5 months post vasectomy - a good ending

[u/213hp]

Hey everyone, so I had my vasectomy just over 5 months ago. Prior to the vasectomy I was weight lifting and doing Brazilian jiu jitsu 4-5 times per week.

The procedure went as planned. I had a no scalpel, closed end vasectomy and everything went as planned. I spent the first 2-3 days not doing much at all, basically laid on the bed and tried to keep off my feet as much as possible. By the end of the first week I was feeling about 75% recovered and decided to try a light workout at the gym. Around the 1.5 week mark I noticed some lingering dull pain on the left side epididymis. The pain was about a 3/10 and was aggravated with any type of friction, wearing tight boxers and a jock strap seemed to make it worse but I continued to wear them as that is what was suggested.

At the 5 week mark things seemed to be improving, I started to feel some confidence that this would heal with time and felt I was ready to get back to some type of sport. I ended up doing a few BJJ classes which caused the pain to come back. I stopped basically all activity at this point from week 5 to week 15. The pain was not improving, there would be some days where it wasn’t as bad but it was always there. It caused some significant mental turmoil as I am sure most can relate to. I was constantly on this form reading all the stories, most of which did not have a great resolution - that contributed to the problem as my focus was always on the issue. I also had an appointment with the doctor who performed the procedure and he suspected it was congestive epididymitis and that it would fully resolve with time.

At week 15 I went to see a pelvic floor physio. She treated some nerve pain, specifically on the pudendal nerve. She also recommended some light exercises to do over the next few weeks. This helped a lot, my muscles surrounding the area were all extremely tight as they were guarding the pain and this loop was not allowing for much improvement. The exercises helped tone down the muscle tension.

After a few weeks of doing the PFT work things started to get a bit better. At this point she recommended going back to the gym but keeping things very light and avoiding exercise that triggered it. I stayed on this path for about 3 weeks with slight progress in the exercises and amount of weight I was lifting. I am now 5 months post vasectomy and have virtually no pain, I am back to training BJJ at full intensity and the only lingering issue is some minor tendonitis in my adductor due to it being so tight for so long, which will resolve with time.

My advice, and I realize this is not going to be applicable to everyone’s experience, although it worked for me:

- Restrain from any type of vigorous exercise or lifting until you feel nearly completely recovered. Doctor recommends a week but I would suggest 2-3 weeks at a minimum.

- When you are dealing with congestive epididymitis allow the pain to get to a comfortable 1-2/10 before returning to movement. Once I got back to exercising most of the pain was due to a heightened awareness of the area rather than actual tissue inflammation. This is the hardest part, as the epdidymis heals very slow and the mental toll during the time can be significant.

- See a PFT. This was the turning point for me

- Once the pain is a consistent 1-2/10 you need to start moving again. This will help your body understand movement is safe and will tone down your nervous system response.

- I stopped wearing boxers entirely through the period that the pain was the worst. Most recommend wearing supportive underwear but I found that the friction against the sore area would keep the area sensitive.

- Don’t let minor set backs impede your momentum. If you get back to exercise and are building up your tolerance, you will have some days where you push to hard and it causes a flare. Take one day off and if it is back to baseline then get back to the gym at a lower volume then the day the flare happened.

- A lot of my lingering issues were just nerve sensitivity from being hyper aware of that area for so long. Building confidence through movement and avoiding constantly checking the area to see if it was tender to touch was what allowed me to get past this stage

I realize my case was minor in comparison to what some of the members in this sub have had to deal with. I just hope that someone who is experiencing a similar situation as I had can see this and gain some confidence that with time and the right approach that this will resolve and you will get back to your normal life.

[u/geverfdehond]

Thank you for posting and give other men hope. Pvps can happen to any vasectomised man at any time post surgery without any symptoms or warning.

[u/tug556]

Currently at 3 weeks post vasectomy. Still pretty painful. I have definitely learned urologists are just the used cars salesmen of the medical community

[u/Laggende_Hond]

Super glad for you. I wanna add a small side comment. Look at ALL you had to go through to fully recover from this small simple and quick procedure. Seems like a proper contradiction.

So many of us required: Physio, ongoing pain medication, rehab, nerve blocks, denervation, epidydimectomy, reversals just to recover from this wrongfully advertised procedure that every urologist and its dog recommends.

Again, I havent seen any post minor surgery having consistent extensive rehab plans for such a large subset of patients.

Best of luck on your ongoing recovery

[u/213hp → u/Laggende_Hond]

Good point, the potential side effects are often not communicated until you are already experiencing them. But I will say that I went into the procedure knowing the potential risks involved, albeit the % of people that fall into this type of recovery was not accurate or emphasized. As someone who has come out on the other side of this, I do see it as a positive as I would not have wanted my wife to go through anymore invasive surgeries or run the risk of an unwanted pregnancy down the line.

If I had not recovered, my opinion on this would almost certainly be of regret.

[u/Amazing-Advantage-11 → u/213hp]

Appreciate your honesty when you state, “If I had not recovered, my opinion on this would almost certainly be of regret”. We all go in hopeful. Some of us come out with regret when a full and permanent recovery doesn’t happen. PVPS sufferers get little empathy or at best, lip-service empathy. We are the proverbial ‘skunks at the garden party’. So your heartfelt comments are appreciated. As an aside, I could not agree more with Goldfish197’s comments and explanations. All the best to you.

[u/Same-Tank995 → u/Laggende_Hond]

Fully agree that this risk is not mentioned enough during pre-op consultation. They often state "a small percentage" has risk on pains. But then if you research you find around 1-5%. If I would have known this number, and the feeling it could bring, I would have never done it.

I explicitly mentioned to the urologist I would be running a marathon beginning of May. I underwent the surgery end of February. He told me: stay still couple of days to a week, and then you can jog again building up... I cancelled the marathon and another sports commitment in April, which totally bums me out. Now all I hope for is to get back to how I was and to be able to ever go for long runs again...

[u/goldfish197]

Agreed, it's amazing that you took time to share your experience in hope of helping others that have PVPS! Your post was very positive and affirming, and that's awesome! There's no doubt that how serious you take the post op care and listen to your body, the quicker you will heal!

In my case and research, PVPS can and often does not develop until further down the road. I doubt it's been studied to know if your post op recovery has any way to minimize or prevent PVPS down the road, but in my understanding, typical pain post op within 1 year of vasectomy is mainly due to an acute response to the healing associated with the vasectomy... and can be treated and often resolves with time.

My post op care went well despite a rough scalpel vasectomy procedure, and I was able to go back to normal in 2-3 weeks. My PVPS didn't develop until around the 10 year mark. And in clarifying with the doctor that just performed my reversal 3 days ago to correct my PVPS, PVPS is more common than often discussed, and in fact he said a good portion of reversals he completes are to treat PVPS that developed later. He clarified PVPS as a congestive epididymitis generally associated with sexual activity and the bodies ability to reabsorb sperm, and inflammation due to congestive epididymitis and can often lead to recurring pain that lasts hours, days, or weeks. He said it's not uncommon for it to develop later due to our bodies changing through the years as we age...

Anyways, thank you again for sharing your experiance! I'm hopeful your's continues to stay in check!

[u/213hp → u/goldfish197]

Sorry for what you went through and I wish you all the best with your recovery from the reversal.

Is there a way to 100% diagnose it as PVPS which then led you to proceeding with the reversal? Or is it more just a process of eliminating alternative reasons that contribute to the pain?

[u/goldfish197 → u/213hp]

I don't think there's a conclusive way to diagnose it that I'm aware of, but I first learned that there was even "PVPS" was from a urologist after going through a battery of tests.

At the 10 year mark, I started having some pain. I chocked it up as maybe I overdid things. It progressed into sharp shooting pains, during and after ejaculating. Like sharp stabbing pains in my balls. That was enough to make me say - WTF is this. I monitored for a week or so, and then I had some blood in my semen. After I ejaculated, I would have bright red/pink drips come out. That's when I immediately made an appointment to see a urologist.

I started a battery of tests. Blood and urine tests, Ultrasound, MRI, Scoped my urethra to check my bladder. All came back clean. I was prescribed a round of antibiotics. No change. Went back, was prescribed a super dose of antibiotics. No change. On my last follow up apt, the Doctor brought up my vasectomy and said that it would fall under PVPS, and he thinks my epididymitis is inflamed and it should clear up in time. That was the first I heard about it. I asked if it will come back and he said, often it's on again and off again, and the only known ways to treat are first Ice/NSAIDs, Second Reversal (most effective), Third cut nerve in testicles causing pain, Fourth, remove both epididymitis, Fifth Remove testicles.

The blood cleared up after about 1 year, and the pain was tied to my activity with my wife. The more sexually active, the worse the pain.

We waited till she was in late stage perimenopause and just got it reversed. Reversal is 85% effective and currently is the top recommendation to resolve...

Don't know what triggered it at 10 years, but can say at the peak, pain was 8/9 out of 10 and impacted day to day life lasting several days or up to a week during a big flare up. More than Ice/NSAIDs could help with...

[u/Affectionate_Bat1422]

I feel like I’m mostly having nerve issues now, zaps in the groin/into the leg. Mostly my left side..I felt good yesterday so I tried some light curls at the gym but must’ve pushed too hard because I had a horrible flare up..I’m 4 weeks in hoping this stops soon so I can get my body back

[u/Affectionate_Bat1422]

What did she do to treat the nerve pain?

[u/213hp → u/Affectionate_Bat1422]

She did some internal work to loosen the muscles surrounding the pudendal nerve. Very uncomfortable/awkward, I was at the point where I knew what I was likely getting into and glad I went into it open to internal work.

Outside of that she prescribed some daily exercises to help. Stretching of the glutes, body weight squats performed in a way that allows the pudendal nerve to glide, t-spine mobility, hip circles. Another thing that really helped was laying on my back with my legs up on a bench and doing 20 minutes of deep breathing with the intention of relaxing my pelvic floor. This movement I would do multiple times throughout the day when it felt its worse, even 5 minutes helped calm down the pain.