How Common Are Scrotal Nodules After Vasectomy?

September 18, 2024

It is common to form a scrotal nodules after vasectomy. A scrotal nodule can best be thought of as a ‘lump’ or ‘bump’ that can be felt somewhere inside the scrotum after vasectomy.

We estimate 1 out of 4 vasectomy patients will form a painless nodule (lump) that persists long after their vasectomy.

Developing nodules after vasectomy are so common, we list ‘nodule formation’ as a risk on our vasectomy consent.

Most patients will feel a nodule at some time after having a vasectomy. Most of these scrotal nodules are healing tissue that will slowly go away with the passage of more time.

Most nodules are sperm granulomas. Sperm granuloma are nodules healing that contain sperm. These are normal after vasectomy. Most sperm granulomas will not cause any symptoms or problems. They may be tender at first but this usually goes away. They may be large at first but will gradually shrink and be difficult to feel.

Some nodules are abnormal (neuromas) and may be a sign of a vasectomy complication that may need further treatment. Neuromas are sperm granulomas with hypersensitive nerve endings. These nodules may not be tender initially but the tenderness could increase in severity with time and not go away.

Forming nodules after vasectomy should not be a major concern unless you are having significant pain and discomfort. Just like vasectomy bruising, developing a scrotal nodule after vasectomy is common and mostly insignificant.

Most vasectomy patients will have no symptoms from their vasectomy nodules. Some patients can experience pain from the nodule but overtime most of this pain will disappear.

A minority of patients could develop painful nodules that do not resolve with time. These patients may require medical evaluation and treatment.

Forming A Nodule After Vasectomy: Where would it be?

A nodule can form as a healing response to having a vasectomy. If a nodule forms after vasectomy this would happen inside the scrotum. The nodule would not visible from the outside. A nodule can only be felt with a careful scrotal examination.

Nodules after vasectomy can form:

On the vas deferens tube, either one side or both sides.
Around the epididymis after a vasectomy, either one side or both sides.
Both on the vas deferens and in the epididymis.

You will not form nodules in the skin, penis, or testicles. Nodules form only at the vasectomy site on the vas deferens or in the epididymis which lies along the back side of each testicle.

Nodules in the vas deferens. Nodule formation at the site of the vasectomy is usually from a normal healing inflammatory response. The inflammation is in response to the cautery (burning) from the vasectomy procedure and/or exposure to sperm. Healing nodules in the vas deferens usually present within the first 3 months of having a vasectomy procedure. They usually shrink in size with the passage of time.

Nodules in the epididymis. Nodule formation in the epididymis always occur from a back up of sperm after vasectomy. The increased pressure in the lower end can cause a dilation, or an aneurysm, of a weakened section of the epididymal tubules. Nodules in the epididymis usually form 3 months or more after vasectomy. It is possible epididymal nodules can form anytime within 3 years of having a vasectomy procedure. Usually they present with a gradual increase in pain that reaches it peak for several days and the begins to slowly subside.

In many cases these nodules are a ‘normal’ healing response after vasectomy. In rare cases, the nodules could be persistently painful and may require additional medical treatment.

Why would you form a nodule after vasectomy in the vas deferens?

During a His Choice vasectomy procedure each vas deferens is:

Divided with heat energy (cautery)
The inside of the upper part of the vas deferens is lightly cauterized
The divided ends are separated and held apart with several small titanium clips the size of a grain of rice

The cause of the nodule depends on when you first notice the nodule and the degree of pain that is experienced.

Vas deferens nodules within 48 hours of vasectomy

If you examine yourself immediately after vasectomy almost all patients will feel the two ends of each divided vas deferens (the divided upper end and the divided lower end) side-by-side.

Usually this may feel like a nodule, or a lump/bump, in the vas deferens. It may be about the size of a nickel or a dime. When you feel the nodule through the scrotal skin it is common for the nodule to feel larger than it really is because the skin folds make it feel as if it is bigger.

We recommend you do not examine yourself after vasectomy. There is no benefit from examining your scrotum and vas deferens soon after you have a vasectomy. The only reason is to satisfy your curiosity. When examining yourself, you may cause yourself more tenderness than is necessary. You are only going to feel things that are ‘normal’ and you will be unnecessarily concerned.

Percentage of patients who will feel a nodule within 48 hours of vasectomy: Almost 100%.

Vas deferens nodules 3 to 21 days after vasectomy

For some patients it can be normal for the vasectomy site to feel like it grows in size the first two weeks after vasectomy. This is because of inflammation from the cautery (burn) in the upper end of the vas deferens.

This is a normal healing response. This is how the body responds to an insult. Just like when you get a wooden splinter in your finger, the area becomes more swollen and tender several days after the splinter happens.

Not only does the cautery cause inflammation, but leakage of sperm from the lower end can also contribute to the inflammation, tenderness, and size of the vasectomy site nodules.

It is common for sperm to leak out of the lower end and within the scrotum soon after vasectomy. This is true even with a closed end vasectomy. The lower end will slowly heal closed but the sperm that leaks out can trigger a temporary inflammatory response.

If patients feel like the nodule is growing and becoming more tender 1 to 2 weeks after vasectomy this is normal. This occurs because of inflammation as the body responds to both the cautery from the vasectomy procedure and the exposure to sperm. When this happens the nodule will feel larger, harder, and more tender.

Over the counter anti-inflammatory medications will be helpful in controlling discomfort.

At first these inflammatory nodules may feel as large as your thumb (not typically but possibly). Over time, the nodule will slowly become smaller and may completely disappear over time. Usually these nodules have completely resolved by the time of the three month after vasectomy semen sample.

In some cases it may take a full year (12 months) for the nodule to become as small as it will ever be which is about the size of a green pea.

Take home message: Nodules within the first three months are normal healing nodules that slowly shrink over time.

Percentage of patients who will feel a nodule two weeks after vasectomy: < 50%.

Non-painful vas deferens nodules 3 months or more after vasectomy.

If you start to experience a nodule 3 months of more after vasectomy then this is most likely a sperm granuloma.

Occasionally after a vasectomy the lower end will heal closed with a small nodule at the end…kind of like a lollipop. This is usually a sperm granuloma.

A granuloma is best thought of as inflammatory healing tissue that contains healing tissue, inflammatory response cells, and sperm.

You can best think of a sperm granuloma as a ‘cul-de-sac’ of the lower end of the vas deferens. This is an area where sperm can collect and gradually be resorbed by the body.

Sperm granulomas are common after vasectomy and should not be considered a complication unless they cause pain and disrupt your daily activities.

Take home message: Nodules after three months are sperm granulomas. They are small and may or may not shrink with time. They do not usually cause significant pain.

Percentage of patients who have painless nodules 3 months or longer after vasectomy: approximately 25%

Painful nodules after vasectomy in the vas deferens: Neuromas

If you develop a nodule in the vas deferens 3 months or more after vasectomy and the nodule is also moderately to severely painful then you could have a neuroma.

A neuroma is a sperm granuloma that has developed hypersensitive nerve endings. The hypersensitive nerve endings cause the nodule to be painful with normal, daily activities.

Neuromas are not normal and they can cause significant pain or dysfunction which may require additional treatment.

If you can take an over the counter ant-inflammatory medication (800 mg of ibuprofen or 550 mg of naproxen) and the pain resolves then you do not have a neuroma!
Anti-inflammatory medication does not decrease pain if you have a neuroma.

If the pain responds to over the counter anti-inflammatory medications then you do not have a neuroma. You most likely have a granuloma with temporary inflammation.

Take home message: Nodules experienced six to twelve months after vasectomy that are significantly painful may be neuromas.

Percentage of patients who have painful nodules 12 months or longer after vasectomy: <1%

Nodules in the epididymis after vasectomy

It can be common to form nodules in the epididymis after vasectomy. These are essentially sperm granulomas that form in the epididymis.

Sperm granulomas that form in the epididymis are usually more uncomfortable when they form in the epididymis than when they form on the vas deferens. Over time the pain should gradually go away.

Sperm are made in the testicle. The sperm are then pushed into the epididymis. The epididymis is a structure that is formed from a long, narrow tube folded over on itself. The majority of the epididymis is located on the back surface of the testicle. The epididymis forms a soft, banana shaped structure on the very backside of each testicle.

The sperm mature in the epididymis and gradually travel up the vas deferens and into the body where they wait to be released during orgasm.

After vasectomy sperm can build up in the lower end of the vas deferens.

In some patients this sperm build-up can cause the epididymis to become distended with sperm. This can causes generalized tenderness in the epididymis after vasectomy. Most patients describe it as a ‘hardness’, ‘tenderness’, or ‘tightness” in the scrotum. This is temporary. Over the counter anti-inflammatories can effectively treat this discomfort.

This sperm back up can happen with any type of vasectomy procedure but is thought to be more common after closed end vasectomy procedures.

In some patients, the sperm build up can cause the epididymis to become dilated. Some patients may form a weakened area (an aneurysm) in a small section of the epididymis. The distention caused by the back up of sperm may cause leakage of sperm from the epididymal aneurysm….and it is this leakage of sperm which causes inflammation and pain within 48 hours of a sperm leak.

When patients experience pain is usually when they will self-diagnose themselves with a nodule in the epididymis on the back of the testicle. They usually have very little symptoms prior to the leak. Not only will they feel a nodule, but the entire epididymis will feel firm and tender.

The good news is over-the-counter inflammatory medications will effectively treat the pain. The discomfort and inflammation will gradually disappear with the passage of time.

On some occasions the pain will go away and the body will heal itself but the nodule in the epididymis could be permanent.

Nodule formation in the epididymis can happen within the first 3 months of having a vasectomy…but more typically happens 3 to 12 months after vasectomy.

We have observed epididymal nodule in a rare number of patients 1 to 3 years after having a vasectomy procedure.

Take home message: Nodules in the epididymis after vasectomy are sperm granulomas that will usually decrease in size and tenderness over time.

Percentage of patients who develop painful nodules in the epididymis : <1%

Although it is theoretically possible for a spermatic granuloma in the epididymis to develop into a neuroma, we have not observed neuroma formation to be a common occurrence in the epididymis.

Does open end vasectomy increase the risk of nodules?

Open end vasectomy is a specialized vasectomy procedure in which the lower end of the vas deferens is allowed to remain open. The His Choice Vasectomy is an open ended vasectomy technique.

More information: Benefits of an open ended vasectomy procedure

Many will understandably question if leaving the lower end open will increase the chance of a vas deferens nodule or sperm granuloma?

It is unclear if sperm granuloma formation is more common after an open end vasectomy.

Sperm granulomas are usually considered a beneficial healing response because the sperm granuloma allows pressure to be taken off the epididymis.

The sperm granuloma provides a larger area for sperm to hang out before they get resorbed by the body. This helps to minimize pressure downstream in the epididymis.

We believe it is much better if the sperm are resorbed in the granuloma located at the end of the vas deferens rather than in the epididymis.

Sperm granulomas are good!

Most nodules felt by patients are either normal vasectomy sites or a sperm granuloma that has formed on the lower end of the divided vas deferens. Sperm granulomas are okay and acceptable. Neuromas are not a good outcome.

Sperm granulomas provide extra absorptive capacity for sperm in the lower end of the vas defers after vasectomy. You can best think of a sperm granuloma as a pressure relive valve.

The end of the lower vas deferens forms a ‘cul-de sac’ where sperm can collect and gradually be absorbed by the body’s immune system. This takes the pressure off the epididymis. You would rather have sperm resorbed in a granuloma rather than in the epididymis.

Many vasectomy reversal specialists will report better fluid and sperm findings in patients who have sperm granulomas after vasectomy. The rationale is the sperm granulomas allow for better resorption of sperm, less back up of sperm and pressure in the epididymis and, an overall, healthier epididymis.

Patients with sperm granulomas of the vas deferens have less epididymal congestive symptoms after vasectomy. Their epididymis is healthier and they have better chance of vasectomy reversal success.

Take home message: Sperm granulomas are okay as long as you dont have significant symptoms. Sperm granulomas are usually healthier for the epididymis and vasectomy reversal findings are usually more favorable.

Neuromas Are Bad!

A neuroma is a sperm granuloma that has turned bad. A sperm granuloma is healing tissue created by the body in response to exposure to sperm. When a sperm granuloma develops abnormal hypersensitive nerve endings then it effectively becomes a neuroma….or a sperm granuloma that has transformed.

Sperm granulomas are always tender and sensitive at first but most sperm granulomas will not evolve into a neuroma. Over the counter pain medications easily treat pain from a sperm granuloma. These same medications will do very little to treat pain from a neuroma.

How will you know you have a neuroma?

Neuromas start off as sperm granulomas. Over time a sperm granuloma will ‘settle down’, but neuromas only stay persistently painful or get worse.

Neuromas diagnosis cannot be made with any degree of certainty until they have been symptomatic for 6 months or more after vasectomy.

Neuromas will be painful. Not just with touch but with walking, running, sitting in a chair, sexual activity, or certain movements or positions that cause physical stimulation of the neuroma.

Over-the-counter anti-inflammatory medications (ibuprofen and naproxen) will do little to reduce the pain caused by a neuroma.

Neuromas do not always go away with time and additional medical intervention is often required. Thankfully neuroma formation after vasectomy is rare.

Take home message: Neuromas are significantly painful, will not go away, and over-the-counter anti-inflammatory medications will not effectively treat the pain. Significantly painful is enough pain that will require you to modify or limit your daily activities.

Vasectomy nodules: What most patients will experience

When you have a minimally invasive His Choice Vasectomy the vas deferens tubes on each side are divided with cautery (heat), the upper portion is then sealed with cautery, and the two ends are separated with a small titanium clip.

Vasectomy site nodule formation is common after vasectomy. Sometimes the nodules resolve overtime and sometimes they are permanent. Initially these nodules are sensitive but over time the sensitivity decreases. Most of these nodules are sperm granulomas (collections of sperm) combined with normal healing tissue.

These nodules usually feel larger the first several weeks after vasectomy (about the size of a nickel or dime) and they may also be tender. They feel larger and tender because of inflammation.

As you heal and the inflammation subsides, these nodules will slowly decrease in size and become less tender. On some occasions patients can feel persistent nodules at the vasectomy site for 12 months or more after vasectomy.

Approximately twelve (12) months after vasectomy, these nodules will either have completely resolved or will have shrunk to the size of a small pea.

If vasectomy site nodules persist one year after vasectomy, they are typically small and painless but will be permanent. These nodules are sperm granulomas and can be considered a normal, healthy reaction to vasectomy.

His Choice Vasectomy: Open ended technique!

It is common to form nodules after vasectomy. Approximately 25% of patients will form a nodule after any vasectomy procedure.

As long as the nodule is not extremely painful and does not cause disruption to your daily life then treatment is not required.

Having a His Choice minimally invasive open ended vasectomy technique. We allow patients to have a single visit vasectomy: no scalpels, no needles and no sutures required.