Post-vasectomy pain syndrome
Encyclopedia
Post-vasectomy pain syndrome is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy
. Because this condition is a syndrome
, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. When pain in the epididymides is the primary symptom
, post-vasectomy pain syndrome is often described as congestive epididymitis.
Any of the aforementioned pain conditions/syndromes can persist for years after vasectomy and affect as many as one in three vasectomized men. The range of PVPS pain can be mild/annoying to the less-likely extreme debilitating pain experienced by a smaller number of sufferers in this group. There is a continuum of pain severity between these two extremes. Pain is thought to be caused by any of the following, singly or in combination: testicular backpressure, overfull epididymides, chronic
inflammation
, fibrosis
, sperm granulomas, and nerve
entrapment. Pain can be present continuously in the form of orchialgia
and/or congestive epididymitis or it can be situational, such as pain during intercourse
, ejaculation
or physical exertion.
on the testicular side following vasectomy
. The epididymides of vasectomized men are often swollen and distended from backpressure effects. The efferent ducts
and seminiferous tubules
of the testes are also impacted by backpressure, leading to an increase in area and thickness. Backpressure from blockage of the vas deferens causes a rupture in the epididymis, called an "epididymal blowout", in over half of vasectomy patients. Sperm sometimes leak from the vas deferens of vasectomized men, forming lesions in the scrotum
known as sperm granulomas. Some sperm granulomas can be painful. Paradoxically, the presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus lessens the likelihood of epididymal discomfort.
As part of the reaction of the body to the surgical wounds of vasectomy, the body produces hard scar-like tissue. Clamping the vas deferens can produce muscle disruption and fibrosis
. As the diameter of the vas lumen
is less than the thickness of the wall, the thick muscle layers can easily become disrupted, leading to sperm
accumulation and extravasation. Cysts often form from the fluid that spreads between the muscle layers.
Nerves can become trapped in the fibrous tissue caused by vasectomy
. This pain is often heightened during sexual intercourse
and ejaculation because, with arousal and ejaculation, muscles elevate the testis. There are several nerves that run parallel to the vas deferens that may be cut or damaged during vasectomy.
One study found that the vas deferens exhibits two periodic forms of electrical activity on an electrovasogram, slow pacesetter potentials and fast action potentials. In vasectomized men, the pacesetter potentials on the testicular side exhibit an irregular rhythm.
One study using ultrasound found that the epididymides of patients suffering from post-vasectomy pain syndrome were enlarged and full of cystic growths.
Nerve entrapment is treated with surgery to free the nerve from the scar tissue, or to cut the nerve. One study reported that denervation of the spermatic cord provided complete relief at the first follow-up visit in 13 of 17 cases, and that the other four patients reported improvement. As nerves may regrow, long-term studies are needed.
One study found that epididymectomy provided relief for 50% of patients with post-vasectomy pain syndrome.
Orchiectomy is recommended usually only after other surgeries have failed.
testicular discomfort that was troublesome and that 33% of respondents experienced some chronic
testicular discomfort.
A retrospective postal survey of 396 men found that 4% had significant genital pain for more than one year that required surgical intervention.
Another study contacted 470 vasectomy patients and received 182 responses, finding that 18.7% of respondents experienced chronic
genital pain with 2.2% of respondents experiencing pain that adversely affected quality of life.
Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
. Because this condition is a syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. When pain in the epididymides is the primary symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
, post-vasectomy pain syndrome is often described as congestive epididymitis.
Symptoms
- Persistent pain in the genitalia and/or genital area(s).
- Groin pain upon physical exertion.
- Pain when achieving an erection and/or engaging in sexual intercourse.
- Pain upon ejaculation.
Any of the aforementioned pain conditions/syndromes can persist for years after vasectomy and affect as many as one in three vasectomized men. The range of PVPS pain can be mild/annoying to the less-likely extreme debilitating pain experienced by a smaller number of sufferers in this group. There is a continuum of pain severity between these two extremes. Pain is thought to be caused by any of the following, singly or in combination: testicular backpressure, overfull epididymides, chronic
Chronic
Chronic may refer to:* Chronic , a disease that is long-lasting and reoccurring.* Chronic toxicity, a substance with toxic effects after continuous or repeated exposure* The Chronic, a 1992 album by Dr. Dre...
inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
, fibrosis
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
, sperm granulomas, and nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
entrapment. Pain can be present continuously in the form of orchialgia
Orchialgia
Orchialgia is long-term pain of the testes. Orchialgia may be caused by injury, infection, surgery, cancer or testicular torsion and is a possible complication after vasectomy.-Diagnosis:Testing for gonorrhea and chlamydia should be routinely performed....
and/or congestive epididymitis or it can be situational, such as pain during intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
, ejaculation
Ejaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...
or physical exertion.
Mechanisms of pain
There is a noticeable increase in pressure within the vas deferensVas deferens
The vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
on the testicular side following vasectomy
Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
. The epididymides of vasectomized men are often swollen and distended from backpressure effects. The efferent ducts
Efferent ducts
The efferent ducts connect the rete testis with the initial section of the epididymis.There are two basic designs for efferent ductule structure:...
and seminiferous tubules
Seminiferous tubules
Seminiferous tubules are located in the testes, and are the specific location of meiosis, and the subsequent creation of gametes, namely spermatozoa....
of the testes are also impacted by backpressure, leading to an increase in area and thickness. Backpressure from blockage of the vas deferens causes a rupture in the epididymis, called an "epididymal blowout", in over half of vasectomy patients. Sperm sometimes leak from the vas deferens of vasectomized men, forming lesions in the scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
known as sperm granulomas. Some sperm granulomas can be painful. Paradoxically, the presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus lessens the likelihood of epididymal discomfort.
As part of the reaction of the body to the surgical wounds of vasectomy, the body produces hard scar-like tissue. Clamping the vas deferens can produce muscle disruption and fibrosis
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
. As the diameter of the vas lumen
Lumen (anatomy)
A lumen in biology is the inside space of a tubular structure, such as an artery or intestine...
is less than the thickness of the wall, the thick muscle layers can easily become disrupted, leading to sperm
Sperm
The term sperm is derived from the Greek word sperma and refers to the male reproductive cells. In the types of sexual reproduction known as anisogamy and oogamy, there is a marked difference in the size of the gametes with the smaller one being termed the "male" or sperm cell...
accumulation and extravasation. Cysts often form from the fluid that spreads between the muscle layers.
Nerves can become trapped in the fibrous tissue caused by vasectomy
Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
. This pain is often heightened during sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
and ejaculation because, with arousal and ejaculation, muscles elevate the testis. There are several nerves that run parallel to the vas deferens that may be cut or damaged during vasectomy.
One study found that the vas deferens exhibits two periodic forms of electrical activity on an electrovasogram, slow pacesetter potentials and fast action potentials. In vasectomized men, the pacesetter potentials on the testicular side exhibit an irregular rhythm.
One study using ultrasound found that the epididymides of patients suffering from post-vasectomy pain syndrome were enlarged and full of cystic growths.
Treatment
Treatment depends on the proximate cause. In one study, it was reported that 9 of 13 men who underwent vasectomy reversal in an attempt to relieve post-vasectomy pain syndrome became pain-free, though the followup was only one month in some cases. Another study found that 24 of 32 men had relief after vasectomy reversal.Nerve entrapment is treated with surgery to free the nerve from the scar tissue, or to cut the nerve. One study reported that denervation of the spermatic cord provided complete relief at the first follow-up visit in 13 of 17 cases, and that the other four patients reported improvement. As nerves may regrow, long-term studies are needed.
One study found that epididymectomy provided relief for 50% of patients with post-vasectomy pain syndrome.
Orchiectomy is recommended usually only after other surgeries have failed.
Incidence
A phone and postal survey of 172 patients 4 years after vasectomy found that 15% of respondents experienced chronicChronic
Chronic may refer to:* Chronic , a disease that is long-lasting and reoccurring.* Chronic toxicity, a substance with toxic effects after continuous or repeated exposure* The Chronic, a 1992 album by Dr. Dre...
testicular discomfort that was troublesome and that 33% of respondents experienced some chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
testicular discomfort.
A retrospective postal survey of 396 men found that 4% had significant genital pain for more than one year that required surgical intervention.
Another study contacted 470 vasectomy patients and received 182 responses, finding that 18.7% of respondents experienced chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
genital pain with 2.2% of respondents experiencing pain that adversely affected quality of life.