Scrotal swelling after vasectomy is not normal. Scrotal swelling may indicate you are having a vasectomy complication.
Severe scrotal swelling within the first 24 hours usually indicates a scrotal hematoma. Severe swelling would be the size of a lemon or larger
Minor scrotal swelling 48 hours or longer after vasectomy is usually suggests scrotal inflammation. Minor…is just that…just enough to notice.
Most patients anticipate their vasectomy procedure may be uncomfortable or downright painful. The reality is patients having a minimally invasive His Choice Vasectomy procedure will report a very low level of pain.
It is common for our vasectomy patients to have little pain and no swelling the first several days after a vasectomy at our practice. Approximately 20% or patients will experience more discomfort 5 to 7 days after an uncomplicated vasectomy. The cause of the discomfort is usually scrotal inflammation.
Scrotal inflammation after vasectomy occurs in approximately 1 out of every 5 vasectomy patients. Scrotal inflammation can be a common cause of pain after vasectomy. Scrotal inflammation causes swelling, tightness, pain, and discomfort.
Scrotal inflammation is not serious in most patients. Inflammation can occur as soon as one week after an uncomplicated vasectomy procedure but can also occur as far out as 12 to 18 months after vasectomy.
If you are worried about inflammation and scrotal swelling after vasectomy then you should not be too concerned.
These conditions can easily be treated with over the counter anti-inflammatory medications, conservative treatment, and letting ‘nature’ take its course.
Why do you get scrotal inflammation after vasectomy?
Inflammation is a normal part of the body’s response to infection or serious injury. Inflammation occurs when the immune system is activated to fight infection or heal damaged tissue.
All surgical procedures, including vasectomy, cause tissue injury. Minimally invasive vasectomy causes minor tissue injury where the vas deferens is divided. The vas deferens tissue injury stimulates the immune system to repair the damaged vas deferens. This repair process is more commonly known as healing.
There are three types of inflammation after vasectomy:
- Acute inflammation which usually happens within the first 48 hours. This inflammation usually results in low grade scrotal discomfort but quickly resolves.
- Subacute inflammation usually means within the first month of the vasectomy procedure but most commonly occurs 5 to 7 days after a vasectomy procedure. Subacute inflammation can happen at either the vasectomy site or in the epididymis.
- Delayed inflammation is any inflammation that happens 3 to 12 months after vasectomy. Most commonly delayed inflammation happens within the first six months of having a vasectomy. Delayed inflammation after vasectomy usually happens in the epididymis.
Acute inflammation happens in approximately 100% of patients and typically resolves within 48 hours. Most patients will report pain levels of 1 to 2 approximately 24 hours after vasectomy. Acute pain and discomfort is what patients worry the most about when considering a vasectomy procedure.
Scrotal pain one week after vasectomy: Inflammation
When used medically the term ‘acute’ means sudden. Subacute means slightly delayed but within a reasonable time frame. We commonly observe subacute inflammation 5 to 7 days after vasectomy in 20% of vasectomy patients.
Subacute inflammation typically results in patients experiencing pain at one or both vasectomy sites and in the epididymis on one or both sides. For reasons that are unclear, most patients will have pain limited to one side after an uncomplicated vasectomy procedure.
As the body responds to the vasectomy and begins healing, the immune system recruits white blood cells into the injured area to begin the healing process. These white blood cells release prostaglandins.
Prostaglandins are chemical compounds that accelerate inflammatory system response to an injury or infection. Prostaglandins help with healing but they also increase the sensitivity of nerves. This is an adaptive response….when nerves become super sensitive patients feel more pain.
Pain can be an adaptive and helpful response because it keeps you aware of where the injured area is and limits you from overusing the injured area. Pain can be harmful if it begins to limit your activity level.
Certain over the counter anti-inflammatory medications can decrease prostaglandin production. Ibuprofen (Motrin, Advil) and naproxen (Aleve) are medications which can greatly decrease inflammation and pain after vasectomy.
Not every patient will have intense scrotal inflammation after vasectomy.
The immune response can be more intense in some patients. This is why 1 out of every 5 patients may report more discomfort after vasectomy and 4 out of 5 patients may not experience any discomfort after vasectomy.
Subacute inflammation can be felt at either the vasectomy site or in the epididymis.
Pain one week after vasectomy: Inflammation at vasectomy sites
When vasectomy patients have pain at their vasectomy sties 5 to 7 days after vasectomy the pain is usually due to an exaggerated inflammatory response.
You can accurately diagnose where the pain is coming from by where you hurt the most. Pain higher up in the scrotum (near where the penis inserts into the scrotum/abdomen) is usually from the vasectomy sites. The vasectomy sites may also feel larger and slightly swollen…about the size of a nickel or dime. In some cases the vasectomy sites could feel as large as a your ‘pinkie finger’.
Usually pain from inflammation at the vasectomy sites is only experienced when you apply pressure to the vasectomy sites. Sometimes the pain is made worse when you laugh, cough or sneeze because contracting your abdominal muscles causes changes in abdominal pressure. These pressure changes cause the vas deferens to move. The movement of the vasectomy sites is what causes the pain.
Inflammation at the vasectomy sites happens as response to the coagulation/cutting the vas deferens, reaction to suture, exposure to sperm. It can also be a combinations of these processes.
Coagulating/cutting the vas deferens. These techniques cause a surgical insult to the vas deferens. Inflammation is a response to the tissue insult (injury). This can be a normal immune response. Pain can be felt at one or both vasectomy sites.
Reaction to suture. Absorbable sutures are only absorbable because the white blood cells attack and dissolve the suture as part of the inflammatory process.
Chromic suture is one of the original absorbable sutures made from chemically processed animal intestines. Chromic suture can cause an intense inflammatory reaction in some patients as the suture is slowly absorbed by the body. The absorption is only happening because the immune system directs immune cells to attack and dissolve the suture material.
Silk suture was one of the original permanent sutures. Although silk suture is not absorbed it can cause intense inflammation in some patients.
Exposure to sperm. Sperm can cause an immune response. In some patients the immune response can be more intense than in others. Sperm can leak out of the lower end of the vas deferens. This leaked sperm can cause an immune/inflammatory response. The body’s immune system is not normally exposed to sperm because the sperm are contained in the genitourinary system.
Sperm leakage can happen with either an open ended vasectomy technique or a closed end vasectomy technique. Even if the lower end is tied with suture or clamped sperm leakage can occur from the lower end soon after the procedure.
Regardless of what technique is used, closed end or open end, there will be some exposure to sperm after the vasectomy due to spillage from the lower end.
Scrotal swelling after vasectomy: Inflammation in the epididymis
Inflammation can also occur in the epididymis 5 to 7 days after vasectomy.
In contrast to vasectomy site pain…which is higher in the scrotum… pain from inflammation in the epididymis is located lower in the scrotum and on the back side of the testicles.
The epididymis is the soft “banana” shaped structure located on the back of each testicle. When patients have pain in the epididymis they usually have pain when they sit , walk/run, have sexual activity, or with any movement that causes the back of the testicle to come into contact with other objects.
The cause of this inflammation is from back up of sperm in the lower end. This back up of sperm causes spermatic congestion and increased pressure within the epididymis.
This epididymis is normally soft and ‘squishy’. When you have inflammation of the epididymis the entire back side of the testicle will feel firm and tender to the touch. The scrotum, especially on the side having the inflammatory reaction may feel uncomfortable, tight, and drawn up against the body.
It is possible to have inflammation at one or both vasectomy sites and/or in the epididymis on one or both sides.
We are unsure why but it is very common for these more intense inflammatory reactions to involve only one side of the scrotum.
We are unsure why some vasectomy patients experience scrotal inflammation after vasectomy and others do not.
Pain 3 to 12 months after vasectomy? Delayed vasectomy inflammation
Delayed vasectomy inflammation can occur 3 to 12 months after vasectomy. In some cases it can happen within the first 3 years of having an uncomplicated vasectomy procedure.
Pain is the primary observation with delayed inflammation. You almost never experience scrotal swelling when you are having inflammation 3 to 12 months after vasectomy.
Delayed inflammation after vasectomy usually happens in the epididymis and not at the vasectomy sites.
The cause of delayed inflammation is congestion of sperm in the epididymis on one or both testicles. The congestion causes distention in the epididymis.
The cause of delayed inflammation is similar to the process that occurs with subacute inflammation in the epididymis the first week after the vasectomy.
The main difference is the back up of sperm causes weakness and leakage of sperm in a small section of the epididymis. This leakage of sperm in the weakened area is what cause the inflammation and subsequent pain.
Sperm congestion in the lower end can cause distention in the epididymis. As the epididymis becomes distended with sperm the structure becomes tender to the touch. Patients will usually notice a gradual increase in discomfort over several days. They usually describe it more as discomfort and less as pain. Usually this will resolve with the passage of time and the use of over the counter anti-inflammatory medication.
In some patients the increased sperm pressure in the epididymis can cause a small aneurysm (or ballooning) in a weakened section of the epididymis. Sperm will fill this aneurysm and the immune system will respond to the aneurysm in an attempt to contain it. This aneurysm will be tender but in most cases in no larger than the size of a dime or nickel.
The aneurysm that contains sperm is called a ‘sperm granuloma’.
Sperm granulomas are tender nodules that can form after vasectomy. If sperm ‘leaks’ from the aneurysm then the body will mount a more intensive immune response and patients can experience more prolonged discomfort. Overtime this will improve and gradually become better.
Eventually the body will deal with the granuloma and, over time, the symptoms will gradually go away and completely resolve.
Treatment of scrotal swelling and inflammatory pain after vasectomy?
Treatment of scrotal swelling after vasectomy is not complicated. The primary focus is on decreasing the inflammatory immune response and supportive treatments to make you feel more comfortable until full healing occurs.
If the discomfort is manageable you do not have to do anything. With the passage of time things should eventually return to normal.
The following is the recommended treatment for scrotal swelling and inflammation after vasectomy:
- Ibuprofen or naproxen as needed
- Wear tight fitting underwear or an athletic supporter
- Hot scrotal baths
Anti-inflammatory medications. The best anti-inflammatory medications are ibuprofen and naproxen.
Prostaglandins are released by white blood cells during the immune response. These prostaglandins cause nerves to have increased sensitivity. Ibuprofen and naproxen decrease prostaglandin synthesis. Anti-inflammatory medications decrease prostaglandin production and pain.
A common issue with these medications is most people do not take the correct dosage.
- Ibuprofen: The best dosage of ibuprofen is 800 mg every 8 hours…this is four over the counter tablets every 8 hours. The over the counter ibuprofen tablets are each 200mg.
- Naproxen. The best dosage of naproxen is 440/500 mg every 12 hours…this is two over the counter tablet every 12 hours. The over the counter naproxen tablets usually are 220mg.
- Naproxen is probably better…if only for the fact this medication lasts for 4 additional hours longer than the recommend maximal ibuprofen dosage.
Acetaminophen is not the best medication for pain. Acetaminophen does interfere with production of some prostaglandins (mainly the fever causing prostaglandins) but only in the brain. Acetaminophen also induces changes that raise the pain threshold in the brain (so tells your brain not everything is painful).
Acetaminophen may not be the best medication for scrotal inflammation. Acetaminophen is a better medication for the treatment of headaches and fevers.
We typically recommend acetaminophen for patients who are allergic to ibuprofen or naproxen or for patients who are not getting good pain relief from these medications.
Aspirin is not an ideal choice because 1) pain relief does not last as long as ibuprofen or naproxen and 2) aspirin inhibits platelets which stop bleeding.
Taking aspirin could increase the risk of bleeding and/or bruising after vasectomy. Aspirin is an ingredient in many over the counter medications; ie Goody/BC powders, Excedrin, etc
Tight firm fitting underwear or an athletic supporter. This helps to keep the scrotum and testicles elevated and protected against the body. If you have inflammation in your scrotum any direct touch or movement will cause discomfort.
A tight, firm fitting scrotal support will prevent the scrotum from being jostled when you walk or run and prevents the testicles from making contact with the surface of whatever you are sitting on.
Hot baths. Hot baths increase the blood flow to the external surface areas of the body, including the scrotum. This causes increased scrotal blood flow.
We are not 100% certain but this increased blood flow may help to ‘flush out’ prostaglandins. It may also bring in ‘fresh’ immune cells to help with healing.
Cold packs may help with pain but they also cause vasoconstriction.
In general, cold treatment is helpful with a fresh injury because it limits swelling. Cold is not usually recommended for injuries that are more than 48 hours old and it could impair the healing response.
We do not routinely recommend cold packs for scrotal inflammation after vasectomy.
Scrotal Swelling After Vasectomy
Patients rarely have scrotal swelling after having vasectomy at our office. We offer minimally invasive His Choice No Cut Vasectomy procedures. Our approach to vasectomy is different from many other vasectomy providers: one visit, no needle, no scalpel, one opening, no sutures, and an open end technique.
We do not remove any portion of the vas deferens. During a His Choice Vasectomy, we do not remove any portion of the vas deferens. By not removing large sections of the vas deferens, we cause less pain, inflammation, and swelling during the recovery phase.
Luminal coagulation. During a His Choice Vasectomy, the inside (the lumen) of the upper end of the divided vas deferens is lightly coagulated (burned). This increases the healing response and causes the upper tube to heal closed quicker.
This decreases the chance of vasectomy failure. We try to lightly coagulate enough of the vas deferens to accelerate closure. Extensive burning will only increase the inflammatory response and may increase the risk of a reconnection.
Fascial interposition. The ends of the vas deferens are caused to be out of alignment with a technique called fascial interposition (which is inserting healthy tissue between the two cut ends). We do this with small titanium clips (the size of a grain of rice) that are permanent and non-reactive. Fascial interposition further decreases the risk of failure.
Some patients are fearful of the titanium clips. They do not want anything foreign in their body. We like to reassure patients these clips are commonly used during vasectomy and have never been shown to cause a serious problem. The clips help hold the ends of the vas deferens apart until they heal closed. The clips do not need to be removed.
The clips are titanium which is commonly used in surgery because this metal is non-reactive, does not rust, and is not recognized by the immune system….this means the clips cause less inflammation. Almost all orthopedic hardware is composed of titanium: screws, rods, artificial knees and hips, etc.
Some patients will request suture to be used during vasectomy instead of titanium clips. Suture is a reasonable alternative to titanium clips; however, absorbable suture is only absorbable because the immune system recognizes it as foreign and attacks the suture. This is how the suture eventually gets absorbed.
Some sutures (chromic and silk) can cause intense inflammatory reactions in some patients. We never use chromic or silk sutures during our vasectomy procedures.
Open ended technique. We leave the lower end open and this minimizes the sudden increase of pressure in the epididymis. This is called an open ended vasectomy technique. The lower end will eventually heal closed. This gives the lower system time to adapt. Even with an open ended vasectomy patients can experience pain in the epididymis from sperm congestion but we believe the percentage of patients experiencing this discomfort is lower than in those patients who have a closed end vasectomy.
Does open ended cause more inflammation from sperm exposure?
We do not believe an open ended vasectomy causes more scrotal inflammation after vasectomy.
It is also important to understand when doctors close the lower end with sutures or clips this does not mean that the lower end is effectively closed for most patients.
What commonly happens is the suture or clips (when placed directly across the vas deferens) will cut through the vas deferens tubes slowly and over several days after vasectomy from pressure necrosis. The lower end will effectively open as this happens. Sperm leakage is going to occur no matter what is done to the lower end.
We do everything we can to make vasectomy easy for patients: no needle, no scalpel, single visit, no removal of anatomy, and no sutures required.
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Our patients do not have a lot of scrotal swelling after vasectomy. Frozen peas and ice are not required after a His Choice Vasectomy.
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We do have patients who have inflammation after vasectomy. This inflammation is easily managed with firm supportive underwear and over the counter medication.
After a His Choice minimally invasive vasectomy you will be back on your feet in 48 hours.
