Post-Vasectomy Pain Syndrome

What is post-vasectomy pain syndrome (PVPS)?

A small number of men who get vasectomies develop chronic pain in their testicles after the procedure. Your healthcare provider may diagnose post-vasectomy pain syndrome (PVPS) if the pain lasts for three months or longer. The pain may develop immediately after the procedure or months to years later.

What is a vasectomy (male sterilization)?

A vasectomy (also called male sterilization) is a minor surgical procedure on the male reproductive system. A urologist, a medical doctor who specializes in the male reproductive tract, typically performs vasectomies.

During the outpatient procedure, your healthcare provider cuts or blocks off the two vas deferens tubes. These tubes carry sperm from each of your testicles (testes) to the ejaculatory ducts. Before a vasectomy, sperm mixes with fluid in the seminal vesicles. During orgasm, you ejaculate semen and sperm through the urethra in your penis.

After a vasectomy, sperm can’t travel through the cut or blocked vas deferens tubes. Instead, the sperm cells stay in your testicles where your body reabsorbs them. Because there’s no sperm in your semen, you can’t fertilize a woman’s egg, causing a pregnancy. You’ll still ejaculate and orgasm normally.

A vasectomy reversal (vasovasostomy) may be possible if you change your mind about wanting biological children. However, healthcare providers consider a vasectomy to be a permanent form of birth control.

How common is post-vasectomy pain syndrome?

Complications after a vasectomy are rare. Out of every 100 vasectomies, approximately one or two men develop post-vasectomy pain syndrome. Healthcare providers perform about half a million vasectomies every year. So, the incidence of post-vasectomy pain syndrome is very low.

What causes post-vasectomy pain syndrome?

Medical experts aren’t sure why a small number of men develop post-vasectomy pain syndrome. Potential causes include:

• Congestive epididymitis (edema or swelling in the epididymis, the coiled tubes at the back of your testicles that store sperm).
• Damage to a vas deferens tube.
• Inflammation.
• Nerve compression or nerve damage (neuropathy).
• Scar tissue.
• Sperm granuloma (a hard, sometimes painful lump that forms at the end of a severed vas deferens tube).

What are the symptoms of post-vasectomy pain syndrome?

Chronic testicular pain that lasts for at least three months is the main symptom of PVPS. This pain may come on soon after the procedure. Some men develop pain months or years after getting a vasectomy.

You may have a dull constant aching feeling in your testicles. Or the pain may come and go. Some men have pain during exercise, an erection, ejaculation or other moments in the sexual response cycle.

What other conditions cause similar symptoms to post-vasectomy pain syndrome?

Other conditions can cause testicular pain, such as:

• Hydrocele.
• Infections such as urinary tract infections (UTI).
• Inguinal hernia.
• Prostatitis.
• Testicular cancer.
• Testicular torsion.
• Tumors.
• Varicocele.

How is post-vasectomy pain syndrome diagnosed?

There isn’t a diagnostic test for post-vasectomy pain syndrome. Your healthcare provider will evaluate your symptoms and perform a physical examination.

You may undergo tests to detect or rule out other conditions that also cause testicular pain. These tests include:

• Urinalysis, urine culture and semen culture.
• Imaging tests like an ultrasound.
• Spermatic cord block (nerve block).

What are nonsurgical treatments for post-vasectomy pain syndrome?

Pelvic floor exercises (Kegels for men) may help ease symptoms of post-vasectomy pain syndrome. You see a physical therapist who specializes in conditions that affect your pelvic floor muscles. These are the muscles that support your bladder, intestines and reproductive organs.

You may also benefit from:

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

What are surgical treatments for post-vasectomy pain syndrome?

Chronic pain from PVPS can be difficult to treat. If nonsurgical therapies don’t provide adequate symptom relief, your healthcare provider may recommend surgery.

A vasectomy reversal provides pain relief for more than 9 in 10 men. However, it also restores your fertility. Other surgical options vary depending on the underlying cause of your pain. They include:

• Removing (excising) a sperm granuloma.
• Epididymectomy to remove one or both epididymal structures.
• Microdenervation of the spermatic cord (cord stripping) to remove nerves that cause pain.
• Vasectomy reversal.
• Orchiectomy to remove one or both testicles (this procedure is rare).

How long does post-vasectomy pain syndrome last?

Surgical treatments can be highly successful. A vasectomy reversal eases pain for as many as 9 in 10 men. About 3 in 4 men are pain-free after undergoing microdenervation (cord stripping). But unfortunately, some men continue to have pain after surgery.

Can you prevent post-vasectomy pain syndrome?

Post-vasectomy pain syndrome is very rare. Because medical experts aren’t sure why some men develop this pain, there isn’t anything you can do to prevent it.

When should I call the doctor?

Call your healthcare provider if you experience:

• Sexual dysfunction like painful erections or erectile dysfunction.
• Swollen testicles or scrotum.
• Testicular pain that persists for months.

What should I ask my provider?

You may want to ask your healthcare provider:

• What’s causing my post-vasectomy pain syndrome?
• What’s the best nonsurgical treatment for me?
• Do I need surgery, and if so, what type of surgery?
• Should I look for signs of complications?