Bleeding can sometimes occur after vasectomy. The most common site for bleeding is from the skin edges of the opening used to perform the vasectomy. This often will resolve quickly after the procedure and with the application of a simple band-aide. Bleeding from the skin edges may be off and on during the first 24 hours. After 24 hours slight spotting may be common. Typically a no-scalpel incision site does not require sutures and should be completely closed within three (3) days.

The more concerning vasectomy bleeding occurs inside the scrotum and forms a collection of blood called a hematoma. Either venous or arterial bleeding can cause a scrotal hematoma.

The risk of large symptomatic hematoma formation requiring treatment is 1 out of 1000 patients or 0.1%.

Venous hematoma after vasectomy

A venous hematoma happens when bleeding comes from a vein. This can occur as a direct result of the vasectomy procedure or because of too much activity immediately after a vasectomy procedure.

Venous bleeding is slower and than arterial bleeding. Eventually the blood will accumulate within the scrotum to the point it is noticeable by the patient. Usually this happens within 24 to 36 hours after the vasectomy procedure but can happen as far out as seven (7) days after.

A venous scrotal hematoma can be as small as a quarter or as large as a grapefruit. Often the scrotal sac is not distended or tense but still has the external ‘crinkles’ in the scrotal skin. Small hematomas may have no symptoms but large ones can be painful because of pressure and the effects of gravity.

Arterial hematoma after vasectomy

An arterial hematoma happens when bleeding comes from an artery. This is often a direct result of the vasectomy procedure.

Arterial bleeding bleeding is brisker than venous bleeding. The blood will accumulate within the scrotum to the point it is noticeable by the patient within 6 to 12 hours after the vasectomy.

An arterial scrotal hematoma will cause the scrotum to be distended, tense, and the scrotal skin will be smooth and taught.

Treatment for hematoma after vasectomy

Patients who have large symptomatic hematomas do not have to guess whats going on. They immediately recognize they are having a complication. Hematomas requiring intervention are noticeable and uncomfortable.

The recommended treatment for a venous hematoma is watchful waiting, anti-inflammatory medication (ibuprofen), and an athletic supporter. The hematoma will liquefy in seven (7) to fourteen (14) days after formation and will slowly dissolve and be absorbed by the body. The scrotal skin will go through color changes as the hematoma is slowly dissolved. If the patient is very symptomatic from a venous hematoma then surgical drainage can be performed.

Arterial hematomas often cause more pain and discomfort than venous hematomas. The recommended treatment for an arterial hematoma is surgical drainage.