If you are thinking about getting a vasectomy then you need to be aware of the risk of developing chronic Post Vasectomy Pain Syndrome.
Developing chronic scrotal pain after vasectomy is not common and occurs in less than 1% of vasectomy patients.
Of all the possible vasectomy complications this is the one you do not want.
Thankfully, this is also one of the vasectomy complications you are the least likely to experience. But if you get chronic scrotal pain then you will seriously regret getting a vasectomy.
Vasectomy is an incredibly safe procedure but nothing is 100% risk free.
Pain is always a risk of any surgical procedure so anyone considering vasectomy should expect some degree of pain or discomfort. Usually normal after vasectomy pain is easily managed with over-the-counter medications.
The medical term for pain in the testicles is orchalgia. Chronic orchalgia, or chronic scrotal pain, is pain that lasts for three months or more. Chronic scrotal pain experienced after vasectomy is sometimes referred to as Post Vasectomy Pain Syndrome. This term is often shortened to PVPS.
Post Vasectomy Pain Syndrome is not common but it is serious. People of who develop chronic Post Vasectomy Pain Syndrome will have daily groin pain for a long time after vasectomy. They will need to see a pain specialist and they will have to consider other treatments or surgeries to treat their pain.
Chronic Post Vasectomy Pain Syndrome is a diagnosis of exclusion. This means all other causes must be ruled out before a diagnosis can be made. Once all other causes have been ruled out then the only remaining diagnosis is chronic Post Vasectomy Pain Syndrome.
If you are diagnosed with chronic Post Vasectomy Pain Syndrome then you may have to live with that diagnosis for the remainder of your life.
What is Chronic Post Vasectomy Pain Syndrome?
Chronic Post Vasectomy Pain Syndrome is groin pain experienced after vasectomy that lasts for three (3) months or more.
All patients have some degree of pain after vasectomy. Normal vasectomy pain is mild and resolves without treatment within 1 to 2 weeks. This ‘normal to be expected after vasectomy pain’ can easily be treated with over-the-counter anti-inflammatory medications.
Patients who develop chronic scrotal pain will have pain that increases in severity over time…it does not get better. Usually the pain begins within the first month of having a vasectomy and the pain increases over time.
More information: Chronic Testicular Pain and Orchalgia
Patients who have Post Vasectomy Pain Syndrome usually experience neuropathic pain.
Neuropathic pain defines Post Vasectomy Pain Syndrome
Neuropathic pain is pain from hypersensitive nerves. The hypersensitive nerves are the cause of the pain.
Most patients will experience inflammatory pain after vasectomy. This is normal and expected.
Inflammatory pain is caused by the immune system’s response to the vasectomy procedure. This is just like when you have a skin cut or laceration. It starts to hurt more a day after the injury, the pain increases in the first several days, and within two weeks the pain resolves as the cut heals.
Inflammatory pain after vasectomy slowly gets better over the course of two weeks. This pain is easily treated with over-the-counter anti-inflammatory medications (ibuprofen or naproxen).
Inflammatory pain will gradually go away.
Neuropathic pain, on the other hand, does not respond to over-the-counter medications. Neuropathic pain will gradually increase until it reaches a steady plateau and stabilizes. Neuropathic pain usually does not resolve with time.
If you develop Post Vasectomy Pain Syndrome you will have neuropathic pain with 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
Post Vasectomy Pain Syndrome is caused by overactive, hypersensitive nerves causing neuropathic pain symptoms.
Causes of chronic post vasectomy pain syndrome
Vasectomy is only one of many causes of chronic scrotal pain. Post Vasectomy Pain Syndrome is a small subset of chronic scrotal pain.
Any insult to the back, pelvis, or scrotum can cause chronic pain in the scrotum. A surgical procedure, infection, or trauma to the groin or scrotum and can cause you to develop chronic scrotal pain. You can even have an injury higher up in your back or abdomen that can cause chronic referred pain to the scrotum.
The following are some of the causes of chronic scrotal pain:
- Surgery: vasectomy, inguinal (ie hernia) or spinal surgery
- Infection or inflammation, such as epididymitis
- Trauma or injury to groin or scrotum
- Structural disorders like varicoceles, spermatoceles, or tumor
- 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 any 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 is the existence of other chronic pain conditions. People who have preexisting chronic pain may be at higher risk of developing chronic scrotal pain after vasectomy.
What is normal vs. abnormal pain after vasectomy?
It is common to experience some pain after vasectomy. For most individuals, the pain is mild, manageable with over-the-counter medications, and gradually improves over time. During the healing process, intermittent low-grade inflammatory pain is normal.
Normal vasectomy pain typically occurs within the first two weeks as the body recovers from the procedure. However, occasional flare-ups can happen anytime within the first six months. These episodes are generally mild and can be alleviated with supportive underwear, warm baths, and over-the-counter anti-inflammatory medications such as ibuprofen or naproxen.
Anti-inflammatory medications are particularly effective for pain relief because they decrease the prostaglandin production that is the cause of inflammatory pain. Most normal after vasectomy pain flare-ups resolve within two weeks.
Abnormal vasectomy pain is characterized by discomfort that does not respond to over-the-counter anti-inflammatory medications. Abnormal vasectomy pain suggesting of chronic vasectomy pain is often described as sharp, stabbing, shooting, or radiating, with a persistent daily pattern. While it may not necessarily worsen over time, abnormal vasectomy pain typically does not improve without intervention.
Chronic scrotal pain: What can be done?
Before treating chronic scrotal pain, it is essential to establish an accurate diagnosis.
Chronic scrotal pain is typically a diagnosis of exclusion, meaning other potential causes must first be thoroughly evaluated and ruled out. If the pain is persistent, occurring daily for three months or longer following a vasectomy, and no other underlying causes can be identified, a diagnosis of chronic scrotal pain is made.
Unfortunately, there is no universally accepted standard treatment for chronic scrotal pain. Management strategies are generally categorized into first-line conservative treatments and second-line surgical interventions.
First-line treatments are always non-invasive and include supportive measures such as warm scrotal baths at night, scrotal support during the day, non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and other medications, such as tricyclic antidepressants or the anti-seizure drug gabapentin, to reduce nerve impulse conduction,
For patients who do not respond to conservative approaches, surgical options may be considered. Procedures with the greatest potential for pain relief include vasectomy reversal and microdenervation of the spermatic cord, which involves disrupting hypersensitive nerves in the scrotum.
Any person suffering from chronic scrotal pain should see a physician who specializes in the treatment of chronic pain disorders. Patients should avoid additional surgeries in the scrotum for treatment of the chronic pain because additional surgeries can sometimes make the pain worse. Second surgeries should only be attempted when recommended by a chronic pain specialist.
It is common for patients who suffer from chronic scrotal pain to become frustrated with their condition because most health care providers have little understanding of chronic scrotal pain and the treatments are not always effective. This is another reason why those who suffer from chronic pain should see a knowledgeable specialist.
What are the chances of chronic scrotal pain after vasectomy?
Research study results on the chance developing chronic scrotal pain after vasectomy are varied and wide ranging.
Research studies have reported that chronic pain after vasectomy can exist in as many as 10% of patients! We believe this number is inaccurate and is an overestimate.
Many of the research studies on pain after vasectomy are poorly done. These studies commonly overestimate the chance of getting chronic scrotal pain after vasectomy.
His Choice vasectomy: Our experience with Chronic Post Vasectomy Pain Syndrome
We perform a lot of vasectomy procedures at His Choice Vasectomy in Raleigh. In our experience, the chance of developing chronic Post Vasectomy Pain Syndrome is less than 1% and is more like 0.3% of patients.
In our experience, if you are unfortunate enough to develop this condition most patients will have mild symptoms. Mild symptoms are symptoms that are present but do not have a significant impact on your daily life. It is extremely rare for us to have a patient that has debilitating pain symptoms.
Any person considering vasectomy should be aware of the risks of vasectomy and risk of developing chronic pain.
As with most things in life nothing is completely risk free.
If you are considering vasectomy then you need to weigh the risks of the vasectomy procedure vs the benefits of not having additional children.
If you are extremely worried about the 0.3% risk of developing chronic scrotal pain after vasectomy….then don’t get a vasectomy.
If you are more worried about the 50% to 90% chance of an unplanned pregnancy and the lifetime commitment to raising another child…then you should get a vasectomy!
We estimate that less than 3 out of every 1000 patients will meet criteria for Post Vasectomy Pain Syndrome. Most of these patients will have mild to moderate symptoms that can be conservatively managed in conjunction with a chronic pain specialist.
Although nothing in life is entirely risk free, 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.
