Post Vasectomy Pain Forum

Satisfactory messaging from medical authorities

I just wanted to call attention to some of the best examples I have found of medical authorities talking about the risk of chronic pain caused by vasectomy. We see a lot of examples doctors failing to give adequate warning, so these can be, if not totally satisfactory, at least somewhat refreshing. Hopefully they are the leading edge of a change to a higher level of awareness if this problem and disclosure to patients:

From the European Association of Urology

Post-vasectomy scrotal pain syndrome is a scrotal pain syndrome that follows vasectomy. Post-vasectomy scrotal pain syndrome is often associated with negative cognitive, behavioural, sexual or emotional consequences, as well as with symptoms suggestive of lower urinary tract and sexual dysfunction. Post-vasectomy pain may be as frequent as 1% following vasectomy, possibly more frequent. The mechanisms are poorly understood and for that reason it is considered a special form of scrotal pain syndrome.

From Yale Medicine

Following the procedure, there is a small risk that you’ll have bleeding or infection. Many men also experience minor achiness for a day or two. Although most patients experience no long-term discomfort after vasectomy, about one percent of men encounter post-vasectomy pain syndrome, which means they have an ongoing ache in the scrotal area.

From Pollock Clinics

Congestive epididymitis resulting in swelling of the epididymis, which is where sperm is normally stored (1-3%). This almost invariably resolves with anti-inflammatories, ice and rest.

Sperm granuloma is a lump made of leaked sperm that develops at the site where the tube was blocked. Sometimes this can become painful (1-2%). It also almost invariably resolves with anti-inflammatories, ice and rest or may require a local steroid injection.

Chronic post-vasectomy discomfort is a rare complication of pain in the scrotum that can persist for months or years and may interfere with quality of life. Medical or surgical therapy such as vasectomy reversal can be effective, but not always, in improving this pain (1-2%).

From Advanced Urology Institute

Other risks and complications are related specifically to these procedures and, although they are not likely to occur, it is important to know about them. They include a painful inflammation in the testicles known as congestion. This might take a few weeks to appear and is usually temporary. However, in rare cases, the pain may last forever.


Exactly what I’ve been going through.

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There is a pretty good job in the recent Mayo Clinic video:

There is also a 3% risk of chronic testicular pain. This can range from an occational dull ache to a severe pain that makes it difficult to do your daily activities. If the pain is severe, you may need surgery to reverse the vasectomy or to cut the nerves that go to the testicle. This will improve the pain in most patients. Men at greater risk for chronic pain after vasectomy are men who have had prior surgery in the groin or scrotum, or men who have a history of chronic pain, infection, or trauma to the scrotum.

I’m liking the 3%, which is higher than the AUA 1-2% but not quite up to the 3%-8% from the recent meta-analysis. Also liking the point about you might need surgery, and it will improve the pain in most patients. This sounds like reasonable language to me.

Not perfect though:

Vasectomy doesn’t affect your sex drive or your testosterone levels. It also doesn’t affect ability your ability to get or maintain an erection or to have an orgasm. After vasectomy, you may ejaculate less fluid, but most often men won’t notice because sperm make up such a small part of the ejaculate.

So chronic testicular pain doesn’t affect your sex drive?

Vasectomy is a safe, cost effective, permanent form of birth control…

So a procedure with a 3% chance of giving you chronic testicular pain is a “safe” form of birth control? I guess we can agree to disagree there. I wouldn’t call a chair that gave 3% of men chronic testicular pain a “safe” chair. I get that they are comparing it to tubal ligation in this video and “safe” is a relative term. Even so, it seems to me that vasectomy is arguably “safer” than tubal ligation, but that doesn’t necessarily make it deserve to be referred to as “safe.”

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Imagine if 3% of airplanes fell out of the sky? I’ve gone through a lot of quality assurance training, and elite companies measure their defects per-million, not percent (per hundred). The whole Six-Sigma craze is based on bad outcomes per hundred attempts not being sufficient.

If any elective surgery is proven to make victims out of 3% of the takers, it ought to come with warning labels like those on cigarettes.

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elite companies measure their defects per-million

But what’s 4 orders of magnitude among friends…

As a benchmark, only 1.5% of space shuttle missions didn’t return to earth in one piece. I guess that’s a pretty safe way to travel according to Mayo Clinic.

The immortal George Orwell called it doublethink.


Second-hand report of how Dr. Stewart McCallum describes PVP in this old news group post:

Jul 22, 2003

The doctor is Dr. Stewart McCallum, a urologist at Stanford Hospital, who “has extensive experience in performing complex vasectomy reconstructions, sperm retrieval techniques and microsurgical varicocelectomies.” (according to the website [1]). He normally performs closed-ended NSV vasectomies.

He started talking about his duty as a doctor to do no harm, and how he always avoided performing surgery on healthy people. He then went into great detail about the risks of PVP syndrome (I was thinking, this is great! I read on this newsgroup how many doctors just seem to skip or gloss over this). He said the incidence is less than 3%, but then he really emphasized, when you get it, YOU DON’T CARE ABOUT THE STATISTICS(I’m emphasizing this with caps to reflect his emphasis). The intern then repeated the same thing. She said, when you get it, you get it 100%. She said there is no standard effective treatment for PVP. The doctor said when they treat a patient with PVP they aim for 60% pain reduction as their goal. The intern piped up with “enough pain reduction so the patient can return to work.”

The doctor said think about it, these are your testicles. He said he has had problems with his back, but he can find a comfortable position to sit in to avoid the pain. He said how are you going to avoid pain in your testicles? They’re swinging all over the place; there’s no way to get them into a comfortable position. He said “What are you going to do, tape them to your thigh or your abdomen?”

Throughout this both of them had a sympathetic tone in their voices and a cooperative attitude. They weren’t trying to scare me; they were educating me.

The doctor said that not any of his vasectomy patients have had PVP yet (knock on wood), but the statistics predict it will happen some day. He said he has had many patients come to him with PVP that had vasectomies elsewhere. He said that when patients don’t respond to pain, they often remove parts (such as the epididymis), and sometimes it’s so bad the patients have the entire testicle removed!

He said patients will sometimes have pain every time they ejaculate, and they often lose interest in sex, for simple Pavlovian reasons. They associate sex with pain.

I asked about the open-ended procedure as a way to minimize the risk of PVP. Both the resident and the doctor were familiar with it and responded that it increases the chance of failure. At any point in the future, they said, the vas could reconnect enough to make the man fertile again. The doctor also discussed how sperm getting dumped in the body can trigger an autoimmune reaction and cause inflammation.

Bravo Dr. McCallum! :clap::clap::clap:

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He’s the group’s Employee of the Month.

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