Vasectomy: a kick in the balls?

Post-vasectomy pain is rarely talked about …

In 2009, Kieran Brennan wrote this:

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.

Kieran BrennanThe operation Kieran, right, was referring to was a vasectomy. He’d had one eight weeks earlier. Seven years on he says he’s OK but ‘it took about 18 months. For a long time, when sitting, I’d have to perch on the edge of the chair to take the pressure off. 

‘I never really got a satisfactory explanation afterwards and post vasectomy pain (PVP) was never mentioned before the procedure. Perhaps things have improved now. The pain affected me mentally as well as physically. I was traumatised – that’s not too strong a word.’

One man who might be able to give Kieran an explanation is Dr Andrew Dawson. He’s a UK-based vasectomy reversal specialist who has had the op himself and also had PVP.  Over 15 years he has performed nearly 3000 reversals of which 70 were for PVP. He is consolidating the data on them for a medical journal. Many also involve sexual dysfunction.

Don't under estimate it

‘PVP tends to appear 3-12 months after the procedure,’ he says. ‘Many men take time to do anything about it. They hope it will go away but often it doesn’t. It may reduce as you get older but not fully go away. In about a fifth of cases there’s also a loss of sexual interest and satisfaction. Pain and sexual dysfunction go hand in hand. Later onset PVP is also possible.

‘Some colleagues are still sceptical about PVP but, now a lot of men have had the snip, attitudes are changing. I’d say around 15% of men have some sort of PVP and in 1-2% of cases it’s so significant they need help.

‘Don’t underestimate it. I’ve seen guys off work, family and relationships ruined. Colleagues at a local pain clinic tell me that 15% of their patients are there for PVP.’

Sperm have nowhere to go

In a vasectomy, the vas deferens, the tube carrying sperm from the testicle to the penis is sealed off. The sperm no longer have anywhere to go. A sperm granuloma, a lump caused by leaking sperm, may well occur but Dawson believes that this back-up also causes pressure that is behind much PVP.

‘This suggests to me that PVP is more likely in highly-sexed men, the sort who feel they physically need sex everyday. These men are more likely to have a pressure build up after vasectomy.’

He also says the method of vasectomy can make a difference. ‘An open-ended vasectomy will leave the end of the vas nearest the testicles open so sperms can leak out. But it’s a far less common method – only about 1% of procedures – because some doctors think it increases the risk of a return to fertility. A local anaesthetic is always preferable too. Surgery is less destructive as a result which reduces the likelihood of later pain.’ Conversion of a closed to an open-ended vasectomy is possible but Dawson is ‘not sure it works in the long-term, although I have done a few.’

Other treatment options for PVP short of reversal include testosterone supplementation to reduce sperm generation or nerve ablations (the heating of nerves to reduce pain).

'A price worth paying?'

But don’t some doctors think PVP is all in the mind? ‘That’s the $64,000 question,’ says Dawson. ‘How much is it about not being potent anymore? But I’d put it like this: if you block up any tube in the body, you will cause pain. The vas is no different. So 95% of men get away with it. Does that make the 5% a price worth paying? For me, personally, I wish I’d never had one.’

Would Kieran have it again? ‘That’s a hard one,’ he says. ‘It eventually settled but it doesn’t change what went before. I’d liken the feeling to the pain you have ten minutes after being kicked in the testicles – imagine that everyday. But if people considering a vasectomy ask me my opinion I say very little except read into it carefully.

‘I’d compare the vasectomy to childbirth in the sense that nobody really wants to talk about the pain. We all - men, women and doctors - want to believe that it’s a good thing and don’t want to be frank about the shortcomings. I’m more sceptical about the medical profession today.’

What’s your experience of vasectomy? Have you had one? Are you considering it? Would you never do it?