Most men who undergo vasectomy have no difficulties, but a small group of men develop chronic testicular or epididymal pain after the procedure. This post vasectomy pain can start immediately after surgery, and is usually due to a sperm granuloma (inflammation at the vasectomy site) or infection. Most cases resolve with the appropriate medical therapy.
Occasionally, chronic pain may develop after the vasectomy, and be exacerbated by ejaculation. This pain is thought to be the result of back pressure building up in the epididymis and is known as "post vasectomy pain syndrome."
Most doctors who perform vasectomy are unaware of the condition of post vasectomy pain and don’t offer appropriate treatments. Some even tell patients that the pain is “in their head” and they should just learn to deal with it. Other doctors refer patients to pain management clinics who can only offer temporary solutions. Groin or spermatic cord blocks rarely provide more than a few hours of relief.
Post vasectomy pain is not uncommon for a few days. This is usually well controlled with ice packs, medication and rest with most patients returning to work within 2 or 3 days. When scrotal pain becomes persistent lasting more than a few months it is considered to be post vasectomy pain syndrome (PVPS). This condition interferes with daily activities and negatively impacts quality of life. Treating it requires an accurate diagnosis of the source of the pain so that treatment can be focused on the exact problem.
Dr. Werthman has a well earned reputation treating difficult cases of post vasectomy pain syndrome. His patients have similar experiences of being undertreated or just being treated for pain. While relieving pain is vital, finding and handling the source of the pain is the focus of Dr. Werthman’s treatment method.
He has performed thousands of vasectomies and is an internationally recognized specialist in male fertility and reproductive issues. His compassionate understanding of the life changing issues connected with post vasectomy pain is appreciated by his many grateful patients who have finally found relief from this syndrome.
Pain can be experienced as dull or sharp, localized or general. The skin can become so sensitive that wearing clothing of any kind over the area is very painful. Pain can radiate to the inner thigh and become worse during physical activity such as cycling. It is usually more severe during or following sexual activity.
PVPS naturally causes reluctance to engage in intercourse or other activities that will cause more pain. Life is greatly impacted by post vasectomy pain syndrome not only for the man but for his partner and others that he interacts with.
Dr. Werthman understands that post vasectomy pain is a serious impairment to the quality of life for those who suffer with the condition. He is acknowledged as a world renowned vasectomy reversal and male infertility authority and as such understands complications resulting from vasectomy.
Patients are evaluated and treated as conservatively as possible initially. Rest, wearing a scrotal support garment, applying hot and cold packs and taking anti-inflammatory drugs comprise the first tier of treatment in most patients. If this does not result in relief, treatment is escalated to injections of anesthetics or steroids followed by surgery if needed. Surgical procedures range from removing granulomas (small clusters of sperm cells and immune system cells) to removal of the epididymis (the sperm storage gland covering the testicles) or reversing the original vasectomy.
Post vasectomy pain stems from various causes. Some of the commonly identified sources of PVPS are:
- Unrefined surgical technique
- Sperm granuloma
- Neuroma caused by swelling and inflammation
- Epididymal congestion
- Vasectomy position too close to the epididymis
Relieving chronic pain is the first goal in treating this condition followed by discovering the source.
Revision surgery may be needed to remove scar tissue or inflamed tissue in cases where the original surgery resulted in damage to delicate tissues.
Relief has been obtained by converting a closed vasectomy to an open vasectomy. This relieves pressure build up in the epididymis which can cause chronic post vasectomy pain. Another option is to reverse the vasectomy which restore proper pressure and function to the vas deferens.
If the original vasectomy was done too close to the epididymis it can cause chronic inflammation and pain. One remedy is surgical removal of the epididymis if vasectomy reversal is not possible or desired.
Chronic post vasectomy pain may be difficult to source. Some diagnostic tools available are doing an ultrasound of the scrotum, screening for anti-sperm antibodies and examining the urethra, prostate gland and the bladder.
In cases where post vasectomy pain occurs shortly after the procedure, the cause is usually infection and inflammation which can be treated with antibiotics and anti inflammatory steroids. For chronic long term pain, it may require patience to discover the true source of the problem. The good news is that once it is identified, the problem can be treated and life can become enjoyable again.
The pain is real. You can be helped
While it must be stressed that these are fairly uncommon occurrences after vasectomy, they are frustrating and difficult to deal with for the patient, his partner and the physician. We offer a range of post-vasectomy pain syndrome treatments for these syndromes including non surgical treatments, vasectomy reversal, open-ended vasectomy, microsurgical denervation of the spermatic cord and chemical sterilization.
Most patients with this problem, which has been ignored for so long, need not suffer. Dr. Werthman has treated many men with post-vasectomy pain syndrome and has emerged as a leading authority on the subject. He has written a section on this in the medical textbook “Complications of Urologic Surgery” and has compiled research on the post vasectomy pain syndrome treatment.
A patient’s story
Here is a letter that Dr. Werthman received from a patient who recently received treatment for his post-vasectomy pain syndrome:
“I write this letter only in small part to thank Dr. Werthman and his supporting personnel- my main motivation is to help the next person in need of a great urologist.
“Before finding and settling on Dr. Werthman, I spoke and met with numerous other doctors (also of high repute I should add) about a reconnection and especially a solution to my post-vasectomy pain (vasectomy performed at family planning 2009) which was a complicated matter not due to the usual causes.
“Most did not listen at all, others even suggested frighteningly unnecessary procedures. With each new doctor, I only felt worse about my predicament. Had I not through good fortune found myself in the office of Dr. Werthman, I doubt my nightmare would have been alleviated.
“From beginning to end my experience with Dr. Werthman was a pleasant one. His office staff has been with him a long time and their experience comes through.
“My consultation with the doctor himself was a meeting with a human being who cared about my individual case, not the usual sit-down with a distant expert selling skills and procedures.
“In response to my questioning Dr. Werthman spoke positively of his profession, and I got the sense that his daily work takes on more the aspect of a life mission. He was the only one who during the initial exam identified the probable cause of pain and proposed a solution that made sense.
“Later, during a successful reconnection, Dr. Werthman indeed took care of the problem which he had previously diagnosed correctly. Several hours afterward he called me personally to check on my well-being. I was pleased to report that all was well and that with only an ice pack the post-op pain meds were surprisingly unnecessary.
“I should mention also that the top-notch facility where the work was performed, Specialty Surgical Center of Wilshire, employs a team of personnel that made me feel exceedingly well cared for, not solely for their professionalism, but also because of a disarmingly warm bedside manner which although unexpected was very much appreciated. To the patient (which was me!) everything matters, and it was a great comfort to see that everything mattered to them as well.
“I now feel as if I had a new lease on life, like a trapped animal newly freed, and in some small way reborn. My deepest heart-felt thanks to Dr. Werthman and everyone involved in ensuring the success of the operation and the end of a dismal three-year ordeal. This is what good western medicine is all about, and I truly feel blessed for having received it.
“I am aware that testimonials generally consist of only a few lines and sometimes read like book-review hype, and surely any that contain high praise for Dr. Werthman are certain to be true. However, I chose instead to offer a more detailed and personal account of my experience so that others might have the good fortune to arrive at the same decision that served me so well. Normally I think I would have ended this by saying 'take care and good luck to you', but if you have already found Dr. Werthman then that may be all the care and luck you need. So instead I will only say: take it easy, relax- you really are in the best of hands.”Sincerely, Eric - Aug 2012