If you have internal bleeding after vasectomy then you may end up with a scrotal hematoma. A scrotal hematoma after vasectomy is a serious bleeding complication.
Vasectomy is a safe surgical procedure. The risk of having a serious complication is low.
The two most serious complications that can occur after vasectomy are chronic scrotal pain and scrotal hematoma.
Chronic scrotal pain is difficult to treat but thankfully rare. Scrotal hematomas are a more common vasectomy complication.
A scrotal hematoma happens in about 1 out of every 100 vasectomy patients.
If you are unfortunate enough to have a scrotal hematoma after vasectomy then you will have one of the more serious vasectomy complications. A scrotal hematoma is not serious in the sense that it is life threatening. It is serious because it will cause you significant pain until it resolves.
A scrotal hematoma happens when bleeding occurs inside the scrotum within the first 24 hours of the procedure. This is the main reason doctors encourage patients to ‘go home and rest’ after vasectomy.
Most vasectomy patients will not have a scrotal hematoma but if you do you will not be a happy camper. Most scrotal vasectomy hematomas will resolve without medical treatment. Patients will be uncomfortable until full resolution occurs.
Some scrotal hematomas… especially large hematomas… may require a second surgical procedure to remove the hematoma (blood clot).
Why do you get a scrotal hematoma after vasectomy?
Any significant blunt force scrotal trauma can cause bleeding.
You could get ‘kicked in the sac’, take a baseball to the groin, or slip, fall and have a straddle injury on a fence, wall, or bike handle bar. Men seem to be at the highest risk for scrotal trauma in their early adolescent and teenage years. This trauma breaks blood vessels and causes uncontrolled bleeding inside the scrotum. The blood collects and forms a solid blood clot.
Minor scrotal trauma in men with bleeding disorders or those taking prescription blood thinning medication can also cause a scrotal hematoma.
In many ways you can consider a vasectomy to be a procedure that causes ‘controlled and focused trauma’ to the scrotal tissue.
The causes of the bleeding after vasectomy is from bad surgical technique, bad luck, or bad patient.
Bad surgical technique. If a doctor is an experienced or has sloppy surgical techniques then they could finish your procedure without making sure bleeding is absent or down to an absolute minimum. Vasectomy providers who are not proficient may have a slightly higher rate of vasectomy hematomas.
Bad luck. Any procedure can cause bleeding and a scrotal hematoma is a well known vasectomy complication even with the best of vasectomy doctors.
Bad patient. Any procedure can cause bleeding…perhaps everything was dry and not bleeding when the procedure was complete…but bleeding started soon after you left the office. Perhaps you did something to cause the bleeding, like lift something heavy.
A scrotal hematoma occurs after vasectomy because of continued vasectomy bleeding or new bleeding within the first 24 hours of the vasectomy procedure. It is rare to have a bleeding complication more than 24 hours after a vasectomy procedure. Most scrotal hematomas will be observed by patients within the first 24 hours.
If the bleeding is a small amount the patient may not notice anything. The larger the amount of bleeding then the more noticeable and more symptomatic the scrotal hematoma will become.
External bruising usually shows up long after the swelling is detected. First the scrotum will enlarge as a result of the bleeding. Bruising will then be observed later.
If you see bruising first then you usually do not have a hematoma.
A scrotal hematoma is a well recognized risk of having a vasectomy. Older scalpel vasectomy techniques are more likely to cause a hematoma. The risk of scrotal hematoma is lower with modern minimally invasive vasectomy techniques like the His Choice No Cut Vasectomy procedure.
Scrotal hematoma: A helpful comparison
You can best understand a scrotal hematoma by comparing this complication to a water balloon.
A scrotal hematoma is a collection of blood inside the scrotum. Initially, the blood is liquid but within minutes the liquid blood turns into a solid, jelly like blood clot.
Your scrotal sac is similar to a balloon. The blood that has collected inside your scrotum is comparable to the water. The only difference is liquid blood will transform itself into a solid blood clot within minutes.
A scrotal hematoma is like a water balloon in which the water slowly turns to jello with the passage of time.
A scrotal hematoma occurs when you have bleeding inside your scrotum after significant scrotal trauma. You will not see blood externally. Instead, the blood is unable to escape the confines of the scrotum. The blood slowly collects inside the scrotum and will eventually stop.
There is a common joke about bleeding among surgeons. Surgeons like to humorously say, “All bleeding stops….eventually!”
The underlying dark humor is that bleeding will stop as a result of blood’s natural ability to patch a bleeding blood vessel…or bleeding will stop when the patient’s heart stops beating.
We want to be clear. No patient has ever died from a scrotal hematoma.
Most bleeding in a scrotal hematoma will stop because the coagulation cascade (blood’s ability to form a solid blood clot) will plug the leaky, bleeding blood vessel and/or because the increased pressure inside the scrotum will decrease and stop the blood coming from the leaking blood vessel.
The liquid blood will then form a solid blood clot. This blood clot will then remain in this state until the body slowly begins the process of dissolving the clot. The key word is ‘slowly’!
Is a vasectomy hematoma dangerous?
A scrotal hematoma is not dangerous. It is painful and ugly but it will not kill you. A scrotal hematoma is simply a large blood clot that will sit inside your scrotum until your body absorbs it.
Most people hear the words ‘blood clot’ and they will immediately think of other more serious ‘blood clots’ they have heard about.
The key to understanding why a scrotal blood clot is not dangerous is: a blood clot inside a blood vessel is dangerous and a blood clot outside of a blood vessel is not usually as dangerous.
Blood clots outside of blood vessels are mostly cosmetic issues. The only exception is blood clots or bleeding in brain tissue or the spinal cord. This causes serious neurological impairment.
A blood clot within a blood vessel is serious because these blood clot cause blockage of the blood vessel and interferes with important biological functions.
- Blood clots in your leg veins (deep vein thrombus or DVT) can cause leg swelling and break off and go to your lungs.
- Blood clots in your lungs (pulmonary embolus or PE) interfere with breathing and absorption of oxygen. Blood clots in your lungs can kill you.
- Blood clots inside the arteries of your heart will cause myocardial infarction (heart attacks).
- Blood clots inside the blood vessels of your brain cause cerebral ischemia (stroke).
Blood clots inside your blood vessels prevent your circulatory system from delivering oxygen, glucose, and nutrients to vital human tissue.
A blood clot inside your scrotum will sit there until it is either surgically evacuated or slowly absorbed by your body.
A scrotal hematoma will not harm your testicles or impair the blood flow to the testicles unless the hematoma is extremely large (size of a cantaloupe)
A scrotal hematoma is not dangerous but will cause significant disruption to your ability to function until the blood clot resolves.
If you have a scrotal hematoma, you will be on the couch for the first few days. You will limp around at first and then walk funny for a few days. You activity level will decrease until the hematoma resolves.
You will be the patient who tells the story of how they ‘swole up huge and your scrotum was black and blue’ after your vasectomy procedure.
When would you notice a scrotal hematoma?
Most scrotal hematomas are noticed within the first 24 hours.
You do not need to be a doctor to diagnose a scrotal hematoma after vasectomy.
You will have significant scrotal swelling. Significant means you can see the swelling from across the room. If you don’t see it then you will feel it. A small hematoma will feel about the same size as a ‘third testicle’ or a golf ball.
The vast majority of scrotal hematomas will be noticed within the first 24 hours. On rare occasions a hematoma could occur between 24 to 48 hours after a vasectomy procedure but this is not common.
You will not develop a scrotal hematoma beyond 48 hours of your vasectomy procedure unless you are taking a prescription blood thinner, have a bleeding disorder, and/or have some other form of scrotal trauma.
Small scrotal hematoma
A small hematoma would feel like you have a third testicle.
They are usually located on one side of the scrotum (ie right sided swelling or left sided swelling). Small hematomas are usually from a low volume, venous bleed. You can usually see and feel the bulge on one side of the scrotum. The non-hematoma side will look and feel normal.
Small hematomas are detected 12 to 24 hours after a vasectomy procedure. Usually patients will detect small hematomas the day after their vasectomy procedure. Pain is usually mild to moderate. Scrotal bruising will usually show up later (within 3 days).
Large scrotal hematoma
A large hematoma could be the size of a lemon, orange, grapefruit or cantaloupe. They are usually so large they take up the entire scrotum and the entire scrotum will feel enlarged.
Large hematomas are usually from brisk venous bleeding or arterial bleeding. The largest hematomas are usually from arterial bleeding into the scrotum.
The bleeding is brisk and of a large amount. The scrotum will grow rapidly in size and could be very large. These are usually detected by patients within the first 6 to 12 hours.
Patients with large scrotal hematomas will usually experience severe scrotal pain. They may require narcotic pain medications. Usually the pain will resolve slowly within the first 7 to 10 days as the brain learns to adapt.
An arterial scrotal hematoma will usually be noticed before nightfall. The pain will usually be moderate to severe. Bruising is delayed and usually shows up 24 to 72 hours after the hematoma.
Scrotal hematoma treatment: Is surgery required?
Most scrotal hematomas do not require treatment. Some will need surgical evacuation.
After the bleeding stops, the blood will slowly turn from liquid to solid. This happens over the first several hours. Bruising is a late manifestation of a hematoma because it takes time for the blood to work its way to the surface skin tissues to be visible.
After the liquid blood turns to a solid blood clot the hematoma will sit and be stable for approximately 10 to 14 days. Nothing will happen. The clot is actually going through a process we refer to as organization. This is when the blood clot becomes firmer and harder.
After organization is complete the body will slowly start dissolving the blood clot from the outer surface. Slowly the blood clot will become softer and start decreasing in size. The color of the bruising visible on the skin will change from purple to brown to yellow. The bruising will eventually go away completely.
The hematoma will form within hours….will stabilize for 14 days…and only after the 14 day period will the clot begin to slowly dissolve.
Most scrotal hematomas are small. Small hematomas will usually be completely absorbed within 4 weeks.
A large hematoma, one the size of a grapefruit or cantaloupe, may require 3 to 5 months to completely resolve.
Most scrotal hematomas can be treated with expectant management. In surgery, expectant management means ‘do nothing’. The body will slowly absorb the blood clot.
How long does it take? The key word is slowly. It is never as fast as you would like it to be.
Do you need surgery for a scrotal hematoma?
You do not need surgery for most scrotal hematomas. Surgery is only required to treat the largest and most severe scrotal hematomas. Most hematomas will resolve slowly by absorption over time. The key word is slow.
Surgical treatment for all hematomas is often more trouble than it is worth because the blood clot becomes sticky and works its way through the tissue layers. It can be very challenging to remove an organized blood clot.
Trying to remove an organized blood clot from tissue is kind of like trying to remove dried chewing cum from hair or carpet.
Surgery is only required for large hematomas that are causing severe pain because of rapid scrotal enlargement. Typically these hematomas are so large they cause severe pain and interfere with walking and sitting. Sex? You know the answer. Don’t even think about it. That will be the last thing on your mind.
If you were unfortunate enough to get a large scrotal hematoma after vasectomy then you may require a trip to the operating room for a procedure to remove the hematoma.
Usually there is no permanent impairment as a result of a scrotal hematoma.
Do ice packs or frozen peas prevent scrotal hematomas after vasectomy?
There are no convincing medical studies that support the routine use of ice packs… to prevent the development of a scrotal hematoma.
Ice packs (or using frozen peas) is more of an ‘old school’ recommendation from the days of traditional, scalpel vasectomy. These older vasectomy techniques caused more pain. Older doctors also believed ibuprofen could increase the risk of bleeding. As a result they advised patients to use ice and to not take ibuprofen.
We have found that ice packs and frozen peas do not prevent scrotal hematomas. Cold treatment is only helpful for the treatment of pain after vasectomy when over the counter anti-inflammatory medications are not providing optimal pain relief.
How long does it take for a scrotal hematoma to go away?
Hematomas will slowly be absorbed by the body.
The amount of time it takes depends on the volume of blood that need to be resorbed. Initially the blood will form a gelatinous like clot. The clot will then slowly become solidified and organized over 7 to 14 days. Only after consolidation will the clot slowly be absorbed.
- A small hematoma (size of a third testicle) will resolve in less than a month.
- A large hematoma (size of a grapefruit or cantaloupe) may take 3 to 4 months to resolve.
When patients ask us “How long will it take for a scrotal hematoma to go away?” We like to be realistic and honest.
We will usually tell them it will never go away as quickly as you would like. What we are trying to emphasize when we say this is that it will require time and patience.
When you have a condition that is uncomfortable and unsightly it will always seem longer than it will actually take to disappear.
His Choice No Cut Vasectomy: A modern vasectomy technique
His Choice vasectomy is one of the most modern vasectomy techniques: no needle for anesthesia and no scalpel is required for a skin opening. The entire procedure takes less than 15 minutes and can be done safely in the office under local anesthesia. Only one opening is made in the scrotal skin.
More information: His Choice No Cut Vasectomy
Any vasectomy procedure will have a risk of developing a scrotal hematoma. With older vasectomy techniques…especially conventional vasectomy done with a scalpel, the risk of infection and bleeding are much higher.
With minimally invasive vasectomy the risks of having a complication is lower.
At His Choice Raleigh we see hematomas in about 1 out of every 300 patients. We perform about 20 to 25 vasectomy procedures per week. We have a patient with a scrotal hematoma about once every 3 months. Most of these hematomas are small and about the size of a third testicle.
A small hematoma will usually resolve without the need for additional treatment within 4 to 8 weeks. Patients who have scrotal hematomas will not have any long lasting complications.
If you are a His Choice patient and think you have a scrotal hematoma then we want you to call or text us. All patients are given the doctor’s cell phone number so they can directly reach them in case of an emergency.
Thankfully, we do not see hematomas that often. When we do most of them will resolve without the need for any additional treatment.
