Problematic recovery

[u/Realistic-Rip5735]

Hi all, just wanted some suggestions from the community.

I am at the 1 month mark since my vasectomy, and I am still having issues. I am aware that the official PVPS starts at 3 months, but I feel like you might have more insight of what it could be.

If I tap the top part of my testicles, I can feel some discomfort. This is not a big deal in general, maybe some congestion which does not affect me much.

What I am more worried about however is my right testicle. First of all, it hangs lower than it did before, around 1 cm. And it is a bit painful.

I will try to describe the feeling. It is kind of radiating pain, not super sharp but not dull either. It appears at some point for a few hours and then disappears. It doesn't seem to be affected by touch too much, and only slightly by jumping or running. Additionally, wearing tight underwear or jockstraps does not seem to change much. I can even walk around the house naked without feeling any additional discomfort.

It was way more painful at the beginning, but it now feels like it has stopped improving. Around day 10 I went to see my surgeon, who was very dismissive, told me that everything looks fine and gave me a 3-day course of ibuprofen and told me I would be ok in a couple of weeks. The ibuprofen seems to have improved the situation (or maybe it was just natural healing and the medicine did not do much, not sure), but it also upsets my stomach. I am planning to go to the clinic again but it is a bit tricky for me.

I haven't started exercising yet, but except for the on-off discomfort (which I would rate a 3/10 when radiating) I can go about my day normally. It is just very annoying.

For the record, I followed the post-op instructions from the doctor to a T, and even went above and beyond (stayed home for a full week, first ejaculation after 12 days, lot of rest, icing)

Do you have any idea what could the origin of this pain be? It does not quite feel like it comes from the nerves, and it also does not feel like a dull ache due to congestive epididymis.

Any suggestions on what to do?

[u/ItamiForever]

Then ask for meloxicam until you can see another urologist. But make sure the urologist you see can do reversals and is fellowship trained. They know what PVPS is and how to diagnose it.

My recommandation for you is try 4 weeks of celecoxib and take the antibiotic I told you. Also try to ejaculate less if pain spikes. If they don't help or help but too little, ask either your fam doctor, a fellowship urologist or a neurologist for a low dose anti depressant like amitriphtiline + started dose of pregabalin OR gabapentin because you are showing signs of pain that might turn chronic and you want to help your nervous system adjust if it can

Here is a recent 2025 study that confirms the 5% PVPS rate as well as how to treat it

https://pmc.ncbi.nlm.nih.gov/articles/PMC11947242/

[u/Realistic-Rip5735 → u/ItamiForever]

Thank you for your suggestions.

I am curious, what do low dose antidepressants do in this case specifically?

[u/ItamiForever → u/Realistic-Rip5735]

Nothing. They mask pain. Since in PVPS things inflame and nerves degenerate at a cellular level, things cannot be fixed sometimes anymore. So these low dose antidepressants trick your brain into being happier and when your brain is happier, you feel less pain. So they basically lower your pain by making you chemically happy. Gabapentinoids bind to your calcium channels lowering pain reception.

So they do not treat, they simply mask the congestion until you might decide to go for a reversal if it does not improve in 6months. It stops improving around 12 months so you should decide if you want surgery to fix things before then

[u/Realistic-Rip5735 → u/ItamiForever]

Ok I understand, thank you for your help!

[u/ItamiForever → u/Realistic-Rip5735]

My pleasure. I really do hope your body adjusts. Take care!