There is a well-recognized condition that can occur after a vasectomy among a small number of men, known as a post vasectomy pain syndrome. This syndrome can begin immediately after the vasectomy or many months or even years after the vasectomy has been completed. The frequency of post vasectomy syndrome varies amongst given practitioners. Some studies report as high as one third of men after vasectomy have some type of lingering discomfort. Other studies report that the frequency of post vasectomy pain is one case in thousands.

• Causes
• Treatments

1. A non-meticulous “rough” surgery where significant amounts of tissue and nerves have been disrupted and/ or tied that have caused lingering irritation of the nerves. While this may be one of the more frequent causes of post vasectomy pain syndrome of post vasectomy pain syndrome one can imagine that it would be less common in the patients of experienced vasectomists.
   
   
2. A sperm granuloma could develop post vasectomy that becomes inflamed and aggravates the surrounding nerve endings. The sperm granuloma is a build up of extravisated sperm at the end of the cut vas tube end. The reason why a sperm granuloma may develop is not well understood.
   
   
3. Inflammation and swelling of the surrounding nerves called neuroma could develop.  This could cause intermittent or constant pain.
   
   
4. A congestive state in the epididymis from back pressure to the epididymis and testes from performing a closed-ended vasectomy. Some authors believe that by blocking both the upper and lower cut ends of the vas tube the normal passage of sperm from the penis and away from the epididymis and testes causes a build up of pressure and ensuing pain. Studies have shown that this situation can be prevented to a large degree by performing an open-ended vasectomy. This is one in which the lower end or testicular end of the cut vas is left open thereby allowing the sperm to drain out of the tube preventing a build up of pressure.
   
   
5. A vasectomy carried out too close to the epididymis can cause chronic pain and inflammation at the epididymis.
   
   
6. Some speculate that post vasectomy pain could be mediated by an immune reaction.  It is known that antibodies to sperm are produce by the body after vasectomy.  It is possible that these antibodies can react with testicular epididymal and or scrotal tissue to cause an inflammatory reaction.
   
   
7. An undiagnosed depression that is totally unrelated to the vasectomy.  In these cases the vasectomy and the perceptions of continued pain become a somatization reaction i.e  a physical expression of psychological pain.  Depression can also be caused by post vasectomy pain syndrome.  The depression can keep the pain perceptions ongoing even once the original cause of the pain is long gone.
   
   
8. Shorter term causes of post vasectomy pain include infection and post operative inflammation which should resolve easily with the appropriate medications and not linger long enough to fall into the category of becoming a syndrome.
   
   
9. While there is no evidence that vasectomy causes prostatitis, new cases of prostatitis have been infrequently described post vasectomy.  So prostatitis should be ruled out by digital exam and possibly scope.
   
   

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1. In regards to a rough surgery, this would likely be the most difficult to treat and to identify as a cause of pain.  Possible treatments could include exploration of the area to remove scarred or inflamed tissue, manual manipulation or stimulation of the painful area, or just allowing time to heal.
   
   
2. In the case of a sperm granuloma, injecting it with steroids or actually cutting out the inflamed granuloma has been found effective in the past. Surgery should always be viewed as a last resort in this case.
   
   
3. Nerve blocks i.e. injection of various anesthetic solutions have been tried. So have injections of steroids, or excision of the neuroma.
   
   
4. In regards to pain resulting from a congestive state from a closed ended vasectomy, converting that vasectomy to an open ended vasectomy or considering a vasectomy reversal have been identified as being effective in the past.
   
   
5. Surgery carried out too close to the epididymis causing chronic epididymitis may respond to medications or require an epididymectomy.
   
   
6. Some advocate the use of a steroidal anti-inflammatory like Prednizone for 1-2 weeks. This treatment may be particularly helpful in treating an antibody/immune mediated cause of the pain.
   
   
7. Regarding treatment of shorter post vasectomy pain like post operative inflammation or infection, the use of anti-inflammatories for inflammation and appropriate antibiotics for infection have been shown to be effective in dealing with this type of pain.
   
   
8. In case of depression and somatization, counseling and anti-depressant medications can be very effective.
   
   
9. Prostatitis can be treated with antibiotics like Cipro, sometimes requiring many weeks of therapy.
   
   
10. Getting a second or third opinion from different practitioners with an expertise in treating post vasectomy pain is always advisable.
    
    
11. Time, sometimes 1-2 years, without doing anything at all, may heal the problem. 

    Some investigations that may help sort out the cause of post vasectomy pain include:
    a) a careful physical examination of the scrotal contents by a qualified physician.
    b) scrotal ultrasound
    c) semen culture and sensitivity and gram stain
    d) anti-sperm antibodies

    e) scrotal exploration

    f) probing of the testicular end of the vas.

    g) a careful psychological history to rule out depression.

    h) Cystoscopy – scoping the urethra with observation of the prostate gland and bladder.

This article was provided by Dr. Neil Pollock of Vancouver, Canada who has a special interest in the diagnosis and treatment of post vasectomy pain syndrome. He is currently offering treatments such as converting closed-ended vasectomies to open-ended. For more information on the subject, you are invited to contact him. Click on this link: Dr. Pollock or use the address:  drneil@netrover.com.

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