Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after

vasectomy Vasectomy, or vasoligation, is an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and ...

. Because this condition is a

syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek σύνδρομον, meaning "concurrence". When a syndrome is paired ...

, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. When pain in the epididymides is the primary symptom, post-vasectomy pain syndrome is often described as congestive epididymitis.

Incidence

In their Vasectomy Guideline (2015), the

American Urological Association The American Urological Association (AUA) is a professional association in the United States for urology professionals. It has its headquarters at the William P. Didusch Center for Urologic History in Maryland. AUA works with many international o ...

stated: An investigation of peer-reviewed articles published in March 2020 examined 559 articles, performed meta-analysis on 25 separate datasets, and concluded that the incidence of post-vasectomy pain syndrome is 5% (95% CI 3% to 8%) with similar incidence of PVPS for both the scalpel and the no-scalpel technique.

Symptoms

* Persistent pain in the genitalia and/or genital area(s) * Groin pain upon physical exertion * Pain when achieving an erection and/or engaging in sexual intercourse * Pain upon ejaculation * Loss of erectile function Any of the aforementioned pain conditions/syndromes can persist for years after vasectomy. The range of PVPS pain can be mild/annoying to the less-likely extreme debilitating pain experienced by a smaller number of individuals in this group. There is a continuum of pain severity between these two extremes. Pain is thought to be caused by any of the following, either singularly or in combination: testicular

back pressure Back pressure (or backpressure) is a resistance or force opposing the desired flow of fluid through pipes, leading to friction loss and pressure drop. The term ''back pressure'' is a misnomer, as pressure is a scalar quantity, so it has a magnit ...

, overfull epididymides, chronic

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

fibrosis Fibrosis, also known as fibrotic scarring, is a pathological wound healing in which connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodelling and the formation of perma ...

sperm granuloma A sperm granuloma is a lump of leaked sperm that appears along the vasa deferentia or epididymides in vasectomized individuals. While majority of sperm granulomas are present along the vas deferens, the rest of them form at the epididymis. Sper ...

s, and

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the e ...

entrapment. Pain can be present continuously in the form of orchialgia and/or congestive epididymitis or it can be situational, such as pain during intercourse,

ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential componen ...

or physical exertion.

Mechanisms of pain

There is a noticeable enlargement of the epididymides in vasectomized men. Sperm sometimes leak from the vas deferens of vasectomized men, forming

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

s in the scrotum known as sperm granulomas. Some sperm granulomas can be painful. The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus lessens the likelihood of epididymal discomfort. One study using ultrasound found that the epididymides of patients with post-vasectomy pain syndrome were enlarged and full of cystic growths.

Treatment

Treatment depends on the proximate cause. In one study, it was reported that 9 of 13 men who underwent

vasectomy reversal Vasectomy, or vasoligation, is an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and ...

in an attempt to relieve post-vasectomy pain syndrome became pain-free, though the followup was only one month in some cases. Another study found that 24 of 32 men had relief after vasectomy reversal. Nerve entrapment is treated with surgery to free the nerve from the scar tissue, or to cut the nerve. One study reported that denervation of the spermatic cord provided complete relief at the first follow-up visit in 13 of 17 cases, and that the other four patients reported improvement. As nerves may regrow, long-term studies are needed. One study found that epididymectomy provided relief for 50% of patients with post-vasectomy pain syndrome.

Orchiectomy Orchiectomy (also named orchidectomy, and sometimes shortened as orchi or orchie) is a surgical procedure in which one or both testicles are removed. The surgery is performed as treatment for testicular cancer, as part of surgery for transgend ...

is recommended usually only after other surgeries have failed.

References

{{reflist , refs = {{cite book , title=Genitourinary Pain And Inflammation , pages=201–209 , publisher=Humana Press , doi=10.1007/978-1-60327-126-4_13 , author=Potts JM , year=2008 , chapter=Post Vasectomy Pain Syndrome , series=Current Clinical Urology , isbn=978-1-58829-816-4 {{cite journal , title=Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years , journal=BJU International , vauthors=Manikandan R, Srirangam SJ, Pearson E, Collins GN , year=2004 , pages=93, 571–574 , pmid=15008732 , doi = 10.1111/j.1464-410X.2003.04663.x , volume=93 , issue=4, s2cid=44286821 , doi-access=free {{cite journal , title=Complications of vasectomy , journal=Ann R Coll Surg Engl , vauthors=Awsare NS, Krishnan J, Boustead GB, Hanbury DC, McNicholas TA , year=2005 , pages=87: 406–410 , pmid=16263006 , pmc=1964127 , doi=10.1308/003588405X71054 , volume=87 , issue=6 {{cite journal , pmid = 2644777 , volume=152 , issue=3 , journal = AJR. American Journal of Roentgenology , year=1989 , title = Changes in the epididymis after vasectomy: sonographic findings. , pages=531–4 , vauthors=Jarvis LJ, Dubbins PA , doi=10.2214/ajr.152.3.531 {{cite journal , vauthors=Reddy NM, Gerscovich EO, Jain KA, Le-Petross HT, Brock JM , title=Vasectomy-related changes on sonographic examination of the scrotum , journal=J Clin Ultrasound , volume=32 , issue=8 , pages=394–8 , date=October 2004 , pmid=15372447 , doi=10.1002/jcu.20058 , s2cid=33127806 {{cite journal , vauthors=Shapiro EI, Silber SJ , title=Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia , journal=Fertil. Steril. , volume=32 , issue=5 , pages=546–50 , date=November 1979 , pmid=499585 , doi= 10.1016/S0015-0282(16)44357-8 {{cite journal, vauthors=Christiansen C, Sandlow J , title= Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome, journal=Journal of Andrology, year=2003, volume=24, issue =3, url = http://www.andrologyjournal.org/cgi/content/full/24/3/293, pmid=12721203, pages=293–8, doi= 10.1002/j.1939-4640.2003.tb02675.x, doi-access=free {{cite journal , author = Schmidt S , year = 1976 , title = Spermatic granuloma: an often painful lesion , journal = Fertility and Sterility , volume = 31 , issue = 2, pages = 178–81 , pmid = 761679 , doi = 10.1016/S0015-0282(16)43819-7 {{cite journal , vauthors=Pabst R, Martin O, Lippert H , year = 1979 , title = Is the low fertility rate after vasovasostomy caused by nerve resection during vasectomy? , journal = Fertility and Sterility , volume = 31 , issue = 3, pages = 316–320 , pmid = 437166 , doi = 10.1016/S0015-0282(16)43881-1 {{cite journal , pmid = 4032545 , volume=134 , issue=3 , journal = The Journal of Urology , year=1985 , title = A late post-vasectomy syndrome. , pages=494–7 , vauthors=Selikowitz SM, Schned AR , doi=10.1016/S0022-5347(17)47256-9 {{cite journal , vauthors=Nangia AK, Myles JL, Thomas AJ Jr , title=Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation , journal=J. Urol. , volume=164 , issue=6 , pages=1939–42 , year=2000 , pmid=11061886 , doi=10.1016/S0022-5347(05)66923-6 {{cite journal , doi=10.1016/S0022-5347(01)65191-7 , vauthors=Myers SA, Mershon CE, Fuchs EF , title=Vasectomy reversal for treatment of the post-vasectomy pain syndrome , journal=J. Urol. , volume=157 , pages=518–520 , year=1997 , pmid=8996346 , issue=2 {{cite journal , doi=10.1111/j.1464-410X.1991.tb15362.x , vauthors=Chen TF, Ball RY , title=Epididymectomy for post-vasectomy pain: histological review , journal=Br. J. Urol. , volume=68 , issue=4 , pages=407–413 , year=1991 , pmid= 1933163 {{cite journal , vauthors=Ahmed I, Rasheed S, White C, Shaikh N , year = 1997 , title = The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management , journal = British Journal of Urology , volume = 79 , issue = 2, pages = 269–270 , pmid = 9052481 , doi=10.1046/j.1464-410x.1997.32221.x, doi-access = free Pain Syndromes Chronic pain syndromes Sterilization (medicine) Vasectomy