The most common fear of men considering vasectomy is how much pain and discomfort they may experience during and after the procedure.
Men are often surprised even when we speak to them for follow-up at how trivial the pain it was. We have had patients who return to sports within days – despite the recommendation of seven days of rest, and this only goes to show that while some men take weeks to fully heal, some men seemingly only take days.
It all varies and it is all within the spectrum of what is normal healing time. So listen to your body and use some common sense. You will heal at your own speed. In an attempt to review some of the most common causes of post vasectomy pain we have outlined them here below.
Vasectomy Procedural Pain
While a vasectomy is considered a minor operation, it is still an operation nonetheless. We use a local anaesthetic that generally provides for a virtually painless procedure. No needle is used so event the anaesthetic application is relatively comfortable.
Everybody metabolizes anesthetic at different rates however, which is why some men require top ups. On average we find out of 100 men we may see, only 1 to 2 require additional anaesthetic top ups, and even then only about 1-2 cc’s.
Keep in mind that the testicles are more sensitive than the fingers or the toes, and so pain in this region sometimes feels more than what it really is – and that is why we focus on a quick and minimally invasive procedure to ensure a pain-free experience.
Initial Recovery Pain
As healing starts to kick in, it is normal to experience local pain secondary to inflammation. Pain can occur at the surgical site or the testicle itself. In fact, we encourage our men to avoid any kind of anti-inflammatories the first two days as we want to encourage the process of inflammation which is important for healing.
This early recovery pain can last from 1-2 weeks up to 3 weeks. Remember every man is different and healing times will vary. It is alright to take ibuprofen as needed during this period and if pain is significant taking it for 7 days straight is usually preferred.
Some men will find this pain radiates into the abdomen; this is quite normal. We tell our patients they will feel a “kick in the groin”. Be patient – We have had some men take up to 8 weeks to fully heal from their procedure before they became pain free.
Granuloma Pain – Weeks After Vasectomy
About 1% of men may contact us anywhere from weeks to months after a vasectomy with the concern: “There is a lump down there and it hurts when I touch it.” This is inflammation around the vasectomy site likely due to the exposure of the body to sperm that either leaked out at surgery or afterwards.
There is a ball of white cells that is actively recycling your sperm which results in higher levels of inflammatory mediators in this region. It is self-limited and resolves soon enough, and may be helped by taking ibuprofen regularly for several days. Rarely some men require steroids to relieve this inflammation.
Congestive Epididymitis – Months After Vasectomy
Rarely men present with an episode of scrotal pain a few months or years after vasectomy. There may even be swelling, but no fever and no granuloma are present.
This is classic congestive epididymitis where increase in sperm production (which can be cyclical) is at its peak and thus there is distension in the epididymis. We try to perform a vasectomy higher up from the epididymis to leave lots of “piping” to relieve the distension. Ice, ibuprofen and time help the most. We encourage the use of heat baths to reduce sperm production and ice for comfort. Ibuprofen to reduce the inflammation. Very rarely, a vasectomy reversal is required to relieve this phenomenon.
Post Vasectomy Pain Syndrome – PVPS
Following vasectomy, a very small fraction of patients experience chronic pain. Post-vasectomy pain syndrome (PVPS) is constant or intermittent testicular pain for greater than three months. This pain interferes with quality of life and requires some degree of medical treatment in approximately 1–2% of men who undergo vasectomy.
PVPS is a rare condition and should not dissuade a couple from exploring vasectomy as a birth control method.
Treatment for PVPS can include prescription and non-prescription medication, physical therapy, and if all else fails, surgery. Treatment often begins based on the symptoms. Ultimately, management of PVPS requires a multimodal approach. Thorough understanding of the potential etiologies of PVPS along with the therapeutic options currently available is important to improve quality of life and promote eventual recovery.
So there you have it. The top causes of pain after a vasectomy – remember, virtually all of our patients heal just fine but some men will invariably experience some of the findings above. If it’s you, do not panic and do not start getting advice from Dr. Google – we are always here to help.