for me but my magic bullet was Metformin, which I took to help me lose some weight. My fasting morning blood glucose was on the border between normal and prediabetes and I was stuck at 217 despite working out a lot so I asked for a script and got one. Within 3 days I noticed a lot of the nerve pain in my groin went away. It was life changing. Metformin every day is too much and not necessary for me. I take it every other day with a day off. I also take breaks which I am on right now. If the pain returns I start up again and the pain goes away. I don’t know how it works but it works and that’s all that matters. Just wanted to share this. It’s a totally off label use for the medication.

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