Post-vasectomy pain syndrome

Overview

Vasectomy is a minor procedure that blocks the supply of sperm to the semen. It is a common form of male birth control that is done by cutting and sealing the tubes that carry sperm. The sperm, which can no longer reach the semen, are absorbed by the body.

Vasectomy has a low risk of problems, but some men develop post-vasectomy pain syndrome (PVPS). PVPS involves chronic pain in one or both testicles that is still present three months after the procedure. Pain can range from a rare, dull ache to sharp, constant pain that can interfere with daily life. For some men, the pain is severe enough to seek treatment.

Symptoms

Having some discomfort after vasectomy is common, but men with PVPS have pain that never seems to get better after the procedure.

Signs and symptoms of PVPS may include:

• Pain and tenderness in the scrotum
• Pressure or pain after ejaculation
• Dull ache in one or both testicles
• Pain and tenderness at the site of the vasectomy
• Swelling of the small, C-shaped tube behind the testicle where sperm are stored (epididymis)
• Pain with sex

When to see a doctor

See your health care provider immediately if you have pain or swelling in your testicles, discharge from your penis, or pain when you urinate. Your provider may be able to treat the cause with medicine or a minor procedure.

If you have severe scrotal pain, seek emergency treatment.

Causes

The causes of PVPS are not well understood. They may include:

• Infection. Inflammation can damage the scrotum, epididymis or other structures along the cord that carries blood vessels and nerves to the testicle (spermatic cord).
• Nerve compression. A narrowing of nerves to the testicle may cause symptoms of PVPS.
• Back pressure. Sperm that are unable to travel through the tube that carries sperm from each testicle and is cut during vasectomy (vas deferens) may cause back pressure.
• Scar tissue. Scar tissue (adhesions) may form and cause pain.

Risk factors

There are no known risk factors for developing PVPS. It is not associated with any specific age group, socioeconomic status, environmental factors or type of vasectomy procedure.

Complications

If left untreated, severe pain may cause significant emotional and psychological distress for men with PVPS. Ongoing pain can affect quality of life for men with PVPS.

Men may be unable to participate in normal physical activity and have trouble working at their jobs. Pain may also result in men avoiding sex.