VasectomyPain.Org

After the birth of our fourth child (the only boy, whom I love dearly and am glad for), the issue of what to do to prevent number five came up again. I began my research in earnest again having looked at this issue two years prior and ended up back in the same place, vasectomy. Since I enjoy having an unrestricted orgasm with my wife, (read orgasm directly into the vagina) it seemed condoms for a decade until menopause, or a vasectomy were my choices. I was seriously considering vasectomy again. I started researching the idea again. The rise of the "no scalpel, open" vasectomy was new and I read more about it. I began to get excited as my research had led me to a "new and better vasectomy method" with fewer side effects… Wasn't I the smart consumer? I actually thought I was...
 

It turns out that  a study existed that showed congestive (not infectious) epididymitis occurred in about 6% of men who had a "closed" vasectomy and in about 2% of men who had an "open" vasectomy. The closed versus open descriptor refers to whether the testicular end of the vas deferens (tube that carries sperm from the testes to the ejaculatory duct) is left closed or open. So I thought I was taking a 2% risk...

This study helped me worry less and made me lean toward an "open" vasectomy, but I later found out that the statistics from this study weren't based on 6220 cases, but 10% of the overall cases. The study did not follow men over time long enough to see if any developed chronic problems either. The study doesn't say what can happens after you develop congestive epididymitis and it leads to post-vasectomy pain syndrome (PVPS didn't even exist as a concept when this study was done.) For some men, the pain symptoms do not respond to warm baths and anti-inflammatory medicine (the prescribed treatment) and can become chronic and affect quality of life and sexual function.

You see, the consents and brochures do not mention you might need further surgery if you are in the group with persistent symptoms of pain (The incidence of PVPS was listed as 1 in 2000 on my vasectomy consent, which I now know is absolutely false.) There are no known risk factors for PVPS except perhaps high pre-vasectomy sperm count and no one tests your pre-vasectomy sperm count to tell you that you have higher risk. Again, no research to identify men at risk has been done as the condition is considered to be extremely rare and perhaps psychological… I can tell you my symptoms were not psychological. It is hard to feign sharp jabbing testicular pain or a constant dull ache that radiates into the groin. Most of the men I have spoken with who developed PVPS were smart, relatively successful men with no past psychiatric history.

Needless to say these statistics and stories were a bit "off-putting", but somehow after I talked to a group of friends and male coworkers, I convinced myself I would not end up like these unfortunates. I was in excellent health, an age group ace runner, and an aspiring triathlete with no medical issues. So I found a surgeon with vast experience (he had performed over 17,000 vasectomies and taught other doctors on three continents how to do the "no scalpel, open" technique), and bit the bullet, so to speak. It turned out to be the worst decision of my life… The idea that it is the surgeon's skill that makes the difference was turned upside down for me.
 

I have had pain from soon after the procedure until the present, and the symptoms not only persisted, but also worsened over time. I contacted the doctor who did the procedure and he adopted a "watch and wait" approach for the first six months. (This is not defensible based on my subsequent research.) I was afraid of additional surgery, so despite the ongoing discomfort, I felt it was a reasonable approach as the symptoms were tolerable with frequent use of Motrin. At that time, I also knew little about post-vasectomy pain syndrome. As things continued to worsen and began to affect my focus at work and markedly affect my quality of life, I felt as though further "waiting" was a poor idea. I contacted the doctor again and he discussed "resecting the vasectomy sites" as a treatment plan. He did not mention reversal, (the procedure with the best treatment response if conservative treatment fails), until I brought it up, and then he agreed it might be warranted. I found out later that he had done four other reversals for pain, but he never mentioned the diagnosis of PVPS. I opted for reversal as the prospect of continuing pain was rather daunting, and I hoped to get back to my former "happy, pain-free self" as soon as possible. All conservative treatment had failed and I wanted my life back. I had already lost the pleasure in life for a year. I couldn't have cared less about becoming fertile again, I just wanted to be normal again.

My symptoms included:

1. Pains near the lower part of the testicles or in the tail of the epididymis – This had been there for at least 10 to 12 months and had stopped me from riding my bike. It was a localized sharp needle or ground glass sensation under my scrotum bilaterally. Even by itself this would have required surgical treatment have as it affected sleep and made long car rides a challenge. (I commute an hour each way to and from work.) I now believe this pain was due to fibrotic back-pressure related scarring in the tail of the epididymis bilaterally. This pain has not totally resolved with vasectomy reversal.
   
   
2. A constant dull ache in the testes, similar to what many men feel if they have no sex for weeks but more intense. The reversal center spokesperson I contacted said their facility had seen some men who got a reversal just for this "weird full feeling" in the genital region, mostly in the testicular area. This sensation was not tolerable to me and is a distraction at the least. It began in the week after surgery and sometimes seemed less noticeable if I took Motrin. Taking Motrin on a long-term basis every day adds risks that I was not willing to take with my stomach and kidneys, however. In addition, chronic discomfort in the testes tends to affect ones mood, quality of life, and sexual function.
   
   
3. The most troubling problem was the appearance of scar tissue (induration) on the right side near the epididymis associated with a fibrotic feeling to a part of the vas there. This occurred at 13 months post-vasectomy. Unfortunately for me, this had begun to pull on spermatic cord structures (nerves) and had caused a chronic low-level "rupture" feeling that radiated into my groin and abdomen. I was most worried about this because I was not sure a reversal would relieve this. Some unfortunate folks I had spoken to had to have the epididymis and obstructed vas removed. I hoped for the most conservative surgical approach. I lost ten pounds in two weeks due to anxiety, pain, and nausea from the radiating groin pain.    
    
4. The inevitable guarding of my "area" kept my three youngest children off my lap or is endured with anxiety. Pain in the testicles during sex tends to put a damper on the experience. Sorry to be so graphic, but I want to illustrate why I was willing to undergo a three to four hour corrective surgery on my genitals. Clearly, I did not want further surgery and waited for over a year.  The right testis always ached and the epididymis on that side became swollen and tender. I went to a local urologist who confirmed this in 4/08. When I had sex, this pain would worsen and become difficult to tolerate for several days, which needless to say, negatively affected my sexual enjoyment and made me begin to avoid sex. It had become an intolerable situation. When I got an erection, the scar tissue on the right side would cause my testicle to rotate outwards as the testes are pulled up toward the body with erection. This would then cause severe pain and made sex completely useless.

A board certified urologist did my reversal. He had completed a fellowship in microsurgery.  He was a "super specialist" in reversal surgery. I found out that success rates for this type of surgery are very much dependent on the surgeon's skill and experience. In addition, having surgery on ones genitals is not like having any other surgery, and I was looking for "the best surgeon" who also had experience with vasectomy reversal for pain, not for fertility. The surgery was not covered by insurance and cost over $8000 plus airfare and lodging. It took over three hours and was done with local anesthesia.

It took an entire year for most of my symptoms to clear up and I am left on medication for the chronic inflammation caused by the procedure. My residual symptoms are manageable but remind me every day of the worst decision I ever made.

You might find this sort of blanket statement about vasectomy: "The operation also has no effect on sexuality. Erections, climaxes, and the amount of ejaculate remain the same. Occasionally, a man may experience sexual difficulties after vasectomy, but these almost always have an emotional basis and can usually be alleviated with counseling. More often, men who have undergone the procedure, and their partners, find that sex is more spontaneous and enjoyable once they are freed from concerns about contraception and accidental pregnancy." Right...Bullshit. Vasectomy is a flawed procedure that leaves up to ten percent of men with chronic pain. If you end up in that group, you will regard it as the worst decision you ever made.