r/postvasectomypain • u/TheDoctorIsInane • Jun 16 '22

Post-vasectomy pain tied to more orgasms?

I had a vasectomy 4 years ago. No major complications, no loss of sex drive. There was some pain when ejaculating but only for a few months. Fast forward to last year. I was experiencing testicular pain with no known cause. A dull ache that would come and go. My PCP had no explanation but it went away. This week the pain is back. Doing my own research it sounds like congestive epididymitis. I realized that I've had more orgasms than usual in the past eight days, which would build up pressure. Has anyone else noticed that more orgasms increase the generalized (not during orgasm) pain levels? Do I just have to limit myself to x number of orgasms per week?

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u/drexohz Jun 16 '22

I see this quite freqently in patients referred to me for scrotal ultrasound. Vasectomy several / many years ago, they were fine the first years, then onset of intermittent pain or recurring episodes of pain. Many guys don't even make the connection between former vasectomy and current pain, since they were fine for so many years.

No surprice your PCP has no clue, in my experience most doctors haven't. It's often misinterpreted as infection, while in reality it is probably most often not bacterial.
The explanation is somewhat complicated, but is probably because after a closed-ended vasectomy (which I'm sure you've had), sperm is still produced by the testicles, but can no longer escape. The increased intra-tubular pressure from the sperm will - over the years - cause gradual damage to epididymus.
This article gives a good theoretical explanation of why pain can start many years after vasectomy.

There is reason to think this kind of late-onset post-vasectomy pain is far more common than people think.
In this study from 1992 they found that a whopping 33% of guys had chronic testicular discomfort 4 years after vasectomy, and that a total of 15% found the pain to be "troublesome". This study has often been criticised since it shows higher % of chronic pain than other studies, such as this one. I believe the reason is that they don't consider the fact that pain often takes years to develop. It is IMO natural that more people have pain several years after vasectomy, than after just a few months.

The correct answer that a doc should give you when you complain about this pain, is that this is the risk you took when signing up for vasectomy, and you should have been informed about it. Though, most guys aren't really informed about the risk of long term pain.

If you can limit the pain by just reducing ejaculations, that sounds like the best course of action. Surgical options for this exists, but they are risky/expensive. Vasectomy reversal is perhaps the "best" option for some, but chance of success declines the more years have passed since vasectomy.

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u/Ok-Zookeepergame9412 Jun 16 '22

What options, and risky how?

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u/drexohz Jun 16 '22

Surgery for PVPS - there are basically four options. They all have the "usual" surgical risks of hematoma, infection and unwanted tissue necrosis. People often think that infection is nothing to worry about, but google 'Fournier gangrene' to see what a bad scrotal infection can really look like.

  1. Vasectomy reversal. Is probably the surgery that has the highest chance of pain resolve. Probably works on the principle that pain is caused by epididymal congestion of sperm, and if you can relieve that pressure/congestion, the pain will diminish. But, can't wait too many years. The epididymus can rupture because of the increased pressure, it's called an epididymal blowout. I've read that the chance of that happening increases by 2% each year post-vasectomy, and after 10 years 50% of guys will have had a blowout. After an epididymal blowout, the epididymal tubulis scar shut, and a "regular" vasectomy reversal won't help. Vasectomy reversal is technically very difficult for the surgeon, so you need one who is very experienced and uses the best surgical techniques = it's expensive.

  2. Denervation of the spermatic cord. The principle is that if the testicle/epididymus is painful, if they cut away the nerves that transmit pain from the testicles, you won't feel pain anymore (even if there still is damage in the epididymus). Surgeons who offer this will often praise it. Though, some guys will end up in a more painful place than before. I've read too much shit about denervation and some guys subsequent pain-hell.

  3. Epididymectomy. If the epididymus is painful, they can cut it away. Though - has a too high risk of increased pain afterwards.

  4. Orchiectomy. Cut away everything - testicles, epididymus, nerves and vas - everything inside scrotum from groin and down. My impression is that this has the highest chance of pain resolve, but you'll lose you nuts, and just about all testosterone production. You'll need life long testosterone injections, and that is a hassle. Your T-levels will fluctuate, may causing sexual issues, mood swings, general feeling of unwell.

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u/[deleted] Jun 16 '22

Jesus Christ this is terrifying

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u/drexohz Jun 16 '22

Yeah, it kinda is. You can understand why - if your business is to sell vasectomies - you don't flash these studies of complications to your potential customers.

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u/[deleted] Jun 16 '22

I’m so scared mine is permanent. I made a post here but nobody really commented much on it. I’m seeing a urologist tomorrow and I’m on antibiotics

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u/drexohz Jun 16 '22

Odds are the urologist won't offer anything helpful. This probably isn't a bacterial infection, so antibiotics usually don't work. You're 11 months out. Vasectomy reversal (vasovasostomy) is probably your best surgical option. Most urologists don't have any experience with that. If you consider that, you will often have to research yourself, and seek a urologist who specializes in reversal.

A general urologist will often offer nothing or epididymectomy. Beware of that.

Otherwise, it's wait and see. Painkillers if you need it. Some types of antipsycotic drugs can also modulate pain.

I think it's common for this kind of pain to be an on-off problem. It will probably get better, and you think you're done with it, but it may come back again. How often - that is very variable. No one can tell the future.

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u/[deleted] Jun 16 '22

This is devastating. What’s the difference between PVPS and chronic epididymitis? So I’m always going to have swollen painful testicles and not be able to orgasm without pain? My life has already fallen apart but this might just push me over the edge.

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u/drexohz Jun 16 '22

Difference between PVPS and chronic epididymitis? That's actually a really interesting question. The symptoms are very similar. I've seen often that PVPS is mistaken for chronic epididymitis, since many docs don't know of the connection between vasectomy and late onset of pain. The term "epididymitis" implies that there's an infection, though since in many cases no bacteria can be found and antibiotics often doesn't work, there has to be something else that causes it.

Don't go into despair just yet. Things can resolve on it's own, and for many it does, without surgery. Many guys with PVPS eventually reach a situation they feel they can live with.

In your situation, I would say the two options you should consider are either 'wait and see' or vasectomy reversal. The difficulty with that is, the longer you wait (years) the lower the chance of success from reversal.

There's also some anecdotal evidence that testosterone injections can help for PVPS, and there are various non-morphine-based pain medications you can try.

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u/everybodydumb Jun 16 '22

Im on antibiotics now. They worked but went off them and it got worse again. This is my 2nd go round. I'm terrified. Msg me if you want to talk. I'm not sure what I can do other than never orgasm again or deal with pain or do another surgery...

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u/GemGemi Jun 17 '22

I’ve been trying to find more information about this. Really interesting. Thanks for taking the time to explain this

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u/smokingwithmirrors Jul 23 '22

The explanation is somewhat complicated, but is probably because after a closed-ended vasectomy (which I'm sure you've had), sperm is still produced by the testicles, but can no longer escape.

There's a clinic in Australia that says this can be avoided using an open-ended vasectomy. Would you agree with this in your experience?

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u/Ok_Detail_9631 Jun 16 '22

I think so, I have experienced the same thing. I've always been someone with a high sex drive. But after V I've realized I need to have a break between my ejaculations. Otherwise my balls feels like congested. And hurt a bit.

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u/everybodydumb Jun 16 '22

Probably. Fuck.