Post-Vasectomy Pain Syndrome

Post-vasectomy pain syndrome (PVPS) is when you develop long-term (chronic) pain in your testicles after a vasectomy. A vasectomy is a procedure that cuts or blocks off your vas deferens. It prevents sperm from mixing with your semen.

A healthcare provider may diagnose post-vasectomy pain syndrome (PVPS) if you have lasting pain after the procedure. It can affect one or both of your testicles.

The odds of having PVPS after a vasectomy are low. A 2020 study shows that it affects about 5% of males after getting the procedure.

Symptoms of post-vasectomy pain syndrome

The main symptom is long-lasting testicular pain or soreness. It may last for at least three months. The pain may occur:

• During exercise
• When you have an erection
• During ejaculation
• At other moments during sexual activity, including arousal, orgasm or when you feel a desire for sexual intercourse (sexual response cycle)

The pain can range. You may only have pain occasionally, or it may be constant. It may feel like a dull, constant aching or a sharp, stabbing pain that comes and goes. It can develop quickly after a vasectomy. But it may also develop months or years later.

Post-vasectomy pain syndrome causes

Medical experts aren’t sure why some males develop post-vasectomy pain syndrome. But possible causes include:

• Congestive epididymitis
• Damage to a vas deferens
• Hard lumps that form at the end of a cut vas deferens (sperm granuloma)
• Inflammation
• Nerve compression or nerve damage (neuropathy)
• Scar tissue

Complications

Any type of pain can affect your quality of life. But pain in sensitive areas of your body can affect your sexual and emotional health. This may cause complications like:

• Anxiety
• Depression
• Sexual dysfunction
• Stress

How doctors diagnose post-vasectomy pain syndrome

There isn’t a specific test that healthcare providers use to diagnose post-vasectomy pain syndrome. Healthcare providers will:

• Review your medical history
• Ask about your symptoms
• Perform a physical exam

They may also recommend tests to rule out other conditions that cause achy testicles.

Testing

Healthcare providers may recommend the following tests to help confirm a post-vasectomy pain syndrome diagnosis:

• Imaging tests, like an ultrasound
• Pee tests, including a pee culture
• Semen culture
• Spermatic cord block (nerve block)

How do you treat post-vasectomy pain syndrome?

There are nonsurgical and surgical treatments for post-vasectomy pain syndrome.

Nonsurgical treatments

Healthcare providers may first recommend techniques to help relax your muscles and ease symptoms. You may need to work with a physical therapist to make sure you’re doing them correctly.

Other nonsurgical treatments may include:

• Complementary medicine like acupuncture or biofeedback
• Pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs)
• Neuropathic pain relievers like gabapentin

Providers may also recommend tricyclic antidepressants. This is an off-label use. “Off-label” means a medication can treat a condition, even if the medication doesn’t have official approval for it.

Surgical treatments

Healthcare providers may recommend surgery if nonsurgical PVPS treatments don’t provide relief.

About 8 out of 10 males who get a vasectomy reversal report less pain after the procedure. But a vasectomy reversal also restores your ability to have biological children. If you don’t wish to have biological children after a vasectomy reversal, you should use condoms or another type of birth control whenever you have sexual intercourse.

Other surgical options vary. They depend on the underlying cause of your pain. They include:

• Epididymectomy to remove one or both tubes behind your testicles that carry sperm (epididymides)
• Removing (excising) a sperm granuloma
• Removing nerves in your spermatic cord that cause pain (microdenervation of the spermatic cord)

In rare cases, a provider may also recommend an orchiectomy. This procedure removes one or both of your testicles.

When should I see my healthcare provider?

It’s normal to have pain for several weeks after a vasectomy while you heal. See your healthcare provider if the pain doesn’t go away or if pain develops after you recover. It’s also a good idea to see a provider if you have:

• Sexual dysfunction, like pain when you get an erection or erectile dysfunction
• Swollen testicles or scrotum
• Pus or foul-smelling drainage from your incision(s)

During your appointment, you may wish to ask:

• What’s causing my PVPS symptoms?
• What treatment do you recommend?
• If I need surgery, what type do I need?
• Should I look for signs of complications?

How long does post-vasectomy pain syndrome last?

It depends on what causes post-vasectomy pain syndrome and how you respond to treatment. Surgical and nonsurgical treatments may help you feel better within a few weeks. But it could take longer. A healthcare provider will give you a better idea of what to expect.

How do you prevent post-vasectomy pain syndrome?

The only way to prevent post-vasectomy pain syndrome is to avoid getting a vasectomy. But a vasectomy is a generally safe and effective type of birth control. Healthcare providers aren’t sure why some males develop pain after the procedure, so there isn’t anything you can do to prevent it.