Vasectomy Diary: The Scrotum Monologues

Kieran Brennan had an NHS vasectomy in Scotland in March 2009. This is his post-vasectomy diary.
DAY 1: 'I felt incredibly vulnerable, lying naked from the waist down surrounded by women'

The thought of having the procedure concerned me a great deal in the lead-up to the operation. At the age of 47 with 4 children - youngest under 12 months - there was no doubt in my mind that I didn't want any more. That wasn't the issue, it was the thought of the unknown, mixed with the inevitable disaster stories you hear third-hand from colleagues.

On the day, I arrived at the hospital at the allotted time, and after a few minutes a nurse came to bring me through for preparation for the surgery. I was led into a small ward and told to strip naked and put on one of those gowns you see in Carry On films which tie up the back and show your backside to the world. By this stage I was feeling very anxious indeed, and the nurse's cheerful chatter, saying that they will be talking to me throughout to keep my mind off things did nothing to allay this.

The doctor, a consultant urologist in his 50's, came to examine me a few minutes later and was very reassuring and pleasant, asking if I wanted to know anything. He told me that I would be wheeled through in a few minutes, and that the operation would take only about 25 minutes.

The female nurse who had greeted me wheeled me through into the operating theatre. I was met by the doctor and two other female nurses who introduced themselves but by this stage I was so anxious that I didn't really take anything in.

The doctor then pulled up my gown and took my penis and testicles in his hand. He 'painted' them in an iodine solution, whilst all three nurses looked on. I felt incredibly vulnerable, lying there naked from the waist down under a spotlight surrounded by gawping women.

After the iodine solution, the doctor injected the skin in the top of my scrotum. It stung a bit but no worse than at the dentist (albeit in a different location). Then the doctor put some sheets over my groin area, just keeping my scrotum exposed, and started the operation by making a small incision on the middle of my scrotum, through which he would work on both the vas tubes. (Note: there's more info on vasectomy and how it is performed on the right-hand menu.)

I continued to feel uncomfortable and incredibly exposed, particularly as the nurses seemed to have no role other than to gawp and chat inanely to me, albeit very pleasantly and courteously.

At one stage I winced and recoiled slightly when the doctor injected one of my vas tubes and I felt some pain, which heightened my sense of vulnerability and exposure. When it came to stitching the wound, one of the nurses did assist the doctor, but during the whole procedure the other two merely stood there - one at my head, and another to my side.

DAY 6: 'Discomfort similar to being kneed in the testicles'

I am experiencing some discomfort - similar to having cycled 30 miles, or being kneed in the testicles a few hours ago - along with some bruising and swelling on the third day, but otherwise seem to be recovering well.

But although my physical wound and bruises are starting to heal, I still feel psychologically scarred by the experience. I am left feeling that I was the subject of some ritual public emasculation.  I, like all men I believe, am very proud of my masculinity, and the obvious focus for this is a man's genitalia.  If I choose to have my genitalia altered in such a way that affects my reproductive capability should I not have the right to have this done in as discreet a way as possible?

I would have found the whole procedure much less traumatic had I had the right to request that male staff only be present, and from my experience, one doctor and one assistant would have been able to cope easily.

I must assure you I am not a prude. I am quite happy on a naturist beach and and have no sexual hang-ups. I just think that men deserve to be treated with the same dignity as women. Would three men be allowed to stand around a woman having a smear test? I think not, and nor should they. When my wife was pregnant she was informed that the hospital had 2 male midwives, and given the chance to opt for a female. Maybe some men are quite happy to drop their trousers and wave their tackle about at complete strangers, but in my experience most men are actually quite reserved. Why is a man afforded no choice? Of course, if it had been necessary to have a female nurse assist with a specific task, I could have accepted that with no problem.

I am not flattering myself into thinking that the highlight of the nurses' day was the sight of my flaccid penis and testicles, but I do think nonetheless that things could have been done with a little more respect for my dignity. In theory, maybe having an operation on your scrotum should be viewed in the same way as having your appendix removed, but it shouldn't really be surprising to say that, in reality, I found this not to be the case. 

I am honestly surprised at the way this has affected me — I did not anticipate feeling this way at all. The operation went well, and I have every confidence in the surgeon's ability. I think the bruising and tenderness will subside with time, and was to be expected - I hope the emotional bruising also subsides.

Am I alone in feeling like this? Given what I know now, I think I should have made some enquiries before my procedure - it may have left me feeling much less traumatised than I currently do. 

DAY 8: 'The female conspiracy ...'

I am still feeling that dull ache, mainly on the left side and continue to feel traumatised by the experience. I have discussed my feelings with my wife who says that I should just let it go. She said that compared with some of her friends' husbands' complications I was very lucky. She neglected to tell me these accounts beforehand for fear it might have concerned me! The female conspiracy theory thickens.

DAY 10: 'Have I done the right thing?'

No change physically — still the dull ache and constant flash-backs of the procedure. Beginning to feel a bit down and wondering if I have done the right thing.

DAY 12: 'I'm told the only male nurse finds vasectomies traumatic'

Still the dull ache — I find myself sitting forward in my chair to take the pressure off my scrotum.  I call the out-patients' department at the hospital urology unit to find out when I can expect this dull ache, like groin strain, to stop. A nurse tells me that after 12 days I can still expect to feel sore and achy.  Given that the pre-op leaflet I was provided with stated that I 'may experience some minor discomfort for 2-3 days which can be treated effectively with paracetemol', I did feel somewhat deceived by this response. She was unable to tell me when this ache would go away, as this would depend on the individual. I said that my experience of the operation was that it was more unpleasant than I had been led to believe. She seemed genuinely surprised at this, and asked me why this was.  

I told her. I explained that my initial sense of vulnerability brought on by being surrounded by female nurses had never gone away and left me feeling traumatised. Again she seemed surprised and said that the extra nurses were there to monitor my colour and blood pressure. I said that I found it very embarrassing and humiliating to be subjected to small talk surrounded by women whilst lying naked from the waist down, and would have preferred a more male environment. She said that whilst there was one male nurse in the department, he didn't like to attend vasectomies as they left him feeling traumatised. Well, I rest my case! 

She went on to say that she could relate to the way a man felt during a vasectomy because her late husband and son-in-law had had it done.  By the same logic I am an expert on pregnancy and childbirth, as my mother and wife have had 8 children between them. Once again, although the nurse was pleasant and listened to what I had to say, I was left with the impression that it was only a minor thing, and aren't men just a bit precious about their bits and bobs?

DAY 13: 'I dissolve into a sobbing wreck'

I resort to taking Ibuprofen again. In the evening my wife asks, out of spousal duty how I am feeling and I dissolve into a sobbing wreck.  I think for the first time she begins to understand how this has affected me. We enjoy a cuddle and make love, which is good, but I note a distinct lack of sensitivity in my penis and I don't manage to come for the first time in my life. We try again in the morning and this time I do orgasm, but again I notice the lack of sensitivity and it takes twice as long as it used to pre-op.

DAY 15: 'Isn't it inconvenient having an erection?'

The dull ache has largely gone! I am beginning to feel more positive about things physically. I manage to masturbate but again note the reduced sensitivity and the increased time taken. I am beginning to be concerned that in am experiencing a general reduction in my libido. I considered myself to be reasonably highly sexed before the procedure, but feel a definite decline in sexual interest post-op. I discuss this with my wife who asks 'would that be a problem?' I am incredulous! 'OF COURSE IT WOULD!' 'Is it not inconvenient having an erection when you wake up in the morning?', she asks.  It dawns on me that the gender gap is even more cavernous that I had realised. I had just assumed that my wife would know that my genitalia is intrinsic to my identity as a man and my general well-being — I am quite shocked to find this not to be the case.  (I would like to stress that our relationship before and after the Op is and remains strong and loving, in case you may think that this conversation was had against a backdrop of a failing relationship or with animosity.)

DAY 18: 'I search on the internet for my symptoms'  

The dull ache is back on the left side and I can detect a small lump in the scrotum near the testicle. I call a work colleague who had the op some years ago and ask him if I should still be experiencing any discomfort.  He told me that he 'didn't feel right for 6 weeks afterwards'! Why the hell didn't he tell me that before when I told him I was going to have the procedure done?

I search on the internet for my symptoms and wonder if I may have a 'granuloma' or a 'congestive epididymus'.  I learn that 60% of men post-op get a granuloma, a lump created by the sperm that continues to be produced with nowhere to go following the cutting of the vas deferens. I don't remember seeing that in the pre-op literature. I am beginning to realise that you aren't told the truth about 'the snip' by the medical profession, your wife and her friends and even your mates.

DAY 21: 'I try out the equipment solo'

My three-week anniversary and the ache has gone! The lump still remains, but as it isn't painful I am hoping that it is just the post-op stitches in the vas area. I even tried out the equipment solo, and was satisfied with the result. Things are finally looking up!

DAY 28: 'The dull pain is back'

My four-week anniversary and the dull pain is back on the left side going into my abdomen. The pain tends to ease whilst sleeping and comes back gradually during the day. The lump remains also. The pain is not agonising but annoying and I am aware of it a lot of the time. I am angry that my 'minor procedure' has caused this. 

WEEK 6: 'Erections return to pre-op levels'

Am beginning to feel more back to 'normal' — maybe my mate was right with his 6 week timescale?  My desire and ability to have erections — even morning glories — have returned to pre-Op levels.

Good news! The lump still remains, but is not painful, so I am ignoring it, although I would like to know what it is. I don't feel like calling the out-patients' department to ask though, as I feel I will just be patronised again. 

WEEK 7: 'It's easier to see the pope than get a post-op appointment'

I have had three days in a row now where I wake up pain-free, only for the dull ache on the left side to return steadily during the course of the day. The discomfort is hard to pin down — a groin strain running from my crotch into my abdomen, extending sometimes into the top of my leg.  More irritating than really painful.  The lump is about the size of a grape, and is soft to the touch — although quite tender. 

Rather than call the out-patients department, I call the consultant urologist's secretary for a follow-up appointment. The secretary consults the consultant who refuses to speak to me and instructs the secretary to re-route my call to the outpatients dept while I am on hold.

I speak to a nurse at outpatients and explain my symptoms. She passes me to a locum doctor to whom I explain the symptoms again. He says that I could have a granuloma but that the symptoms I'm describing would not give rise to concern — easy for him to say, he isn't the one with the aching groin.

The locum says that if I had cared to look at the pre-op literature I would have been made aware of the possibility of long-term pain. I say that it refers to a figure of 10%, and that the word granuloma was never mentioned.  He admits that the possibility of a granuloma isn't mentioned by name, as 'medical terminology can often frighten people'. He doesn't disagree with my 60% figure of patients who get this, and mutters something about my having 'done some research'. 

He says I could be one of the unfortunate ones who has longer-term issues — be it 10% or 60%. When he finally arrives at the stock response — take some Ibuprofen - I lose it. Getting to see anyone face-to-face to discuss a post-operative concern is proving more difficult than obtaining an audience with the pope. I am passed to yet another nurse, and again go through my symptoms. She agrees to fit me into the clinic  — eight weeks to the day after the procedure was carried out, and the day my first semen 'sample' is required!  

WEEK 8: 'Will I need another operation?'

My first trip back to the hospital since the procedure — I feel a little unnerved. I present my sample bottle to Pathology. It isn't as embarrassing as I had imagined. Another sample is required in two weeks before I am declared sterile. I go to Urology Department for my appointment, and am met by the locum doctor I had talked to on the phone. I am a bit perturbed as he starts the 'consultation' in the waiting area within earshot of all present. Maybe I am unrealistic in my assumption that patients should be treated with a modicum of privacy in today's NHS? I am finally taken into an examination room and the offending lump examined. The doctor diagnoses a cyst or 'pseudocyst'. He suggests this could have been caused by the haematoma — the accumulation of blood after the op - reacting with the scar tissue to form a pocket, or it could be a blocked tube in the epididymis. He does not rule out the possibility that it is the start of a granuloma. The groin/abdominal discomfort is explained by the fact that there is a nerve running exactly this line from the scrotum along the groin into the abdomen area. The doctor is unable to say how long the discomfort will last. He says to leave it for another six weeks for a follow-up appointment. If there's no improvement, we will discuss options then. The usual treatment is, he says, is removal under a general anesthetic, with all the same associated pain, swelling and risk of infection as with the vasectomy, but probably a longer recovery time. I am struck by the fact that this is all very matter of fact to the doctor — he seems oblivious to the fact that this most unwelcome prospect has arisen only a direct result of having a supposedly simple and problem-free vasectomy. I have a mixture of feelings: Relief that I have finally been seen and there is something there. I haven't imagined it. Mild anger and frustration that I have had to fight and make a nuisance of myself to be seen again by the medical profession post-operatively. Anxiety that this may take a while to resolve and need another invasive procedure. A feeling of deception that potential complications seem to be withheld from. What would happen if 10% of cars taken for service left the garage with faults which they previously didn't have? I am undecided on whether I would have had the procedure given my experience and how I now feel.  I am tending towards regretting it, but my final decision will depend on how long and by what means the matter of the swelling and discomfort is resolved. My advice to other men

My advice to a man considering a vasectomy is to discuss carefully with your partner how you may feel. The medical profession sees vasectomy as just a minor physical procedure and ignores the potential, psychological effect. As a result, too many women, in my experience, dismiss it as having the 'snip' and can trivialise it. It is important that your partner is there for you afterwards to support you should you need it, as you were there for her in pregnancy and childbirth. 

It is not like to having an in-growing toenail removed. Expect a fair degree of bruising and discomfort for the first week to ten days. Don't be taken in by the pre-op propaganda. If you expect it to be painful, you will be better able to deal with it.

In addition to the more publicised and expected bruising, realise that there is the real risk of other less visible, yet potentially longer-lasting complications. From my personal experience, I was shocked and disheartened at the lack of support and follow-up reassurance from the medical profession. I found there to be a lack of transparency about the actual recovery time from the procedure and the potential longer-term complications, as well as a distinct reluctance to address any such post-operative issues. I was either fobbed off and told to take Ibuprofen for an indefinite period of time, or told to refer to paragraph 3 page 2 of the pre-operative consent form.  I now strongly suspect that these 'rare' issues are much more common than you are led to believe.

Don't rush to see if your modified equipment is working! It can lead you to think that you have irreparably damaged yourself, or rendered yourself impotent. This caused me great unnecessary anxiety. I would say abstain for a couple of weeks if possible, and don't expect to feel even mostly 'right' for at least 4 weeks.  There was a loss of sensitivity and volume of ejaculate even until week six but this did eventually return to pre-operative levels. I wish I had known this in advance.

I'm not saying you should spend a lot of time reading disaster experiences on the internet but you should try to obtain a more balanced view of what the procedure involves, rather than take at face value the dumbed down version provided from the hospital.

Men are their own worst enemy.  If only we could talk openly about our experiences I am convinced that a consensus would emerge that the vasectomy isn't as straightforward as we are led to believe currently. We would have a more informed and open debate, regular slots on morning telly and, I suspect, the numbers of procedures carried out would drop.

Page created on May 25th, 2009

This article reflects the experience of the individual. It is not health information from the MHF under the terms of the NHS England Information Standard. It was last updated in 2009. Up-to-date information on this topic can be found here: The Snip FAQs.
 

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