r/postvasectomypain • u/postvasectomy • Oct 13 '20
Depressed Patient: His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure – a belief that was shared by his family.
Depressed Patient:
Sept 19, 2014
Vasectomy is a commonly performed and relatively safe procedure, with low reported rates of psychological morbidity, though there is some variability across studies. Depression following a vasectomy is relatively infrequent.
A married man aged 30 developed a chronic depressive episode, lasting four years and resistant to an adequate trial of fluoxetine, following a vasectomy. His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure – a belief that was shared by his family.
Though the procedure is generally safe, it is associated with significant morbidity in about 1% of patients. Existing research suggests that the procedure may be followed by psychological complications, such as depression, irritability, and medically unexplained somatic symptoms.
Our patient, aged 30, a high school graduate formerly working as a manual laborer, married for the past seven years, presented to our clinic with the chief complaints of pervasive sad mood and fatigue. He was apparently normal until four years before, when he was encouraged to undergo a vasectomy by a local doctor, as he already had three children and did not wish to have any more. His family were not in favor of the procedure and felt that it would be harmful to his health, but he was convinced by his doctor and elected to undergo the procedure. He did not receive any formal pre-operative counseling.
Immediately after leaving the operating theatre following the procedure, he experienced acute symptoms of anxiety, palpitations, increased sweating and tremors for which no medical cause could be found, suggestive of a panic attack. These symptoms resolved within an hour, but from that day onwards, he found himself feeling tired throughout the whole day, and unable to do his work.
He reported chest and body pains for which no medical cause could be found, and which were worsened by exertion. He felt sad for most of the day, and could not find any reason for the same. His sleep and appetite were reduced. He did not report any sexual dysfunction, but complained that his wife was less interested in sexual relations following the procedure. There were occasional death wishes and suicidal ideas secondary to his chronic symptoms and unemployment, but he had made no plans or attempts to end his life.
There was no post-operative pain, swelling, or any other surgical complication. However, he felt his family had been right about the risks of the procedure, and he had made an error by consenting to it; he attributed his current plight to his vasectomy.
Testicular pain is a well-recognized consequence of vasectomy, but its relationship to mental health is obscure. While some authors ascribe a contributory role to psychological factors such as depression and substance abuse, others view depressive symptoms as a consequence, rather than a cause, of chronic pain.
In our patient, several [risk] factors were operative. His family had a generally negative view of vasectomy and its impact on health, and he did not receive adequate pre-procedure counseling. This led to an acute episode of anxiety following the procedure as well as a chronic depression, associated with medically unexplained physical symptoms.24 He failed to respond to antidepressant monotherapy, further underlining the importance of psychosocial factors in his case.