Post Vasectomy Pain Forum

True incidence rate of PVPS - scientific, jounrnal, PA papers

I am in dire need of research papers, published in journals and/or peer approved, that review PVPS and its incident rate. I have seen many papers and citations spread all over this site, but I am looking for the most recent, most up-to-date, most scientifically precise, published paper that there is on this topic that gives the true rate of occurrence. I hope @RingoStar, @Choohooo, @MikeO, @raising4girls, @SomeGreyBIoke or @Ethan_Scruples have something they can share.

I just need one paper that would be accepted, by other medical professionals including urologists, as a serious source on the topic.

Thanks.

Here is a post that Vic made many years ago with some studies:

Arguably the highest quality evidence so far is Leslie 2007 which, at 7 months, found:

Pain Number Percent of 443
No answer 2 0.5%
Very mild, no trouble 22 5.0%
Mild, bit of a nuisance 31 7.0%
Moderate, require pain killers 6 1.4%
Quite severe, noticeably affects life 4 0.9%

Leslie was a well-designed, prospective study of a suitably large size and response rate. The AUA talks about Leslie 2007 this way:

The most robust study of this indicates a 0.9% rate of such a pain seven months after the surgery.

https://www.auanet.org/guidelines/guidelines/vasectomy-guideline

Note that the AUA blunts the message of Leslie by only mentioning the 0.9% with “severe” pain and not the 1.4% who are still taking pain killers 7 months after vasectomy, which in my judgement is a pretty bad outcome that easily merits the label “chronic scrotal pain” and should be communicated to patients.

This is similar to the bait-and-switch that you often see. Doctors will say that PVP is very rare, and that it is usually resolved by conservative measures. The “and” is the lie. The kind of PVP that resolves with conservative measures is not the rare kind – it probably happens more than 10% of the time. Even severe pain lasting more than 7 months is not “rare” – at about 1% it is on the low end of “common.” I would guess that the “rare” outcome is probably the guy who is getting denervation or epididymectomy.

If urologists want to talk about complications of vasectomy that are “very rare” then I recommend that they tell their patients that it is possible that they may end up with bilateral orchiectomy due to life-destroying chronic pain that fails to respond to other surgical options, and that the orchiectomy may fail to resolve their pain. That would be a “very rare” complication of vasectomy.

AUA also specifically calls out three other studies in their guideline document:


There is also the recent meta-analysis which reviewed a lot of articles published up to 2019. They filtered the published studies down to 18 for inclusion in their analysis and concluded that the true PVPS rate is probably somewhere between 3% and 8%.

The meta-analysis included the four studies already mentioned above:

As well as 14 other studies, here in chronological order:

  • Ahmed 1997
  • Sandhu and Rao 1998
  • Sokal 1999
  • Zambon 2000
  • Black and Francome 2003
  • Chen 2004
  • Manikandan 2004
  • Song 2006
  • Amory 2010
  • Cho 2011
  • Frates 2011
  • Bhuyan 2012
  • Valsangkar 2012
  • Sharma 2014

There could be something else that is more recent or more compelling. I haven’t really put a lot of effort into researching the scientific studies. It is unfortunate that the available studies are not very impressive. It would be pretty easy to replicate Leslie on a shoestring budget. Recruiting participants would be the hard part, but it seems like that part would be pretty easy for urologists if they were interested.

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The latest meta analysis (scientific search and collaboration of recently published literature) was last year 2020.

Conclusion: “the incidence of post-vasectomy pain is higher than previously reported estimates.”

I usually refer to the article in the British journal of urology below…

I believe there was an article published 2-3 years ago.

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To the best of my knowledge the most recent paper published on the topic you are inquiring about has been brought up twice in this thread already.

Unless you want to cherry pick data from other sources, which many references have already been brought up by Ethan, I would stick with the most recent data and perhaps work your way backwards.


Even the most recent data will not change the minds of countless urological monsters that are basically pvps denier’s.

I won’t mention any names, but there was an example of what I am talking about brought up not long ago in a video posted on this site. At least one of those monsters is sitting there shaking his head back and forth denying pretty much all of the data that has already been posted in this thread. According to him, pvps is an extreme rarity. According to him, pvps is far and few in-between.

Things start getting squirrelly as to how one defines pvps too. Some very experienced urological associates seem to be making it up as they go - seemingly because there is data that suggests that men that had a very painful recovery for many months, years, etc, were questioned about their outcome many years later, and such data “suggests” that a large percentage of those men are actually happy with their outcome many years down the road. Pvps denier’s like to mix that kind of data up with the actual truth. At that point, people that are unfamiliar with what is really going on beforehand get the wrong idea as to what is really happening and what isn’t. Hardcore advocates for vasectomies like to twist data in such a way and in other ways.

That said, I’m not sure who you plan on showing such studies, data, etc, to…

Hope that helps - good luck.

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If my urologist, instead of breezing over and downplaying chronic pain, described it as chronic debilitating pain that would more than likely require surgical intervention with a rare but possible chance of no resolution… well then I would definitely have rethought my decision.

Here’s an article that sums up a couple of studies.

Anyways, good luck on what you’re likely after.

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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:

https://www.reddit.com/r/postvasectomypain/comments/po3c51/luan_the_sperm_is_trapped_and_pressure_cannot/

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.

https://groups.google.com/g/alt.support.vasectomy/c/2TYNErkNzNY

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Add to this the guys who got it done and didn’t have problems. I see a lot of that on Reddit. They aren’t helping the dialogue with comments like “It’s not a big deal,” or “I healed up in two days; I love it,” or words to that effect. I think the thread running through this site is spot on. You just need the information to make a correct decision. If you want play Russian Roulette for the benefit (or, in my case, being pressured to do it) of being able to have guiltless sex
, go for it. If I had had the information now available, I never would have done it. I would have bought a big box of condoms.

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