Post Vasectomy Pain Forum

Undecided on post-vasectomy surgery options

I have read this forum for years (basically just before my vasectomy, I should have trusted my gut), but here is my turn to come for help. First I’ll vent a bit with my story.

I got a vasectomy in 2018, it was intensely painful during the surgery and I asked for additional pain relief in the middle of it. The surgeon said it was not possible to feel any pain, but there I was crying and squirming. I always had a high tolerance to local anesthetics it seems.
I could feel a bit of the local pain, but also pain shooting up towards my stomach. I was white as a ghost after surgery, the nurse was very worried for me apparently. The pain was intense and disabling for months on end, it was hard to walk more than a few hundred feet even after a number of weeks of recovery. Recovery took many months of waxing and waning pain, easily 6+ to feel a bit more normal.

Then I had a few ‘ok’ years of much less pain, much more like sensitivity and an occasional set back.
The biggest difference was I just never felt the same again since that surgery. Immediately afterwards and to this day there is a tightness around the base of my penis, it feels strangled at times. My orgasms are different, sex is different. All of the things that I was promised to remain normal…

Roughly a year ago now, some pain started to come back, slowly but surely things really didn’t feel great. Shortly after that, one night during sex I had major discomfort and nausea set in. I lost my erection almost immediately and pain started to set in the coming days.
Immense, life changing pain. I literally could not function, hold conversations, eat. It was terrible, finally after a couple of urologists I got on a strong dose of gabapentin which helped me at least get to the point of minimal viability as an adult and father.
I’ve been in this limbo of pain and uncertainty, and I feel like sometimes that I am a disabled person. It’s hard to go for walks, I can’t do anything athletic except maybe occasionally swim. Forget about trying to be an active father. Plus sex is really just sad now. I actually find my self now trying to not think sexually at all, because it’s simply more pain free.

I’ve tried the regular kind of relief stuff, antibiotics and NSAIDs.
Then cord blocks, oh boy were those crazy painful during the injection process. I am just so tender down there. The first did seem to help with pain maybe to the point of 80% for about an hour-- but sometimes I wonder if it was simply me being super enthusiastic. After it wore off I had increased pain for 2+ weeks.
I then tried a second block mixed with a steroid and it went awry it seems, caused tons of pain and never any relief. More pain ensued and easily lasted 3+ weeks.

Really any examination, or touching, causes 8-10 pain for days on end it seems, but the cord block after effects were just not worth it at all.
I also tried things like pelvic floor exercise (no relief), alternative medicines (some of which I found on here, sometimes very tiny relief but never consistent for me to suggest using), and acupuncture multiple times a week for months (a waste really).

After tests and attempts, I’m at the point of reversal, denervation, or maybe both…

I have local pain which I attribute to congestion, I also have sharp shooting pains up into my abdomen (often) and to my anus (less often), leg (rare), and penis(also rare). I know it has flared up bowel issues, and I’m trying to figure out how to basically supplement what I am now losing in nutrients.
I also have vague but strong pain on one side that causes me to feel nearly disabled because I now literally hobble around and walk with a weird gate to prevent any additional discomfort. I am literally in 24/7 pain for nearly 10 months now, plus good ol’ nausea and often IBS too. I find my self tearing or straight up crying sometimes. Occasionally, I find my self almost doubled over in pain and I think it’s just getting worse some how. At least a few times I fell to the floor in sharp pains.

I have seen multiple urologists/surgeons at this point.
Denervation is a common topic it seems, not without risks obviously. I’m basically terrified of the idea, it seems extreme and I feel like it doesn’t really fix the underlying issues which are constantly brewing.

One surgeon in South Carolina is absolutely adamant that reversal is the only way to truly alleviate pain. He in particular performs a handful of reversals a week and 1-2 in a month tend to be for pain relief. He’s been operating for the last 30+ years with 100% success rate at reversal (offers no post op care).
A point he made during my call with him is that sedation and local anesthesia is better during surgery than general since a ventilator would technically move my testicles under while operating which is less than ideal.

I was a bit gun-ho to go for it, just based on his confidence, but I just saw the most highly regarded urologist/ surgeon I could find, based in NYC. He was very knowledgeable during exam (but said I simply have congestion and nothing out of the ordinary) and his suggestion was start at denervation. He did also offer up a reversal and that he would also perform denervation at the same time in my case (his idea).
He was highly confident that there would be zero issues from the denervation as he is highly skilled, but there is a chance of permanent minimal numbness at the area and surrounding area (including a bit of my leg).
He had statistical rates of pain-relief success that was just around 70-80%, which I think is simply the rates everyone seems to refer to at this point. He performs 1-2 reversals a week with 100% success rate of connectivity, also been doing it for 30+ years.
I was in so much pain from the examination that I couldn’t think straight, but I’m going to inquire about his denervation success rates versus complications soon as I get a chance.

Obviously I want the best course of action but I’m at a bit of cross roads and it all seems a bit like a crapshoot.
I lean heavily towards the guy in SC, with the reversal; simply because his confidence was so high at my overall recovery, it also seems the least likely to cause permanent irreparable damage.
Part of me thinks that the vasectomy is going to have long term effects like testosterone issues, or maybe something else, and that denervation may not alleviate my issues of stomach nerve pains or bowel issues-- maybe nothing from a urologist will though…
I’m also a bit nervous about long term effects of denervation. The NYC guy told me no major effects, but that the nerves can grow back and a second round may be necessary. He was highly confident about removing nerves one by one, and that the process is easier and faster to heal from than a reversal.
Has anyone knowledge of a reversal WITH a denervation performed as well?

Appreciate any words of wisdom (any at all, general or specific) or ideas I need to further research!

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Sorry you are here but feel welcome to the group. Much of what you describe resonates with me, starting from pain right at the surgery to your pending decision how to proceed further. I’m at a similar decision point on my path but I only consider a reversal not a denervation. I have consulted with some surgeons, including Dr P, and all but one recommended a reversal to start with. I’m on Lyrica and the pain is manageable but I feel disabled, too, and pain has steadily increased the last year. I recommend consulting with Dr P. The one surgeon who was hesitant about a reversal gave it a 50/50 chance. He is experienced, in his 60ies, but recommended cord blocks before as an indicator of success. I’m shit scared of them and I won’t get them. His reasoning is that he thought the main benefit from reversal is from cleaning the stumps of the cut vas and cauterizing some nerves when doing that (as I recall, I might be wrong), and relieving congestion is an added on bonus. He called it a “mini denervation” when doing a reversal. I’m not sure if that is the default way to do a reversal, but I read there is different ways to do it, so I really don’t know. I believe there is lots of sense in removing scar tissue. I believe that is also what Dr P thinks and as far as I understood from eg IVRC (Dr Marks), they do too. Maybe someone else who had their reversal with them can chime in. Please keep us posted!

So the NYC doc got back to me and had this to say:

The initial success rate in recent vasectomies (under 5 years out) is over 95% return of sperm. Of those that are initially successful, 15% shut down at 6-12 months post op.

Has done 25 denervation in 35 years. Last one was 6 months ago. About 70% relieved most of the pain. No surgical complication. Zero risk of losing testicle (if he performs surgery)

Bear in mind that if you get a reversal, you can go back and do a denervation later. If you get a denervation, you cannot do a reversal later.

Edit: Apparently there is a targeted denervation option that would not preclude a reversal in the future.

Hi, thanks Ethan. This NYC guy was pretty adamant that the denervation could preclude a reversal and I should start there. Do you have a link that I could read regarding your statement?
My gut says reversal then denervation later, if required.

Who’s the NYC guy? Marc Goldstein?

I was basing my statement about not being able to get a reversal after denervation on Dr. Helo’s video:

Start at about minute 7:30

Someone sent me a PM about the targeted denervation option. I didn’t look for a source for that one.

Personally, I would be hesitant to put too much weight on a surgeon’s assurance that they can spare enough tissue for you to have a successful reversal later. This is not an exact science to put it mildly.

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Yes, that’s him. The feeling I got was that he does not have the latest and greatest knowledge on PVPS, but has a good handle on it from past research. He was unable to answer some of my pain related questions such as radiating pain (does not know, might be irrelated), orgasm changes (psychological) etc.
Do you have any input on him?
Thanks

That’s interesting thanks, I can’t seem to find any articles on this but it definitely makes sense.

Goldstein is a really nice guy and I think it’s really cool that he was a Air Force fighter pilot too! Over the course of 2 visits the most treatment he suggested was warm baths. At that point I was 2 years into having issues and had seen several doctors who had me try several different treatments. Warm baths weren’t going to fix anything, although I tried. Spoiler alert… they didn’t fix me. Maybe he has a very methodical approach and subsequent visits would have bore more fruit, but his office was a 5 hour trip for me and it wasn’t feasible to keep making that drive without guarantee of some progress.

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@Ethan_Scruples doc got back to me and claims denervation can precede reversal. I do believe in what you shared with me, it definitely resonates with my mindset on all of this. My gut says reversal, which may also help my orgasm and general well being-- doc also said denervation unlikely to fix my radiating pain. I think he has low hopes for reversal for my pain, despite being a reversal specialist.
Going with gut now, looking for reversal. Thanks for the nudge… now to find a way to break this to the lady :grimacing:

Thanks for sharing your story @thatoneguy.

I am the person that sent the PM in regard to - it has been known for over a decade that a man can have targeted denervation first and a vasectomy reversal after the fact. In fact, that philosophy used to get pushed pretty hard by a specific well known pvps doc a ~decade ago. I am personally not a fan of that protocol myself. I’m not sure if that perticular pvps doc still pushes it like they used to either. Whatever the case, obviously some urologists still push that methodology, philosophy, or whatever you want to call it.

There is at least one member on this site that gave a similar philosophy a whirl to no avail. He didn’t have a reversal and targeted denervation done at the same time, but he had the targeted denervation and a varicocelectomy done first and moved onto a reversal after the fact. Again, to no avail. One can only wonder…


I figured I would let others chime in here before I said anything. The first thing I noticed in the OP was the guy in NYC moreless saying that no side effects, nobody made worse, etc, from the seeming “targeted” denervation, but in some of the same sentences he is seemingly referring to potential numbness in the surrounding area, leg, etc, side effects are possible. There definitely seemed to be some double speak going on there. There is at least one such review on this website. TBH, I feel pretty confident saying that there are numerous such reviews.

I have always liked the sounds of Dr Daniel in the Carolinas. I assume that is the VR surgeon you were referring to. He has been brought up numerous times on this website by several members. If it is him, I’d be interested to know what his opinion is about targeted denervation as a singularity, and his opinion on having it done at the same time as a reversal.

I can only assume the guy in NYC was suggesting a bilateral targeted denervation and a bilateral reversal at the same time? Whatever the case, that sounds rough.

On a side note, I have always been a bit skeptical - or I have had several concerns about having multiple procedures at the same time. For instance - if you end up worse off, which one made you worse? If it helps, which one helped?

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Appreciate the candidness. My gut really says go for reversal as a first step. It was Daniels I spoke to, we only ever talked about reversal-- he was adamant that’s the best course, in a general sense. I’m at a point where I want to find a reversal surgeon that is well aware of pain, I guess the NYC doc was one last opinion I needed. I do find it interesting and concerning how these doctors can have such different opinions. Thanks again for your input

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So I have given this great thought and I’m about 10 months of agony and despair, preceded by years of off and on pain since day 1 and loss of great orgasms, urinary drips where I am totally convinced something is messed up with my prostate, etc etc, I feel this is best choice for me.
I have considered a reversal for nearly 3 years now following what I consider to be a horrific vasectomy experience, knowing it isn’t a silver bullet but I feel very helpless and just want my body to be as close to factory original as possible. Sometimes hope and time are all we have in the moment, but I’m going to take my first surgical step for recovery. I’ll probably start a log in another thread for perusal.

I do wonder about this statement from Dr Daniels website (https://www.carolinavasectomyreversal.com/faq):

"One factor that is very important with regard to the success of a vasectomy reversal is how the vas is actually put back together. There are some physicians who use glue to reconnect the ends of the vas. In our opinion, surgical glue lacks precision and has not been approved for internal use. Others place 4, 5, or 6 sutures around the vas. This is what we commonly see on the reversals that have been performed elsewhere that we are asked to re-do. Placing 4, 5, or 6 sutures in the repair will not be water tight and it does not adequately hold down the lining of the vas, which can lead to scar formation and failure. This is actually the most common reason we see for reversal procedures that have failed. Absorbable sutures used to reconnect the vas also commonly fail, mainly because they dissolve with an inflammatory reaction causing scarring inside the vas. We only use absorbable sutures to close the skin incisions, allowing you to leave without needing to make a return visit to have them removed.

We always use very small permanent sutures to reconnect the vas as they are the least reactive with the tissue and as a result cause the least amount of scar. We purchase only the finest suture available. We never purchase suture that has passed its expiration date or has been re-sterilized and might be brittle or inferior in any way. Dr. Daniel will place between 20 and 30 extremely small sutures around the circumference of the vas. This allows for a more precise and water tight closure. Although on rare occasion, scarring can still develop, the likelihood is significantly less than when one of the other techniques mentioned have been employed."

I could find no such information from ICVR - Dadsagain.com
Does anyone know if that is also the case (suture type, amount of stitches, suture pattern)? Is this a ‘typical’ of higher quality reversals?

From here

https://www.dadsagain.com/questions/

21. What size sutures does the surgeon use for the inner layer of the vasectomy reversal?

“The most up-to-date technique that we teach is to use six to seven stitches of the tiniest 10-0 (the higher the number, the thinner the sutures) Nylon micro sutures with a 70 or 100-micron needle on the innermost layer for every vasectomy reversal. It is critical to use the smallest suture thickness on the smallest needle that will do the job. Larger, thicker sutures and needles cause more damage to the tissues, with concerns for increased inflammation and scarring at the connection sites, so a higher risk of delayed failure of the vasectomy reversal. I understand that there are doctors that use thicker 8-0 or even 7-0 on the inner layer. ICVR’s doctors will only us the most delicate 10-0 microsutures to give each patient the very highest vas reversal success rates.”

From here

https://www.dadsagain.com/vasectomy-reversal/

“A correctly performed microsurgical vasectomy reversal is one of the most technically challenging surgeries in urology and perhaps all of medicine (2). The goal is for the urologic microsurgeon to precisely reconnect the previously damaged and surgically prepared ends of the vas together in precise 3 to 4 layers by placing more than 2 dozen delicate individual microsutures under a high-power surgical microscope.”

Ah great thank you, yea I gathered the suture size and type were likely the same, but that second part mostly answers how many and probably the pattern/technique is the same. I’m operating under the assumption (yikes!) that this is likely the current favorably practiced method but thought I would compare anyways.