Description

Vasectomy is a minor procedure that blocks the supply of sperm to the semen. It is a common form of male birth control that is done by cutting and sealing the tubes that carry the sperm. The sperm can't reach the semen, are absorbed by the body.

Vasectomy has a low risk of problems, but some men develop post-vasectomy pain syndrome (PVPS). PVP involves chronic pain in one or both testicles, that is still present three months after the procedure. The pain can vary from a rare, dull ache, or sharp, constant pain that can interfere with daily life. For some men, the pain is severe enough to seek treatment.

Symptoms

Have some discomfort after the vasectomy is common, but the men with PVP is a pain that never seems to get better after the procedure.

The signs and symptoms of PVP may include:

  • Pain and tenderness in the scrotum
  • Pressure or pain after ejaculation
  • Pain in one or both testicles
  • Pain and tenderness at the site of the vasectomy
  • Swelling of the small, C-shaped tube behind the testis where sperm are stored (epididymis)
  • The pain with sex

When to see a doctor

Consult your health care provider right away if you have pain or swelling in the testicles, discharge from the penis or pain when you urinate. Your healthcare provider may be able to treat the cause with a drug or a minor procedure.

If you have pain in the scrotum, seek emergency treatment.

Causes

The causes of PVP are not well understood. They may include:

  • Infection. The inflammation can cause damage to the scrotum, epididymis or other structures along the wire that carries the blood of the blood vessels, and nerves of the testis (spermatic cord).
  • The compression of the nerve. A narrowing of the nerve to the testicles can cause symptoms of PVP .
  • Back pressure. The sperm are not able to travel through the tube that carries sperm from each testicle is cut during vasectomy (vas deferens) can cause back pressure.
  • Scar tissue. Scar tissue (adhesions) may form and cause pain.

Risk factors

There are No known risk factors for the development of RRP . It is not associated with any specific age group, socio-economic status, environmental factors or the type of procedure of vasectomy.

Complications

If left untreated, the severe pain can cause significant emotional and psychological distress for men with PVP . Ongoing pain can affect the quality of life for men with PVP .

Men may be unable to participate in normal physical activity and have problems to work on their jobs. The pain can also lead men to avoid sex.

Diagnosis

Your provider will perform a complete physical exam, checking for tenderness and swelling of the testes and the epididymis. Your healthcare provider also looks for the presence of a small ball of scar tissue where the vasectomy is performed (sperm granuloma).

Other possible causes of testicular pain you will have to be discarded. The tests that your doctor may recommend that you include:

  • Sexually transmitted infections (STI) screening. A narrow cotton swab is inserted into the end of your penis to obtain a sample of discharge from the urethra. The sample is analyzed in the laboratory for sexually transmitted infections such as gonorrhea and chlamydia.
  • Blood and urine samples. The samples of urine and blood is tested for the infection and any other unusual findings.
  • Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside the body. The ultrasound can be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testis or epididymis; or a hernia.
  • Magnetic resonance imaging (MRI). An mri uses a powerful magnet and radio waves to produce detailed images of the internal structures of your body. Magnetic resonance imaging can be used to evaluate the spine or hip in men with a history of back or hip problems to rule out nerve compression.

Treatment

Treatment for PVP depends on your symptoms and how much pain you have.

Drugs

  • Medications for pain. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after the ejaculation can take these drugs before sexual intercourse. Prescription for pain medication may also be used to treat the pain.
  • Other medications. If anti-inflammatory medications do not help after four weeks, your doctor may consider a tricyclic antidepressant or an anticonvulsant. These medications may be useful in the treatment of nerve pain, although it has not been extensively studied in men with PVP .

Therapies

  • Support of the underwear. Use a jock strap or compression shorts can help to reduce pain in the testicles.
  • Ice or heat . An ice bag or a pad of warming can help reduce the pain. Sitting in a warm bath can also be helpful during an outbreak.
  • The physical therapy. Men who have pain in the pelvic area or when you urinate can benefit from pelvic floor physical therapy to learn how to relax certain muscles of the pelvis.
  • Blockade of the nerves. Your doctor may suggest a nerve block, which uses a drug to target the nerve that goes to the testicle. This will probably only temporarily relieve your discomfort. The pain often returns once the numbing medication wears off.

Surgery

  • Removal of a sperm granuloma. Some men develop a small ball of scar tissue in the vas deferens without pain in any other part of the scrotum. Men can experience pain relief after a procedure to remove the scar tissue.
  • Microdenervation of the spermatic cord (MDSC). In this procedure, the surgeon separates the nerves and the veins that go to the testicle from other parts of the spermatic cord to reduce or eliminate the pain signals. MDSC seems to be more effective in men who experience a temporary relief of a cable block. When you have success, MDSC can significantly improve the quality of life. Complications can include ongoing or worsening pain, the development of the accumulation of fluid in the sheath surrounding a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.
  • Epididymectomy. For men with pain in the epididymis, the elimination of the C-shaped structure that stores sperm behind the testicle may relieve the pain. The procedure seems to be more effective in the relief of pain in men who have a cyst, granuloma, or a mass in the epididymis.
  • Vasectomy reversal (vasovasostomy). Vasectomy reversal will restore sperm to the ejaculate and can restore fertility. This procedure can relieve pain and pressure that occur with ejaculation. For some men, the vasectomy reversal is more effective than the MDSC approach in the relief of pain.
  • The orchiectomy. The removal of the testicles is a last resort for men who do not respond to more conservative treatments. Even after the testicle is removed, the men sometimes feel a phantom pain in the area where the testicle that used to be.

Alternative medicine

There is not much known about the alternative medicine for the treatment of RRP .

Your healthcare provider may consider acupuncture, either alone or together with medication. Although there are no clinical trials demonstrating the effectiveness of acupuncture in the treatment of RRP , acupuncture is considered safe and non-invasive for men recently diagnosed with PVP .

Preparing for your appointment

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment
  • Key personal information, including major stresses, recent life changes, and the medical history of the family
  • All medications, vitamins or supplements that you are taking, including dose
  • Questions to ask your provider

Have a friend or family member, if possible, to help you remember the information they give you.

For PVP , some basic questions to ask include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask several questions, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid doing anything that seems to worsen your signs and symptoms.

Symptoms and treatment of Post-vasectomy pain syndrome