<<Back to Story List
Please heed this warning and don't make the worst mistake of your life!
6/14/2010,
jwatts
ABSTRACT:
My ability to be an active, helpful, physical father was completely upbraided by chronic pain from what was supposed to be a "minor" procedure. After learning more, I can confirm it is certainly not minor and should never be attempted by anyone for any reason.
SYMPTOMS:
Large, tender granuloma. Periodic bouts of massive inflammation for the entire 6.5 months of vasectomy.
TREATMENTS/MEDICATIONS:
Lots of NSAIDs, Tylenol, Tramadol, and some Vicodin.
OUTCOME/CURRENT CONDITION:
After reversal and granuloma removal, things are getting better. But my ability to enjoy life has been dealt a long, serious setback.
Pre-vasectomy
After the birth of our second beautiful child, we felt our family was complete. Both had been Caesarian deliveries, and the thought of my wife going through that again was too much. I had always assumed I would get a vasectomy at that point, so I started talking about it with my wife. Neither of us really knew the details, so I started reading and she started talking to people she knew.
Basic internet searches tend to turn up mostly boiler-plate information indicating vasectomy is "safe, minor surgery" that is "cost effective" and "convenient." While this may be true for some, if complications do arise, the long-term pain that results is not given sufficient discussion on these sites. One must search for "vasectomy pain" to really get to the sites that outline what happens when things don't go perfectly smoothly. Unfortunately, I did that search a little too late.
I made a consultation appointment with a local urologist (Dr. Moody) to find out some basic information before going through with it. While waiting for the doctor to enter the room, my cell phone rang. It was my wife, who had just found out from her gynecologist that he knew someone who lost a testicle from vasectomy. She thought I should ask the urologist what the chances of that were. This should have worried me more than it did. Much to my surprise, the doctor quickly informed me that he himself had the same vasectomy he would be giving me: no-scalpel, closed ended. This is the one recommended on my internet searches, so things seemed positive. He laughed at the loss of testicle issue saying that "so far, we have lost zero testicles" and the new techniques they used were so minimally invasive that nothing goes wrong anymore. I press for more details. He says "most pain patients I see were from vasectomies years ago that were done with more primitive techniques." It sure seemed that statistics were on my side. He had done a lot of these with apparently few issues.
The procedure: October 8, 2009
After being prepped, the doctor entered and started small talk. I told him I wanted a gentle operation so there would be less chance of pain. He replied that he also was a bit apprehensive about having himself vasectomized as well, but after a scare where his wife thought she was pregnant he said "my wife wouldn't stand to have a urologist husband who wouldn't get a vasectomy". That made me want to get up and flee right there, but I was already getting pricked with the needle. If only I had been strong enough anyway!
Post-Vasectomy
Everything seemed fine until day 7 after the vasectomy. I noticed the pain was actually greatly increasing since day 6, rather than getting better. This seemed odd, so when I got a chance I inspected myself to discover a large lump forming over the top of the right testicle. It was very painful, and was causing an intense "sunburn" feeling all along the back of both sides. I would later learn this was inflammation of the epididymis, or "epididymitis" in the jargon. It sounds so benign when described in clinical terms, but imagine trying to just sit in a chair and feeling continuous intense heat and pain in the most sensitive area of your body. All you want to do is lay down. But you can't lie down all day, and even that only provides some relief.
The bump really worried me, but all calls and visits to the doctor's office provided no answers; no names given to my condition. Was I some kind of freak? Had this never happened? The doctor was not concerned and simply prescribed Cipro and Naproxen. This cut the pain by about 50% which at least let me go to work, but not comfortably. I figured it would soon all subside.
At the 6 week point, I went back to the doctor to complain again of no improvement and he prescribed elavil (amitriptyline) to try and "calm down whatever nerve was bothering me." I would later learn this all had nothing to do with nerves themselves. I took it for 3 weeks before the serious side effects grew too much: 1) Blurry vision 2) extreme fatigue all day long 3) constipation beyond belief and 4) impotence. Happily, they all went away after stopping the elavil. The painful lump remained unaffected.
I kept calling the office and went back three times for follow up visits. The doctor seemed to either not understand the lump or ignored it and said that it was just my testicle. No it wasn't I wanted to scream! The third visit I switched to a different doctor (Dr. Bong) of the same practice, to try someone different. He listened to my story, and without any physical examination, said there was no need to worry at all: "Epididymitis can occur randomly to anyone, even without vasectomy. Just wear a jock strap for a month straight, and if that doesn't help go to a pain management doctor to get a nerve block and see if that makes things feel better. If that doesn't work, and you get out to a year without improvement, we can simply remove your epididymis. Don't worry, you don't need it. We could even remove an entire testicle and you'd still be ok, because you only need one you know." I had read on several internet sites that removing the epididymis was a bad idea for pain relief, because it rarely works and often leads to removing the whole testicle. Suddenly a startling reality became clear: the guy my wife told me about who lost his testicle didn't lose it from the actual surgery, but from attempts to manage the pain that followed. I decided right then to never return to this practice again, and renewed my internet searches for other answers.
As time went by, the typical pattern emerged for Post Vasectomy Pain syndrome. I was always in some level of pain from the mysterious lump, even if my activity level was kept at zero. Increasing activity greatly increased the pain. To add to that, it seemed that every other week a massive bout of epididymitis would lay me flat for a solid week at a time. I spent a lot of time simply lying in bed, waiting for it to pass. The severity of the condition cannot be overstated.
As an example of how even limited activity could affect things, I would simply vacuum a portion of the house. Soon afterward, I would have a "hernia" feeling radiating up my groin (worse on the right). This could last for several days. I became very afraid to move around too much. Sleeping at night was difficult because of the constant radioactive heat emanating from the lump. Often it would wake me up at 3am and I would be unable to go back to sleep.
If that wasn't all bad enough, the most debilitating aspect was being unable to sit in a chair for any length of time. I realized how much time we spend driving in cars, sitting at the office, sitting on a plane, sitting at dinner. All of which compressed the lump and made it hurt more and more.
My internet searching had turned up a support group called "Vasectomy Pain" at groups.yahoo.com. The forum is moderated by a couple doctors who have been through similar pain themselves and know how real it is. To summarize their research, you basically have 3 months to heal completely from vasectomy, otherwise you are now PVP. Once there, you have little chance of ever getting over it yourself. Either you go for 1) nerve stripping to destroy the nerves that are feeling the pain or 2) a complete reversal. The problem with #1 is it's not always effective. Of course, neither is #2 sometimes. I decided to find a better doctor that could help me decide.
Another important point they make is to find a specialist in microsurgical reversals, ideally one who has done some for pain. This called for going up to Denver, where a modern urology center exists with an advanced facility and specialized doctors to handle this. I called and asked for the best microsurgical specialist, and was immediately directed toward Dr. Mills. He was highly recommended and I made an appointment.
The difference between this office visit and the previous ones was like night and day. He did a complete exam and immediately knew what the lump was: a spermatic granuloma. Finally, I had a name for my condition. I had heard the term, but had no idea that's what I had. It is formed due to leaking from the cut end of the vas. I clearly had A LOT of leaking because of its size and tenderness. The leaking causes an immune response, and thus the inflammation. Many vasectomy ends leak, but this one was far worse than normal. The leaking was never going to stop since sperm production is unaffected by vasectomy. His theory was I had a high sperm count, and the clips simply couldn't hold it all back. He proposed a reversal, which would remove the granuloma, and by reconnecting the cut ends would prevent further leakage. Things moved quickly at this point, and a reversal was scheduled for April 23, 2010. This would be 6.5 months after the vasectomy.
The reversal
A vasectomy reversal is not minor surgery. A large granuloma removal is not minor surgery. Put them together and things get rough. General anesthetic is required, and it lasted for some 2.5 hours. For the first four days, I appreciated help getting in and out of bed. I could not return to work until day 12, and even then it was not possible to walk very much. I consumed two bottles of Vicodin in the first two weeks. The first three weeks are really a blur, and I can't remember much except how painful everything was.
After four weeks, we revisited the reversal center to see if things were reconnected with a sperm count test. They warn you your count might not yet be up to the 20 million/ml required for fertility until many months after a reversal. Shockingly, my count was already at 112 million/ml. This lends credence to the doctor's theory that a high sperm count contributed to my problems. It will likely go higher as heeling continues.
Currently, as of week 7 post-reversal, there have been no attacks of epididymititis, and the painful granuloma is gone but not forgotten. Rather than hurt when I sit, the area of the lump now hurts when walking; each footfall makes things jiggle, and thus hurt. Too much walking sends pain going up the groin along the vas lines. This pain is fading too. The area immediately under the incisions is still very tender and sore and thus activities must remain limited. All pain is a little better than the week before. But it is not rapid by any means.
My understanding from talking with others who had this same type of surgery performed are these general recovery stages:
- The first 2 to 3 months are very painful
- After 4 months, general daily activities return to normal
- After 6 months, strenuous activities return, like mowing, jogging etc.
- It can take up to a year for complete healing
I would agree this seems to be the trajectory I am on with healing. Copious amounts of Tylenol, Ibuprofen, and some Tramadol are used to keep the pain to a manageable level. I hope to reduce the amounts over the next month or two.
<<Back to Story List