Post Vasectomy Pain Syndrome: Should You Get A Vasectomy?
December 10, 2024
Post Vasectomy Pain Syndrome is a bad name for an uncommon but serious vasectomy complication.
Post Vasectomy Pain Syndrome is rare. Although rare, patients who experience this complication can have daily scrotal pain that interferes with their quality of life.
Post Vasectomy Pain Syndrome is commonly shortened to PVPS. Post Vasectomy Pain Syndrome is a bad name for a condition that unfairly suggests vasectomy is the only cause of chronic scrotal pain.
PVPS is a subset of a much larger pain diagnosis, which is more appropriately called chronic scrotal pain, chronic orchialgia, or chronic testicular pain. Vasectomy is just one of many causes of chronic scrotal pain.
If you have a vasectomy and develop chronic scrotal pain then you won’t care what the condition is called. You will fully acknowledge that vasectomy caused your pain. You will not disagree with the name and you will just want it to go away.
In reality, there are many causes of chronic scrotal pain and having a vasectomy is one of the many conditions that can lead to the development of chronic pain in the scrotum.
Chronic scrotal pain is easy to diagnose but difficult to treat. In some cases, patients may have to live with this condition for the rest of their lives.
What is chronic scrotal pain?
Chronic scrotal pain is pain in the scrotum that lasts for three (3) months or more after either a surgical procedure or a disease process. The pain symptoms are from neuropathic (nerve) pain and not inflammatory pain.
All patients have some degree of pain after vasectomy. Normal vasectomy pain is mild and resolves within 1 to 2 weeks.
Normal inflammatory pain after vasectomy
Most pain experienced after vasectomy is inflammatory pain caused by inflammation after the vasectomy procedure. This inflammation is caused by the immune system’s response to tissue injury. The immune system responds to tissue injury and releases prostaglandins.
Prostaglandins temporarily cause nerves to be hypersensitive and cause the sensation of pain. This is a protective response. The perception of pain causes you to avoid stimulating the injured area and allows for better healing. When the tissue injury is repaired the prostaglandin production decreases and the inflammatory pain resolves.
Inflammatory pain is easily treated by over the counter anti-inflammatory medications which inhibit prostaglandin release. These medications do not interfere with healing.
Inflammatory pain gradually resolves as the body repairs the injured tissue.
Abnormal neuropathic pain after vasectomy
Neuropathic pain is pain from hypersensitive nerves. The nerves themselves are the direct cause of the pain. The pain is not from inflammation and prostaglandin exposure.
Neuropathic pain is not always localized to the vasectomy sites and can have radiating qualities. Neuropathic pain may or may not resolve.
Neuropathic scrotal pain has the following qualities:
- Neuropathic scrotal pain. A burning, stabbing, or electric shock-like pain that can have the qualities of shooting, radiating, tingling, crawling, or deep and aching pain.
- Skin hypersensitivity. A heightened sensitivity to touch or cold in the scrotal skin. Sensations of pins and needles, heat or coldness, or unexpected sensations that feel strange, unpleasant, or painful.
- Scrotal numbness. A loss of feeling in all or, most commonly, an isolated area of the scrotal skin.
- Insomnia. Difficulty sleeping due to pain or disturbed sleep
Chronic scrotal pain is pain originating from overactive, hypersensitive nerves.
You can best think of inflammatory pain as something experienced within the first two weeks after vasectomy. Inflammatory pain gradually resolves after vasectomy.
You can best think of neuropathic pain as pain that develops as healing occurs after vasectomy. The pelvic and scrotal nerves heal with abnormal function after vasectomy. Neuropathic pain evolves and persists after vasectomy.
We do not know why some patients develop chronic scrotal pain and others do not. Chronic scrotal pain, like most chronic pain syndromes, is poorly understood.
What are the causes of chronic scrotal pain?
Vasectomy is only one of many possible causes of chronic scrotal pain. There are many possible events that can result in chronic scrotal pain. The following are some of the causes of chronic scrotal pain:
- Structural disorders like varicoceles, spermatoceles, or tumors
- Infection or inflammation, such as epididymitis
- Trauma or injury to groin or scrotum
- Surgery: vasectomy, inguinal (ie hernia) or spinal surgery
- Referred pain from another part of the body, such as the lower back
- Psychological factors, such as somatization disorder, depression, or chemical dependency
Chronic scrotal pain can occur after surgery, infection, or trauma to the male reproductive system (testicles, prostate, penis, etc), urinary system (kidneys, ureters, bladder), or surgery to the anterior abdominal wall (i.e. hernia surgery) or posterior abdominal wall (i.e. spine surgery). Spine and disc disease are the most common causes of referred chronic scrotal pain.
It is unclear why some patients develop chronic scrotal pain. The only identifiable risk factor is the presence of other chronic pain conditions. People who have preexisting chronic pain may be at higher risk of developing chronic scrotal pain after vasectomy.
Vasectomy pain patterns: Normal vs abnormal
It is normal to have pain after vasectomy. For most patients the pain is mild, responds to over the counter medications, and improves with time. During the healing process it is normal to have intermittent low-grade inflammatory pain after vasectomy.
The pain pattern is mostly within the first two weeks as the body is healing from the vasectomy procedure. Occasionally, the pain can flare up anytime within the first six months of having a vasectomy.
Usually the episodes of pain flare ups are mild and easily treated by wearing supportive underwear, taking hot baths, and using over the counter anti-inflammatory medications (ibuprofen or naproxen).
Anti-inflammatory medications work the best for relief of pain. These pain flare ups usually resolve within two weeks.
Abnormal vasectomy pain is pain that does not respond to over the counter anti-inflammatory medications. Patients who develop chronic scrotal pain will have pain pattern that lasts for six months or longer.
The pattern of pain will be sharp, stabbing, shooting, and radiating qualities. The pattern of pain is usually daily. The pain may not get worse over time but it usually does not get better.
What is the treatment for chronic scrotal pain?
Before chronic scrotal pain is treated it must be accurately diagnosed.
Usually the diagnosis of chronic scrotal pain is a diagnosis of exclusion. This means all other causes must be evaluated and ruled out before a patient is diagnosed with chronic scrotal pain. If the pain is daily, has lasted for three months or longer after vasectomy, and no other causes can be determined then the exclusionary diagnosis of chronic scrotal pain is made.
Unfortunately, there is no standard treatment for chronic scrotal pain. Treatments are usually grouped into first line conservative treatments and second line surgical management.
First line treatments for chronic scrotal pain are always conservative medical treatments: hot scrotal baths, scrotal support, non-steroidal anti-inflammatory medications, steroids, and medications that decrease nerve impulse conduction (ie tricyclic anti-depressants and the anti-seizure medication gabapentin).
Second line treatments are usually more invasive surgical procedures. There are many different approaches to surgical management. Surgeries that may have the best chance of decreasing the pain are vasectomy reversal and microdenervation of the spermatic cord (surgery to disrupt the abnormal, hypersensitive nerves in the scrotum).
Most experts will recommend considering surgical procedures for treatment of chronic scrotal pain as a last resort because additional surgery can sometimes make the pain worse. Chronic scrotal pain is best treated by a doctor who specializes in chronic pain disorders.
What are the chances of chronic scrotal pain after vasectomy?
Research studies are varied when citing the chances of developing chronic pain after vasectomy. Medical studies have reported that chronic pain after vasectomy can exist in as many as 10% of patients!
We believe 10% is an overestimation of the chance of developing serious neuropathic pain after vasectomy.
Many of the research studies on pain after vasectomy overestimate the chance of chronic pain because these studies ask poorly defined questions about pain.
- If you ask patients, “Have you had any pain within the first year of your vasectomy?” Many patients will respond with “Yes”.
- If you ask these same patients, “Have you experienced pain after vasectomy that interferes with your daily activities, requires you to miss time from work, and made you seek the advice of a medical professional?” many of these same patients would respond “No”.
Poorly defined questions result in inaccurate estimations of pain after vasectomy. The more precise questions will give you a more accurate determination of the number of patients who experienced chronic scrotal pain after vasectomy.
The His Choice experience with chronic scrotal pain
In our experience, the chance of developing chronic scrotal pain after vasectomy is less than 1% and is more likely less than 0.5% of patients.
We estimate that less than 5 patients out of every 1000 patients who have a vasectomy with our office will develop pain that meets the conditions for chronic scrotal neuropathic pain. Most of these patients will have mild to moderate symptoms that can be conservatively managed.
Any person having a vasectomy has a real but very small chance of developing chronic scrotal pain.
Nothing in life is risk free, but if you choose to have a minimally invasive vasectomy you can be confident you are choosing the safest and most effective method of long term birth control.
