Post-vasectomy pain syndrome

Diagnosis

Your doctor will perform a comprehensive physical examination, assessing for tenderness and swelling of the testicles and epididymis. They will also inspect for the presence of a small ball of scar tissue at the site of your vasectomy (sperm granuloma). Additionally, other potential causes of testicular pain will be investigated to rule them out. Tests that your doctor may suggest include:

• Blood and urine analysis. Your blood and urine samples are examined for infections and other abnormal findings.
• Screening for Sexually Transmitted Infections (STIs). To collect a sample of the discharge from your urethra, a thin swab is placed into the tip of your penis. The sample is examined in the laboratory for STIs like chlamydia and gonorrhea.
• Ultrasound. This imaging technique creates images of the internal body structures by using high-frequency sound waves. Testicular torsion—a rotation of the testicles that twists the spermatic cord bringing blood to the scrotum—spermatocele, an epididymal cyst, infections of the testicles or epididymis, and hernias can all be ruled out by ultrasound imaging.
• Magnetic Resonance Imaging (MRI). An MRI scan creates precise images of the internal organs in your body by using radio waves and a strong magnet. Men with a history of back or hip issues may consider having an MRI to assess their spine or hips in order to rule out nerve compression.

Treatment

The course of treatment for PVPS is determined by the severity of your symptoms and the level of discomfort you experience.

Medications

• Pain relievers. Pain or swelling may be lessened by anti-inflammatory drugs such ibuprofen. These drugs can be taken by men who experience pain before or after ejaculation before sexual activity. One more option for treating pain is to take prescription painkillers.
• Other medications. After four weeks, if anti-inflammatory drugs are still ineffective, your doctor can suggest an anticonvulsant or a tricyclic antidepressant. These medications have not been thoroughly investigated in men with PVPS, but they may be useful in the treatment of nerve pain.

Therapies

• Adequate undergarments. Compression shorts or a jock strap can help lessen testicular pain.
• Heat or ice. Pain relief options include an ice pack or warming pad. During a flare-up, sitting in a warm bath could be beneficial as well.
• Treatment with physical therapy. Pelvic floor physical therapy can help men who have pain in the pelvic region or during urination by teaching them how to relax specific pelvic muscles.
• Nerve block. Your doctor can recommend a nerve block, which targets the nerve that leads to the testicles using numbing medicine. Your discomfort will most likely only be momentarily alleviated by this. Once the numbing drug wears off, pain frequently returns.

Surgery

• Sperm granuloma removal. Some men experience no pain in other areas of the scrotum, but instead develop a tiny ball of scar tissue on the vas deferens. Following the scar tissue removal operation, some guys might feel less pain.
• Microdenervation of the Spermatic Cord (MDSC). In order to lessen or completely stop pain signals, the surgeon divides the veins and nerves that supply the testicle from other areas of the spermatic cord during this treatment. Men who get momentary relief from a cord block seem to benefit most with MDSC. When MDSC is effective, life quality can be considerably increased. Testicular atrophy, persistent or escalating pain, and fluid accumulation in the sheath surrounding a testicle that results in scrotal enlargement (hydrocele) are possible complications.
• Epididymectomy. Eliminating the C-shaped structure that stores sperm behind the testicle may provide relief for males with epididymis pain. The treatment appears to be most successful in reducing discomfort in males with an epididymal mass, cyst, or granuloma.
• Reversal of vasectomy (vasovasostomy). Restoring sperm to the ejaculate can potentially increase fertility by reversing the vasectomy. The pressure and pain associated with ejaculation may be relieved with this technique. In certain cases, vasectomy reversal relieves pain more effectively for men than the MDSC method.
• Orchiectomy. Men who do not respond to more conservative therapies are left with no other option except to have their testicles removed. Men occasionally have phantom limb pain in the region where the testicle once was, even after it has been removed.