Pain After Vasectomy

IN medicine, one of the most important keys to success is communication. An informed consent is when doctors convey information about an intervention to patients prior to treatment.

During this conversation, it is crucially important for doctors to discuss the pros and cons.

In medico-legal angle, it is also important for patients to understand the statistics of the risks involved.

In a way, statistics are neither helpful nor meaningful if adversity truly happened to you and not others.

The iconoclastic Victorian Era English author Samuel Butler once said: “People are lucky and unlucky not according to what they get absolutely, but according to the ratio between what they get and what they have been led to expect.”

So, does it boil down to patient expectations at the end of the day?

On that note, we deal with a reader, who did not expect to be “unlucky” and faces complications after a simple intervention of vasectomy.

Dear Dr G,

I am a fan. I follow your article regularly and agree with your views on men taking charge of their own health.

After reading your articles about vasectomy, I volunteered to have the snip when my wife and I decided to “close shop”.

I agree with the fact that I can never experience the difficulties of childbirth my wife went through with our two girls, but this is the least I can contribute in family planning.

I went for a vasectomy six months ago. The procedure was essentially straightforward.

However, three days after the operation, I had a slight pain and ooze from the wound site. I went back to the doctor who told me it was infected.

Despite the antibiotics, I constantly had this discomfort in the sac since the operation.

Although the ooze had disappeared and the semen analysis had shown the sperms had “dried up”, I still think something is not 100% right, as I have some discomfort in the scrotum.

I don’t want to mention anything to my wife, as I don’t want her to think I am a wimp.

I am grateful if you can tell me whether something went wrong with the operation? I guess, I have some regrets following the snip!

What can I do about this and do I have to endure such discomfort for the rest of my life?

Desperate

Vasectomy is a surgical procedure of male sterilisation for long-term contraception.

During the intervention, the vas deferens is severed and then tied or sealed in a manner to prevent the drainage of sperms into the seminal vesicle and be part of the ejaculate.

When the vasectomy is complete, the occlusions ensure no sperms exiting the body. Although the sperms are still produced at the normal rate, the formed sperms in the testicles will soon be broken down and absorbed by the body.

Vasectomy is gaining popularity among men in recent years, as it is the most effective, least invasive and most cost effective form of permanent male contraception.

In New Zealand, 18% of men and 25% of married men have had a vasectomy with the highest level age group between 40 and 49 years old.

After vasectomy, the membrane in the epididymis absorbs much fluid content; and most of the solid content is broken down by white blood cells and absorbed in the blood stream.

As the vasa is occluded, the membranes of the epididymis increases in size and pressure to accommodate more fluid, this in turn will also trigger the immune system to break down and reabsorb the sperms.

Although the intervention is simple and generally straightforward, vasectomy is by no means risk free. Short-term complications such as infection, bruising and bleeding into the scrotum may affect 2.5% of men.

Such problems usually recover with minimal long-term consequences. The long-term concerns are chronic discomfort known as post vasectomy pain syndrome (PVPS).

The typical symptoms experienced by men with PVPS include persistent pain or discomfort in the scrotum, groin pain on exertion or sexual intercourse and pain upon ejaculation.

The range of symptoms can be mild and annoying to debilitating in minority of men.

A retrospective postal survey of 396 men found that 4% had genital pain about one year after the intervention.

The most robust study by the American Urological Association (AUA) found that 0.9% of men after vasectomy described the pain as “noticeably affecting their quality of life” seven months after the procedure.

The pain is thought to be associated with the combination of testicular backpressure, overflow epididymis, chronic inflammation, nerve entrapment and scarring.

The good news is, the vast majority of men with the discomfort will experience no further bother after one year.

The other good news is that nine of 13 men who underwent vasectomy reversal in an attempt to relieve the PVPS became symptom free following relief.

In others studies, the denervation of nerves (the operation to remove the nerve) in the spermatic cord also provides pain relieve in 13 out of 17 men.

Although complications after intervention will leave some feeling unlucky and regretful, the reality is, most of the problems following a vasectomy will only leave men with minor transient pain in the sacs.

Hopefully, there will be no long-term complications after the snip!