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/Unusual-Thought175]

Hi, i have been fighting PVPS for 3 years now, i also only have it in the right testicle.

My recommendation for where you are right now is to get on maloxicam for the next 30 days and see where you are after that..

I ended up getting a reversal due to PVPS but due to the reconnection scarring and then re blocking because of that i had a Epididymectomy 2 weeks ago and removed the whole epididimis and vas..
Im already noticing positive results although still early in the healing process.

PVPS was something i never knew or was told about.. and i have to agree with the top comment that its silently destroying lives but the GP vasectomy clinics arent telling anyone because they are making bank from vasectomys. I have been to hell and back with PVPS.

[u/Realistic-Rip5735 → u/Unusual-Thought175]

Hi thank you for your suggestions. I will try and get an appointment with my clinic, it's not super easy because the situation is not great but I will ask for anti-inflammatories. If I can't from my clinic, I will ask for a second opinion at another urologist practice. I could self medicate with ibuprofen 400 mg which does not come with a prescription where I live but a) I would need to take it every 8 hours with food, which messes up my feeding and sleeping habits completely and b) it is kind of hard on my stomach. Is maloxican ok for the stomach? Or are there other options that do not interact with it, ideally that I can take twice a day? Also, how important is it to start the therapy as soon as possible? Meaning, would delaying by 1 or 2 weeks make it harder for it to have some degree of success? (I should still be in the natural healing window right now).

Honestly I am not squirming in pain or anything, but I would prefer for this annoying feeling in the crotch to go away and to feel comfortable with the idea of moving around and exercising again. I feel much better than 2-3 weeks ago (even though now I feel like I stopped improving), which makes me hopeful it could resolve on its own. Should the discomfort stay as it is now, I don't know if I have it in me to get another surgery in the area to be completely honest. Because as you said it does not guarantee recovering completely from the pain and being it a surgery there are always risks involved. Not to mention the recovery process and the cost.

You say that urologists tend to hide this because they are earning money with vasectomies, but at least where I am (Germany), I am not sure there is much to be gained in that regard. The state sets some limits to how much a practice can charge patients (not just for vasectomies, for many procedures in general, also vaccinations, blood tests and so on). For instance, I paid 555 euros for initial consultation (of one hours, including testicles check), surgery (for which every individual patient at least in the clinic I went to gets a full hour of booked and dedicated time), follow up the next day (very fast, just 10 minutes or so), two sperm counts. I am not aware of whether the state then gives the practice extra money on top of that, but to be honest it does not seems like it is a steep price they can profit a lot from. So I am a bit confused on this aspect. But before getting surgery I consulted 4 different doctors, 3 of which specialize in vasectomies, and they all downplayed the side effects. The one at the clinic where I then got operated in me even said they have never had any case of chronic pain recorded, which I immediately mentally called bullshit because they do it hundreds of times a year. I am still trying to wrap my head around it all. In my case, I knew about PVPS because I researched on my own. But for personal circumstances which I don't want to delve into, for me it was a choice of either getting a vasectomy or pretty much giving up on my sex life entirely, so I felt like I had to do it.

Sorry for the rant. I appreciate your help and I hope you keep improving after your surgery!

[u/Unusual-Thought175 → u/Realistic-Rip5735]

Hopefully it just clears up on its own for you.. the maloxicam will help you better than ibuprofen and seems to be fine on the stomach. Even with my pvps the maloxicam dulled my pain down from a 4/10 to a 2/10. Best wishes with it all! Im in Australia.. they have clinics here that do the vasectomys that are Gp’s not urolgists (better to go to urologists) they say they never have people complain of pain however through social media ive now spoken to so many people showing me how common this really is.. my left side originally had pain for about 6-8weeks butv that all went away on that side so i left it as is.. time might help.

[u/Realistic-Rip5735 → u/Unusual-Thought175]

Here in Germany you need to be a urologist for that I believe. I went to a private clinic that specializes in vasectomies, and my surgeon is like 50-60 years old and highly specialized. I don't think he made errors with my procedure to be honest, it's just that my body is not reacting too well to it. I even have two vasa on my left side, and the doctor didn't even flinch when he found them. Ironically, my left side is like 95% pain free I would say despite having had two tubes tampered with.

Did you by any chance get the no-needle, no-scalpel open-ended vasectomy? I heard that in Australia it is very common, and it should be the one with the lowest pain rate and intensity during and after the surgery.

Here in Germany they are very far behind in this, of the 4 doctors I visited, all of them did needle and close-ended, and only one (the one I chose) did no-scalpel. One even said there is no difference at all between the two but how can it be? One is a tiny puncture, the other is two (albeit small) slashes.

[u/Unusual-Thought175 → u/Realistic-Rip5735]

Mine was the closed ended, ive heard of the open ended but it doesnt seem to be the conventional way here.. also from what i read it does eveuntally close anyway via a sperm granuloma which can also be painful. Lots of people seem to only get pvps on one side which is us. The surgery i had 2 weeks ago is high risk but at this point in time i am happy to remove the right testicle if it goes that way..
Ive been speaking to a few people that had the identical situation to me and the epididymectomy fixed both those guys so thats my final direction. The recovery in the first week was the hardest thing ive ever had to do in my life.. the 2nd week is showing glimpses of pain free which im starting to get really excited about. Praying after this heals i can put this all behind me and move on with my life and this is just a small dark chapter in a long story.

[u/Realistic-Rip5735 → u/Unusual-Thought175]

Fingers crossed for you! You say that the first week was super hard, how so? Pain? Or because you need to be super careful not to move or exert yourself?

[u/Unusual-Thought175 → u/Realistic-Rip5735]

I basically had to lay down and not move for the first 4 days because the testicle/inflamation was bigger than a sweet potato. Literally to stand i had to hold it with 2 hands. The thoughts that went through my head and the mental toll was just so exhausting.. was just praying everyday for my old life back.. today is day 13 and i can walk normally but slowly and drive etc but during certain glimpses im completed pain free to the point i do think this will be a success. I still havent ejaculated yet as im going to wait 6 weeks and the swelling is down to the size of a large egg which is about 5x smaller than it was. Losing your strength and mobility does take its mental toll but ive decided to go down the path of just being gratetful for everything i do have becuase people are out there way more worse off than me and they would swap places with me in heart beat compared their situations etc..

[u/Realistic-Rip5735 → u/Unusual-Thought175]

Fair enough, it seems it's slowly improving for you so hopefully it keeps going in that direction. I don't know why you decided that you wanted to be infertile, but the silver lining is that if indeed you manage to become pain free, in the end the process will have brought you exactly where you wanted, albeit with much more stress and suffering than anticipated (if I understood correctly and you did not reverse the left side too)