It can be common to form hard lumps after vasectomy inside your scrotum.
If you are thinking about having a vasectomy then do not let the possibility of forming small lumps deter you from the safest and best form of long term birth control. Vasectomy is far easier and safer than tubal ligation so don’t let your fear of forming a few lumps scare you!
If you are curious because you are now feeling hard lumps after vasectomy in your scrotum then we will reassure and explain what is happening.
Most people will call these hard areas ‘lumps’ or ‘bumps’. The medical term for a lump or bump is a ‘nodule’.
We estimate approximately 25% of vasectomy patients will form a painless lump (nodule) after vasectomy. We like for patients to be well informed. We want you to know it can be common to develop hard lumps after vasectomy.
Don’t worry because most of these lumps are small. Most will go away with the passage of more time.
Most of the hard lumps after vasectomy are harmless sperm granulomas. These granuloma are small and could end up being about the size of a ‘green pea’.
The reality is most patients will never detect these small lumps unless they go checking for them!
These lumps may be tender at first but will not cause long term problems. Some will stay forever. Some will gradually get smaller with more time.
Some hard lumps are neuromas. Neuromas are not normal and may be a sign of a vasectomy complication.
Neuromas are sperm granulomas with hypersensitive nerve endings. The biggest difference between a sperm granuloma and a neuroma is that a neuroma is painful and the pain will not go away with the passage of time.
The chance of forming a hard lump neuroma after vasectomy is way less than 1%.
Forming Hard Lumps After Vasectomy: Where would they be?
If a lump forms after vasectomy this would only happen inside the scrotum. The lump would not be visible from the outside. These lumps can only be felt with a careful physical examination.
- A lump after vasectomy can form on the vas deferens in the area where the vasectomy was performed
- Hard lumps can also form in the epididymis (area behind the testicle)
You will not form lumps or nodules in the skin, penis, or testicles.
Hard lumps in the vas deferens. A hard lump at one or both sites of the vasectomy is usually from healing tissue. This is common after vasectomy. Inflammation may cause the hard lumps to feel tender. The inflammation is a healing response that results from the burning of the vas deferens during the vasectomy procedure but also from exposure to sperm. This is normal after any vasectomy procedure.
Hard lumps in the epididymis. A hard lump in the epididymis always occurs from increased pressure in the lower end of the vas deferens. This increase pressure causes a build up of sperm in the lower end of the vas deferens after vasectomy.
This increase pressure can cause an aneurysm in weakened sections of the small epididymal tubules. When this happens some patients may feel a painless lump in the epididymis. If there is leakage of sperm from the aneurysm then this causes inflammation, the lump became harder, and patients experience more pain. If you have leakage of sperm from the aneurysm then you will have increased pain from the inflammation but this will gradually go away over 1 to 3 weeks as your body adapts and contains the area of the leak.
Lumps in the epididymis usually form three (3) months or more after vasectomy. It is possible epididymal lumps can form anytime within three (3) years of having a vasectomy procedure.
In many cases these lumps/nodules are a ‘normal’ healing response after vasectomy. In rare cases, the nodules could be persistently painful and may require additional treatment.
When would you form a hard lump after vasectomy?
Scrotal lumps within 48 hours of vasectomy: Normal!
If you examine yourself immediately after vasectomy almost all patients will feel the two ends of each divided vas deferens side-by-side.
Usually this may feel like a hard lump high in the scrotum on the vas deferens. This lump would be felt at the vasectomy site… almost in the area where the penis exists the abdominal wall. The lump may feel about the size of a nickel.
Scrotal lumps 3 to 21 days after vasectomy: Normal!
It can be normal for the vasectomy site to feel like a lump that grows in size the first two weeks after vasectomy.
The lump will also become more tender to the touch. This is because of inflammation from the cautery (burn) in the upper end of the vas deferens. This is a normal healing response.
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.
The lump that previously felt about the size of a nickel will now feel larger and more tender. The lump that previously felt the size of nickel may now feel like the size of your thumb!
The change in size and tenderness is from inflammation as the body tries to heal from the vasectomy procedure.
As inflammation sets in the lump will slowly begin to feel larger, harder, and more tender.
Over-the-counter anti-inflammatory medications will be tremendously helpful in controlling the pain. Ibuprofen or naproxen are the best medications to help treat the tenderness from scrotal lumps after vasectomy.
With more time and as further healing takes place, the lumps will decrease in size and may completely disappear over time. Usually these scrotal lumps 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 lump to become as small as it will ever be which is about the size of a green pea.
Why do you get hard lumps after vasectomy?
The medical term for hard lumps formed after vasectomy is a sperm granuloma. A granuloma is healing tissue. In particular it is healing tissue that forms in response to sperm.
The body contains the sperm in the granuloma. You can best think of a granuloma as a ‘cul-de-sac’ of the lower end of the vas deferens. Sperm are gradually resorbed by the body in the granuloma.
Sperm granulomas can be common after vasectomy. Granulomas are considered a normal response to vasectomy. They are not considered problematic unless they are painful and cause a significant interruption of your daily activities, ie exercise, sexual activity or work.
Neuromas: Painful lumps 3 months or more after vasectomy!
If you have hard lumps after vasectomy in your scrotum and the lumps are persistently painful they you may have a neuroma.
A neuroma is a granuloma that has developed abnormal nerve endings. The abnormal nerve endings cause the lump to be painful and to stay painful. Granulomas can be tender at first…usually this tenderness goes away. If the pain persists then the granuloma could be evolving into a neuroma.
Neuromas are not normal and they can cause significant pain or dysfunction which may require additional treatment. Less than 1% of vasectomy patients will develop a neuroma. In fact out of every 2,000 vasectomy patients perhaps 1 or 2 may develop a neuroma after their vasectomy procedure.
Hard lumps in the epididymis after vasectomy
Some patients will form hard lumps in the epididymis after vasectomy. These tend to be more painful at first but the pain should gradually decrease with time. Over-the-counter anti-inflammatory medications should greatly help with the pain.
Why does this happen?
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, ‘C-shaped’ structure on the very backside of each testicle.
After vasectomy, sperm can build up in the lower end of the vas deferens. In some patients the pressure caused by the sperm build-up can cause the epididymis to become distended with sperm. This can cause generalized tenderness and hardness in the epididymis after vasectomy but over-the-counter anti-inflammatories (ibuprofen and naproxen) 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 weak area in a small section of the epididymis or an aneurysm. In some patients 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 the leak starting.
Patients will usually self diagnose themselves with a hard lump in the scrotum when they start feeling discomfort. They will feel a hard lump in the epididymis, which is located on the back of the testicle. Not only will they feel a hard lump, but the entire epididymis will feel firm and tender.
Patients who have inflammation in the epididymis will have tenderness anytime the epididymis is touched. The epididymis is on the back of the scrotum. Patients with epididymal inflammation will report pain when sitting, running, and sometimes with sexual activity.
More information: His Choice Vasectomy: Open end vasectomy technique
On some occasions the pain will go away and the body will heal itself but the lump in the epididymis may be permanent.
Lump formation in the epididymis can happen within the first three (3) months of having a vasectomy…but more typically happens three (3) to twelve (12) months after vasectomy. We have observed lumps forming up to three (3) years after having a vasectomy procedure in a small number of patients.
Hard lumps: Granulomas are good!
When patients feel hard lumps after vasectomy..especially high up in the scrotum and away from the testicles… they are usually feeling their vasectomy sites or vasectomy granulomas.
Granulomas provide extra absorptive capacity for sperm made in the lower end of the vas defers after vasectomy. You can best think of a granuloma as a pressure relief valve. This relief valve helps to take pressure of the epididymis.
Many vasectomy reversal doctors will report better fluid and sperm findings in patients who have granuloma after vasectomy. The rationale is the granuloma allows better resorption of sperm, less back up of sperm in the lower end, and less pressure in the epididymis.
Patients who form granulomas after vasectomy usually have less congestive symptoms (pain and pressure) and a better chance of vasectomy reversal success.
Hard lumps: Neuromas are bad!
A neuroma is a granuloma that has turned bad. You can only diagnose a neuroma with confidence when the lump continues to be painful for 6 to 12 months after vasectomy.
If a granuloma develops abnormal hypersensitive nerve endings then it effectively becomes a neuroma. It usually takes about 3 to 12 months after the lump has formed before it starts to declare itself as a neuroma.
Granulomas are always tender and sensitive at first. Usually the pain will completely go away with time. Most granulomas will not evolve into a neuroma.
How will you know you have a neuroma?
The nodule will be very 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.
Neuromas do not always go away with time and additional medical intervention is often required. Thankfully neuroma formation after a vasectomy is rare.
On some occasions patients can feel persistent nodules at the vasectomy site for 12 months or more after vasectomy.
Is it normal to have hard lumps after vasectomy? Be informed!
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
- The two ends are separated with a small titanium clip
To better understand the minimally invasive nature of a His Choice Vasectomy: His Choice Vasectomy explained
It can be common and normal to have hard lumps after vasectomy. Just like bruising after vasectomy, hard lumps in the scrotum after vasectomy can be completely normal.
- Painful vasectomy site lump formation that does not decrease with time is not normal after vasectomy.
- Painless vasectomy site lump formation is common after vasectomy.
Usually these lumps feel larger the first several weeks after your procedure (about the size of a nickel or dime) and they may also be tender.
The lumps feel larger are harder because of inflammation. As you gradually heal and the inflammation subsides, these lumps will slowly decrease in size and become less tender. Approximately twelve (12) months after vasectomy, these lumps will either have completely resolved or will have shrunk to the size of a small pea. Usually the pain from the lumps will decrease with time.
If vasectomy site lumps persist one year after vasectomy, they are typically small and painless but will be permanent. These lumps are sperm granulomas and can be considered a normal, healthy reaction to vasectomy.
His Choice minimally invasive vasectomy
It is common to form scrotal lumps after vasectomy. Approximately 1 out of 4 vasectomy patients will form a lump somewhere in their scrotum after a vasectomy procedure. Although it sounds bad…these lumps can only be felt with a careful scrotal examination. Most patients will not be aware they are there unless they go looking for them.
As long as the lump is not extremely painful and does not cause disruption to your daily life then no treatment is required.
Having a His Choice minimally invasive open ended vasectomy technique that can be performed in a single office visit using local anesthesia.
To get started scheduling now visit: Scheduling a single visit His Choice Vasectomy
We encourage you to do your research, watch our videos, and schedule a single visit vasectomy with a His Choice vasectomy provider.
