I still vividly remember my pre-op counselling. The uro mentioned that there was a small chance of chronic pain, but, as she said, “we don’t do anything for that.”
She said that one of her former patients had some mild ongoing pain, and she gave the example that he would sometimes get out of a truck and feel an uncomfortable twinge. She mentioned that another of her patients regretted getting the vasectomy due to chronic pain. Then she said that the incidence of such chronic pain was 1 in 2000.
I completely misread everything about that conversation. For one thing, I should have instantly called bullshit and asked her if she had performed 4000 vasectomies, since chronic pain only happens every 1:2000 and she already had two bad outcomes.
For another thing, when she said “we don’t do anything for that” I interpreted it to mean that it the kind of pain that wasn’t worth doing anything for. The kind of problem that maybe reminds you you had a vasectomy when you bounce out of a truck too hard. I didn’t parse that as “we will not have any solution to offer you so you will just have to live with it no matter how bad it is.”
I followed up with her later by email about the pain I was having and in her reply she said:
“I am sorry to hear that you have had such a severe and persistent pain problem since the vasectomy. I would suggest you see my partner ___ at ___ to consider a denervation surgery of the spermatic cord. It has offered pain relief for some men with a problem such as yours.”
I wanted to reply and remind her that prior to the vasectomy the message was that they don’t do anything for the post vasectomy pain, but now apparently she has this partner two hours away that sends people with problems such as mine to. Maybe when she said “we don’t do anything for that” she meant “at this hospital. You have to go to a specialist.”
Anyway, the vasectomy was not botched, but the pre-op communication was completely botched. The incidence was wrong. The description of the range of impacts was wrong. The language was confusing. This stuff needs to be standardized like they do with a black box warning on the outside of a pack of cigarettes to avoid future screw ups.
SURGEON GENERAL’S WARNING:
Vasectomy carries at least a 1-2% chance of daily scrotal pain which reduces your quality of life and/or enjoyment of sex. This condition may be permanent and there is no reliable cure.
If they included that in the consultation though I bet some guys would literally walk out of the appointment as soon as they read it. Probably something like half of the guys would cancel their surgery date. And assuming that is the case, it would imply that the information is extremely material to the man’s decision and failing to deliver it is a gross violation of his rights.
Urologists need to realize that their own industry has spoken publicly in a way that has created a false impression about how safe this surgery is, and consequently to properly obtain informed consent they must work extra hard to communicate in a way that cancels out this misinformation and corrects the false beliefs that the man is likely to have when he arrives. If they fail at this task, the false public reputation of vasectomy will do the dirty work of misleading the man.
I recently abridged a story from “Luan” – a really interesting guy. You can read his profile here:
What he wrote in 2005 seems like a good description of the urologist who fails to fully inform their patient about PVP before surgery:
This vasectomy business reminds me of some Sky Diving I did in Alaska back in the 70s. The old hard core guys in this club were a little strange with their humor. If they saw a man pack his chute incorrectly they would not tell him. They just watched when he jumped again to see what would happen. Of course we all had reserve chutes and could survive a malfunction. However, I DO NOT need friends like this! I think it is like this with vasectomy. Don’t Tell and then see what the poor unsuspecting man will do when he MALFUNCTIONS! It is like playing Russian Roullet… the poor ignorant guy who shots himself in the head is a joke and he USUALLY doesn’t talk either! PVPS has been PART OF VASECTOMY since day one! 50 years of this big joke is about enough I hope.