Post Vasectomy Pain Forum

Size of epididymus on ultrasound - theory?

10 weeks after vas, still pain. Pain feels definitely as congestion - it is laser focused on the epididymus, and varies from side to side. One day left, other day right.

I’m a radiologist myself. I’ve probably seen thousands of both healthy and sick testicles and epididymuses on ultrasound. They normally have a wide range of sizes. And I’ve definitely looked very closely on my own. I’ve noticed that my epididymuses are quite small and thin, even now 10 weeks in, compared to what I consider the normal thickness of it. Possibly because of my quite frequent ejaculations before surgery (1-3 / day). I wonder if that could be part of the cause for why I still have pain?

The epididymus is really just a very long coiled tube, mashed together like a lump of spaghetti. It’s function is to mature and (short term) storage of sperm.

My own quasi-medical theory, which I have no papers to back: When the vas is cut, if you have a decent sized epi, it will be more robust to absorb the immideate pressure build up and most people won’t feel anything. But if they’re small and slim, the rapid pressure build-up can become too much for it to handle, and it becomes painful. Ejaculations will also cause the epididymuses to contract, increasing the internal pressure and cause increased pain. I wonder therefore, if a possible conservative route away from the pain, is to stop ejaculations completely for, idk, months?, to allow the epididymuses time to gently adapt and increase in size without the extra pressure stress of ejaculations.

Does this sound far fetched?

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That’s interesting. I don’t have a ton to compare too but I know my testicles overall would probably be described as a little smaller then average. Interesting theory. I just don’t know how I could go months without a release hahhah. Seriously a week is pushing it for me. If I go reversal you have to wait 2 weeks minimum and I already think about how I don’t know how I will be able too hahaha.

Yeah, not saying it would be easy to keep ‘hands and wife off’ for that long. Though I am motivated to at least try, if there’s some anecdotical evidence it could have a benefit. At current, the pain increases for days after ejaculation, and I always regret it in the days after.

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I kind of experienced the opposite. Not ejaculating frequently early on did not do any good. More frequent ejaculations seem to help me with pain. An obvious change noticed is the viscosity if the ejaculate has come down, more to a pre-vas state, and immediate pain after ejaculation lasts shorter. Don’t know how to make sense of this.

Interesting theory @stk. I didn’t think it sounded far fetched at all. A decade ago, back in my early days post vas, I remember some avid PVPS researchers commenting that men who ejaculate frequently and always have, seem to get worked over, messed up, etc, by congestion related complications more than others. Their comments were based on their observations reading vasectomy pain forums.

The men that were making those observations nearly a decade ago refered to men like myself and many others as jackrabbits. I knew what they were getting at, and I’m not thinking that being a jackrabbit makes anyone a bad person, abnormal, something to be ashamed of, or anything of the sort. I can only speak for myself, but my schedule seemed pretty natural to me.

I feel confident saying that we are not all the same either. There is data out there regarding what an average man’s sperm count is. I never had any pre vas semen analysis done, but while I was fertile, my post redo reversal SA numbers were considerably above average.

I was never one of those guys that didn’t ejaculate frequently. My epididymis’s never really knew what spermatic congestion was. I suppose I may have experienced some epididymal hypertension in my life - AKA blue balls, but never really experienced these things on a significant level until I had a vasectomy.

Even after nearly a decade of married life, if my wife wasn’t into it for whatever reason, there was a good chance that I wouldn’t be able to get to sleep if I didn’t get a release, and I would have to take care of business myself. That was my norm from age ~13 all the way up to age 35 when I had a vasectomy. The vasectomy certainly worked me over. I certainly regretted it.

I’m not sure if the study below is relevant to this discussion, but I tend to think it is. Whatever the case, it’s more proof that us men are not all the same in that department, and it’s certainly interesting. I think size could very well be relevant to many related discussions, including reversal failure.


I drifted off topic a bit in regard to how size may also be related to reversal failure above. Figured I’d post a legitimate link to such information. I can’t say if size is relevant or not, although I do have some curious thoughts.

On a side note, in over a decade of making my own observations, I don’t think the vast majority of us men knew our testicles as well as we thought we did, and that includes myself. That goes for men that thought they were very familiar with themselves too.

Obviously there isn’t a one size fits all answer to many topics on this site, but I found your OP to be very interesting @stk.


This describes me pre vas too lol.

A couple thought to add. One, sustained epididymal pressure will ultimately lead to thinning of the wall, much like that of a balloon. Of course the pressure isn’t always there but perhaps it doesnt go back to normal.

Two, which I think is more likely, the epi is a muscle with small contractions to push sperm out. As with any muscle, quit using it or surgically sever it and naturally you should expect a bit of atrophy.

I agree. But - IMHO - after a vasectomy, the muscles in the epi are no longer needed. You’d actually want them to atrophy, to avoid painful pressure peaks at and after ejaculation. If you could achieve that, without them bursting and creating granulomas and other mess, you could in theory become one of the happy vasectomy guys. But if you have a reversal later, atrophic muscles in the epi will be a downside, cause the epis will be less able to push the sperm through (?). This isn’t easy…

Here’s a few more links that contain information that is relevant to this topic.

“Vasectomy: When the vas deferens is cut to prevent the sperm from passing through, the side coming from the testicle was traditionally closed, though the standard of care now is an open ended vasectomy (see section on open ended vasectomy). This leads to build up of pressure in the thin walled epididymis which can then blow out and subsequently scar down. This is relevant for men who are seeking to have children after having a vasectomy, and are considering a vasectomy reversal”.!

Thanks man. If you have more literature you could recommend, I’d be grateful. I have an idea brewing. A big one. It needs to mature for a while before I share.


I haven’t had much free time to do research that is related to this topic lately, but I did come across this.


So far it’s better. Week 11 post-vas now. No sex / ejaculations for a week. Pain is almost gone on the left side, and very reduced on the right. Sometimes it’s just an itch, which I interpret as the epi’s “growing”.
I will continue this no-ejaculation strategy at least out the month. I will also continuously monitor my epididymuses with ultrasound, and see if they gradually increase in thickness. Doubt many have done such monitoring before. Has it any value? Who knows.
My philosophy at this point is that anything that causes increased pain (trauma, orgasms), should be avoided for a long time, and those times I do have pain - at night mostly - I will smother it with painkillers (Tramadol 50 mg). In the hope that my scrotum can “forget” the pain. Then we’ll see what happens when I start ejaculating again. I can live with no sex for a while, if that increases the hope of less pain in the long run.

Yeah, the inhomogenous echo pattern is something I’ve seen in patients as well. I interpret it as increased volume of fluid / sperm within the enlarged tubules of the epididymus.

So, the idea I had 10 days earlier - no sex for months… failed. After a week and a half I had such intense pressure in prostate area, that I just couldn’t stand it any longer. Had sex, was almost pain free for a few hours immideately after. Then - as anticipated - the next day I got pain intermittently in both epididymuses. Could hardly do any work friday. Pain has lasted three days now, slowly declining. When it comes to sex / ejaculations, it seems I’m damned if I do, damned if I don’t.

I wanted to say something, but figured I’d wait and see how your plan worked out for you.

Yeah. Next time I write something you think is stupid, feel free to call me out.

Haha - I had a feeling it might not be the best option for someone like you, but I wasn’t sure. I didn’t want to rain on your idea, or taint your thoughts with some sort of subliminal predictive programming that manifested into reality somehow.

Sometimes abstaining seems to help some men. The thought process, ideology, etc, has been around for well over a decade.

My epididymuses hasn’t grown either, as far as I can measure on ultrasound during this last month. The idea that they will grow from abstaining from sex is maybe stupid. Idk. I’ll see the following months.

I have never heard that abstaining would cause the epididymis/s to grow. The general idea behind abstaining is to avoid the ejaculation process.

Could abstaining cause a buildup of fluid within the seminal vesicles, prostate, etc? That sure seems very realistic and plausible to me.

I forget exactly what week you are at post vas, but in my case, I certainly looked heavily congested around month ~1.5 - 2.0. Knowing what I know now, that engorged look to everything could have been more related to inflammation in general that was being cause by various things. I was already leaking sperm bilaterally by this period of time and the lump sure hurt like hell on my left side. I had a lot of crazy stuff happening.

By month ~2.5 - 3.5 I didn’t look so inflamed, engorged, etc, anymore. I seemed to be getting better, but I was getting worse at the same time. By then, my pain had morphed into what many describe in pain forums like this one. My epididymis/s didn’t look engorged anymore. In fact, they “seemed” smaller. I was still having some crazy pain episodes. By then, I felt completely hormonally out of wack like never in my life. I felt like something was sucking the life out of me.

Anyway, this isn’t about me. I prefer to not remember anyway.

Hope that helps.

Sorry man was hoping you were on to something. I’m 8 days now and things are about the same for me as well…