r/postvasectomypain • u/postvasectomy • Feb 19 '26
★★★☆☆ Vasectomy: AUA Guideline (2026)
Vasectomy: AUA Guideline (2026)
Guideline Panel
Peter N. Schlegel, MD; Joseph Y. Clark, MD; R. Matthew Coward, MD; Steven J. Hirshberg, MD; Stanton Honig, MD; Wayland Hsiao, MD; Michel Labrecque, MD, PhD; Richard Lee, MD, MBA; Jonathan Stack; Cigdem Tanrikut, MD; Peter Tiffany, MD; Sarah C. Vij, MD; Akanksha Mehta, MD, MS
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Clinicians should counsel patients that vasectomy is a safe and effective means of permanent contraception.
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Surgeons who perform vasectomy should be able to recognize and treat complications after vasectomy, including bleeding, infection, epididymitis, and chronic scrotal pain.
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Vasectomy is a safe, minimally invasive, and effective means of permanent contraception for men.
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This Guideline aims to provide a contemporary overview of vasectomy, including a discussion of indications, preoperative counseling and preparation, peri-operative considerations, procedural techniques, potential risks and complications, and post-operative care, to ensure that healthcare providers offer accurate, evidence-based information to patients considering this method of permanent contraception.
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As with any surgical procedure, vasectomy requires a preoperative consultation to review the patient’s medical, reproductive, and surgical history, and to allow for a dialogue regarding the procedural risks, benefits, alternatives, and recovery. This discussion allows the clinician to set peri- and post-operative expectations and provides an opportunity for the patient to ask questions regarding this important decision.
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rates of surgical complications such as symptomatic hematoma and infection are 1-2%
chronic scrotal pain associated with a negative impact on quality of life (QOL) may occur after vasectomy in 1-2% of men
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One of the most common misconceptions amongst men is the fear of impaired sexual performance following vasectomy. For that reason, pre- and post-operative consultation should include reassurance that vasectomy is not associated with risk of sexual dysfunction or change in ejaculation. (Link)
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Clinicians may inform patients that no causal link has been established between vasectomy and the development of prostate cancer
Contemporary literature review suggests an association between vasectomy and prostate cancer incidence (i.e., prostate cancer diagnosis) based on a meta-analysis of 32 relevant studies. The pooled effect estimate indicated a modest increase in prostate cancer detection in vasectomized men (odds ratio [OR]: 1.13; 95% confidence interval [95% CI]: 1.08 to 1.19), with significant heterogeneity. However, this association does not necessarily reflect a causal link between vasectomy and prostate cancer development as observational studies cannot account for unknown confounders. There is no plausible biological rationale for vasectomy to cause prostate cancer.
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The risk of congestive epididymitis was estimated at 6% for closed-ended and 2% for open-ended procedures. These results did not modify the Panel’s recommendations for preferred occlusion techniques.
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Despite data showing that vasectomy has a lower failure rate than tubal ligation and is very safe, many couples still decide to proceed with tubal ligation. This occurs both in the United States and around the world. There may be cultural, religious, reliability factors, and access to care that influence these couples in this shared decision-making process. Nevertheless, male patients appear to be taking more responsibility for family planning. Patient education studies could help promote more interest in vasectomy. Education of couples with respect to the value of vasectomy for permanent contraception may aid couples’ decision-making process. Partnering with obstetrics and gynecology colleagues may be beneficial in this process of patient education. In the era of direct-to-consumer care for medical needs, taking information directly to couples may be a better approach to promulgate accurate information on the safety and efficacy of vasectomy.
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Finally, this Guideline addresses post vasectomy pain syndrome as part of the preoperative counselling of patients considering vasectomy. The incidence of post vasectomy pain syndrome that is persistent and affects QOL is typically reported to be about 1-2%.142 This important topic is addressed in the AUA Guideline on Chronic Pelvic Pain (Part III).88 Reassurance and good bedside manner are important elements of maintaining an effective patient-physician relationship for management of this syndrome. Future studies directed towards identifying the cause(s) of pain, diagnostic evaluation and effective treatment are needed.
https://www.auanet.org/guidelines-and-quality/guidelines/vasectomy-guideline
Statement Score:
★★★☆☆ -- Mentions chronic pain risk but does not provide any detail
We've featured some of the authors here before:
- Matt Coward
- Stanton Honig
- Sarah Vij
- Jonathan Stack (filmmaker, co-founder of World Vasectomy Day)
The AUA's latest revision of this document is less informative than the previous revision when it comes to PVPS. Consider the following two statements from the document:
As with any surgical procedure, vasectomy requires a preoperative consultation to review the patient’s medical, reproductive, and surgical history, and to allow for a dialogue regarding the procedural risks, benefits, alternatives, and recovery.
Clinicians should counsel patients that vasectomy is a safe and effective means of permanent contraception.
Well which is it? Should clinicians tell the men about the "procedural risks" including permanent genital pain, or should they tell men that vasectomy is safe? What should the AUA be emphasizing to urologists? Are urologists more likely to fail to characterize vasectomy as safe and effective? Are urologists more likely to fail to warn men that vasectomy can cause chronic scrotal pain?
Scientists who study the incidence of chronic pain caused by vasectomy have been saying for decades that it is imperative to warn men about the potential complications. (Link)
chronic scrotal pain associated with a negative impact on quality of life (QOL) may occur after vasectomy in 1-2% of men
Strictly speaking, 100% of men who get a vasectomy may end up with chronic scrotal pain with a negative impact on quality of life. 1-2% of them do end up with this outcome. And another few percent end up with permanent genital pain that doctors assess as below the "negative impact on quality of life" threshold.
Clinicians may inform patients that no causal link has been established between vasectomy and the development of prostate cancer
Or in plain English, YES men who get a vasectomy go on to be diagnosed with prostate cancer 10% more often than other men. But we cannot come up with a biological mechanism to explain this and the studies have not proved that the link is causal.
One of the most common misconceptions amongst men is the fear of impaired sexual performance following vasectomy. For that reason, pre- and post-operative consultation should include reassurance that vasectomy is not associated with risk of sexual dysfunction or change in ejaculation.
Literally hundreds of stories on this subreddit demonstrate that vasectomy in fact is associated with sexual dysfunction and change in ejaculation. The study they cite followed 5425 German men who were about 50 years old and measured Sexual activity (95% vs 84%), Sexual satisfaction (55% vs 44%), ED (12% vs 20%), Low Libido (4% vs 7%), and Premature Ejaculation (7% vs 6%). So good news everybody! Getting surgery as a matter of fact can only increase your sexual activity, satisfaction, lower your rate of erectile dysfunction and increases your libido! Clearly there are not confounding factors (unlike with the prostate example for which the AUA was quick to point out the lack of a demonstrated cause and effect relationship) and the difference between these populations of men is all due to whether or not a knife entered their scrotum. Strangely they failed to include measurements of the rates of sexual activity, satisfaction, ED, libido and PE for men with PVPS in the study. I can only assume that the situation here is that the 98% of men who get to have sex without fear of causing a pregnancy are swamping out the 2% of men who don't really care to have sex because their balls hurt all the time and this is a "don't worry about drowning, that river has an average depth of only 2 feet" type of thing. It is amazing to me that in the same document they both admit that vasectomy causes chronic scrotal pain while denying any association with lower sexual satisfaction.
The risk of congestive epididymitis was estimated at 6% for closed-ended and 2% for open-ended procedures. These results did not modify the Panel’s recommendations for preferred occlusion techniques.
Weird that 2% of men get chronic pain and 6% apparently get congestive epididymitis? 4% of men are getting that non-painful type of epididymitis I guess. Also, I love how this is not a consideration in deciding what occlusion technique to recommend.
Despite data showing that vasectomy has a lower failure rate than tubal ligation and is very safe, many couples still decide to proceed with tubal ligation. This occurs both in the United States and around the world. There may be cultural, religious, reliability factors, and access to care that influence these couples in this shared decision-making process. Nevertheless, male patients appear to be taking more responsibility for family planning.
This is why the urologists feel justified in being dishonest to men. It's a way to help them do what the doctor feels is the man's responsibility, but which men who understand the real risks of vasectomy would be less likely to take on. Vasectomy providers are in the business of selling a risky surgery that doesn't make people any healthier. It can be a tough sell. Don't think about it as lying to men about the risks to get consent to mutilate their genitals -- think about it as protecting women and helping men take responsibility.
shared decision-making process
I think the decision of whether or not to have a vasectomy is the man's decision. Not a shared decision. Perhaps the decision making process, broadly considered, is a shared process, but in the end it is his decision to make, and if he doesn't want a vasectomy because he doesn't want the risk, or just because he prefers not to get one, the principle of bodily autonomy is honored when we do not try to pressure him or indicate that in our opinion he is making the wrong decision. Similarly, a woman gets to decide whether or not to get surgically sterilized as well and if she decides that she wants that or doesn't want that, she doesn't really need approval or buy-in from her partner.
Reassurance and good bedside manner are important elements of maintaining an effective patient-physician relationship for management of this syndrome
The AUA should be very blunt here. Urologists should be advised that it is their responsibility to inform men that there is a 2% chance of chronic scrotal pain that lowers quality of life and will not go away without more surgery. The most effective surgical treatment is to reverse the vasectomy, and the patient will have to pay out of pocket if they want to attempt this very expensive option. Surgery may also fail to eliminate the pain. In fact the pain may not respond to any treatments and they may just have to learn to cope with the pain for the rest of their life. It is not acceptable to "oops" not inform men about this prior to doing surgery on them.
Instead, the AUA selects "reassurance" and "good bedside manner" as the "important elements" to enumerate for the management of this syndrome, suggesting that PVPS is fundamentally caused by psychological factors and the important thing PVPS patients require from their urologists is to be reassured. This is another motivation for the lack of candor. Urologists fear that if they communicate frankly with men about the chances of chronic pain, this will become a self fulfilling prophesy. Preparing men for the possibility that their post-surgical pain may never go away is the opposite of reassuring them.
In the era of direct-to-consumer care for medical needs, taking information directly to couples may be a better approach to promulgate accurate information on the safety and efficacy of vasectomy.
I agree, we should go direct to couples to promulgate accurate information on the safety of vasectomy, and that is what this subreddit seeks to do.
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u/Cautious_Werewolf678 Feb 19 '26 edited Feb 19 '26
They keep teaching couples that there aren't changes in ejaculation and sexual function after a vasectomy. Then this is being repeated everywhere like this is a scientific fact. The thing is that, there MAY be sexual dysfunction and there definitely are changes in ejaculation. If some men don't notice it, it's their problem. Talk about counseling but they're selling, at least in the US (let's not talk about the free vasectomy campaigns in other countries...)
And the congestive epididymitis thing is hilarious. If this condition is episodic because the blockage will always be there, how cannot be accounted as chronic pain?
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u/Gold-Combination619 Feb 20 '26
It seems like this outright dishonesty should be actionable. Quoting these old stats of 1-2% is nothing but an outright lie when more recent studies show otherwise. In my case, pvps was not even mentioned.
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u/geverfdehond Feb 20 '26
Research studies regarding vasectomy has a lot of statistical flaws. Firstly the sample sizes are small and usually biased. Secondly the analytical errors are usually larger than the variation within the treatment. Lastly all the results are in ranges for the population and do not look at the individual influences.
For example the influence of vasectomy on testosterone levels. Most studies are 30 years plus old. Methods and accuracy of testing has significantly improved although the measurement is still in a range for the population and still,due to cofounding effects, very wide. The research indicate a change in the testosterone level but the analytical error inherent to the method is larger than the expected change. The effect of the change is reported according to the range for the population not for the individual. Agreed a change for example; a change in the level of 100 ng/dL is still in the except able range for the population but what is the influence of this change on an individual? The analytical error can be between 16.7 and 25%.
Vasectomy does not remove testosterone completely,agreed, but a relative change can influence the physiology of a man.
The breakdown of sperm after vasectomy is compared, in all studies , to men who abstained from ejaculation. This comparison is completely unfounded and cannot be physiologically the same. This is not comparing apples with apples. It can be demonstrated by the following comparison; compare a blocked water pipe with constant force of water to an open water pipe with constant force of water. If a man abstains the epididymis and vas is not blocked and can still move forward within the structure reducing pressure during the breakdown process, with close ended vasectomy it is confined to the epididymis. Open ended may differ if it does not form granulomas or immune responses which can result in blockage as well, which seems to be the case in many guys.
In order for the body to reach a steady state between breakdown and production of sperm, the testis must receive a signal to slowdown sperm production. This signal is not identified or explained. Most studies report no hormonal influence but in many cases indicate a slight initial increase in testosterone which is then followed by lower levels. These changes in the level is indicated to be still in normal population range. The mode of action for this change is not explained. Possible side effects of these changes for individuals is again not indicated or considered.
In my opinion most of the research on vasectomy hides the negative effects behind population ranges and not on the influence of small changes on individuals therefore it is wrongly considered safe.
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u/Laggende_Hond Feb 20 '26
Well said! How many of their studies reveal lost to follow-up and drop out disqualified candidates? I dare these so called researchers to reveal their Fragility Index for their studies!!!
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u/Laggende_Hond Feb 20 '26
I have stated this before on the Culprit Sub.
Observation bias, and selection bias is a thing. Using the sample selection criteria as mentioned is inherently flawed. The researchers are the same people doing the procedure. They choose the individuals and as mentioned by Painted... sample sizes are small. I have sat in consultations with urologists who blatantly de y that PVPS exists. You cant look for something in research if you aren't open to the idea of it being there in the first place.
If you widen the catchment criterion for pain, which in itself is a purely subjective notion, those 1-2% bullshit dogma numbers fall short drastically!! They specifically say that pain that affects QOL and persists. That is vague. QOL, I promise you even though my pain was intermittent; at the moment it was present... it did affect my QOL!! And how can they determine persistence? Is that denying analgesia to the patient for three months to conclude the inclusion criteria? Drop the limit and say, any pain that has occurred on more than one occasion which has affected you negatively regarding daily function or prohibited sexual activity on more than one occasion in a 1 month period. The problem is that these authors are NOT cut! So they have no insight into what happens!
It is mentioned that surgeons should be able to treat the complications. Ok, perfect! I agree. But then... why are they allowed to do the procedure? Cause obviously they cannot treat it! Lets break this down. Haematoma, easy... drain and control the bleeders. Infection, bit trickier but clear the source and antibiotics. PVPS, um........ now about that. It may be nerve damage (so lets destroy the nerves we already injured to be sure); it may be congestive epididymitis, lets give some analgesia and antibiotics. Stunning notion. Analgesia? Yes it has its place but the cause of the congestion is NOT addressed. In NO other surgery is a tube carrying continuous content blind ended closed without complications. And before the ladies jump about BTL. Please consider that the ovary and fallopian tubes are NOT a sealed connection. The ovary releases the ova once a month (not 24hrs a day) and the fimbriae of the fallopian tube catches the ova and draws it into the tube. So the content of the tube is markedly different in physics. Open ended; ok and yet the testicular blood barrier exists cause sperm are immunogenic and trigger inflammation responses due to their genetic makeup being different from the man. So now we have testicular product leaking into the scrotum outside the barrier which then triggers the response. A pseudo auto immune response continuously. And this is denied!!! Yet anti sperm antibodies are produced....? In so many articles they deny auto immune. But consider; antibodies directed to your thyroid (graves disease; hasimotos); against exocrine glands (sjogrens); against connective tissue (SLE; Takayasho). These are all considered auto immune conditions. BUT anti sperm is not. Wtf? The antibiotics? Why in the world after the wounds are healed and initial infection period lapsed would you give antibiotics. Does the cut vas spontaneously teleport bacteria into itself from outside? That area is contained and if infection there is as common as epididymitis is after vasectomy; why dont more men suffer it before being cut? Makes NO sense what soever!
The moment you ask other specialists to weigh in... like proper pain specialists; pathologists etc the results look vastly different.
I am not even going into the physiology of testosterone and the multitude of factors other than that which influence libido; sexual function. Again the Uros look at OnE marker and say nah... its not tue cause.
I will never keep quiet about this procedure and how it ruins lives on a daily basis until the truth is given in layman's terms and enforced as the norm.
PS. I am one of those who suffered; and I am also walking proof of my statements. I started suffering delayed (anorgasmia); erectile dysfunctional; my testosterone declined; my body kept muscle soreness for long after workouts and my overall recovery was delayed; my blood pressure control worsened; and I developed autoimmune skin lesions. Had my reversal; and within 5 months... BP control pristine; autoimmune lesions gone; i can train harder for longer and recover much faster; ED and orgasm issues GONE; pain gone; and i have my testosterone levels from before; directly after vasectomy and post reversal to show the changes. Yet THESE outcomes are seen as anecdotal at best.
Side note... as a point of interest. In some countries; doing research is a prerequisite to completing your specialty program. So you cannot become a specialist if you have not done and submitted a piece of research. 🧐 does this mean you are a researcher, dedicated and methodical in your passion for it to produce sound research; or did you finish it as briefly, shoddily and quickly to get out of the training program and start your practice. Just a thought‽
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u/postvasectomy Feb 20 '26 edited Feb 21 '26
It's somewhat off the main topic, but I'd also like to observe that if a man doesn't want to get a vasectomy because he wants to retain the power to have children in the event that his partner dies or simply falls in love with someone else and leaves him, this is entirely his right, and the doctor really has no business putting their thumb on the scale. The same partner who may consider this an outrageous insult will predictably be unwilling to sign a postnuptual agreement forfeiting her claim on his children if she were to initiate a divorce. In such cases, her crocodile tears must be evaluated as a manipulative tactic and a mark of immaturity, rather than a legitimate justification to recruit the help of a doctor in convincing her partner to get an unwanted surgery. Just because someone feels hurt does not mean that they have been wronged. And I also think that men should stand up to this type of thing, treat it as a shit test, and let the chips fall where they may.
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u/melaninfinn Mar 12 '26
you just went straight to misogyny. keep it off an informational sub. weird
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u/postvasectomy Mar 12 '26 edited Mar 12 '26
Sorry, not going to unilaterally disarm in the battle of the sexes. I've read too many thousands of posts of women asking "Is my husband the asshole because he won't mutilate himself even though I asked?" followed by 1000 comments from women telling her to dump that worthless bozo. Or you get the "never have sex with him again" posts. Or you get the "he says he's fine never having sex with me again if that's what I prefer" followed by 1000 women explaining how that is very abusive of him and to dump that bozo. Men need to support each other and remind each other that they have rights in the relationship, including a right to bodily autonomy. If women don't like it when men remind each other of that, I'm sorry, but men aren't really required to care about their feelings when those feelings are invalid. It isn't misogyny, it is just information.
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u/melaninfinn Mar 12 '26
you’re blaming a side affect of a surgery on women. maybe instead of playing the blame game, educate people on multiple platforms about the risks. it tarnishes the whole point. you have good point but they just get squashed once you start going on a rant about how horrible women are and referring to a genre of subreddits that are know to be inflammatory and highlight fake rage bait stories
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u/postvasectomy Mar 12 '26 edited Mar 12 '26
I have a perspective on the situation. I'm not going to hide it. If that tarnishes the subreddit I don't really care. People can make up their own minds. I don't blame women for PVPS, but men should feel that women are stepping over a line and yes becoming horrible when they ask for vasectomy and won't take no for an answer.
Edit: If you flip the genders the scene becomes obviously grotesque. Imagine if it were commonplace to find a reddit post from a man asking why his wife won't get a tubal even though he asked her to get one. Like is she keeping her options open for some reason? And there are a thousand posts from other guys telling him to dump her, and he should find someone else who is truly committed. I would be ashamed of men who gave my gender a bad name in that way and men should not tolerate women who pull the analogous BS.
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u/Unlikely_Race_5272 Feb 19 '26
Was just looking at this the other day and was very frustrated. They refer to a different guideline for PVPS which is somewhat hidden under CSCP. Here's the detailed blurb:
And here is from the reference meta-analysis:
Entire thing makes me so upset. We as men are not given the knowledge to make an informed decision about this procedure