Thursday, March 26, 2009

Pain After Vasectomy

I started this blog to help men find information about persistent pain after vasectomy. There are about 500,000 vasectomies performed per year in the U.S. According to published post-vasectomy surveys, about 10 to 15% of men develop persistent pain in the scrotum, epididymides (mushy sperm maturation organs attached to each testis), or in the testes after vasectomy. This complication can take years to develop and affects quality of life or sexual function in 2 to 5% of men. Unfortunately, it is not featured on the usual vasectomy consent process and if it is mentioned, it is listed as much more rare ("1 in a 1000"). No mention is made of the inevitable affects of chronic genital pain on the life of the affected men. This blog will focus on this complication and adequate informed consent regarding this tragic outcome of vasectomy.

Despite the common view that vasectomy is completely safe and has no long-term side effects, several post-vasectomy surveys have confirmed that some men have persistent pain after vasectomy. These contemporary studies are published in peer reviewed medical journals and document this problem in a significant percentage of vasectomized men. While most men have trivial short-term pain, some men have pain that lasts a few months, and up to 15% of men still complain of testicular or other scrotal pain seven months after their vasectomy (Leslie et al 2007). After one year, the incidence may decrease, but this has not been proven, and a study of two groups of men one year post-vasectomy and ten years post-vasectomy showed no difference in incidence. (Manikandan et al.)

There are six post-vasectomy survey studies that document the incidence of persistent pain. Severe pain, affects on sexual function, or quality of life are reported in 2 to 6% of vasectomized men in these studies. Summaries are available below and you can access the abstract by clicking the direct links:

1) McMahon et al - 253 surveys sent, 172 responded, and 33% complained of chronic testicular pain. The time interval from vasectomy averaged 4 years and 5% of the men complained of pain during sex. One in sixty respondents regretted having the vasectomy due to chronic pain.

Choe/Kirkemo - 470 surveys sent, 182 responded, and 19% complained of pain. The time interval from vasectomy averaged 5 years and 2% of the men complained of pain that affected quality of life. Nine percent of the men were dissatisfied with their vasectomy.

Morris et al - 198 surveys sent, 101 responded, and 52% complained of some level of pain. The time interval from vasectomy averaged 3 to 4 years and 6% of men complained of pain severe enough to seek treatment.

Ahmed et al - 560 surveys sent, 396 responded, and 5% of men had pain that lasted longer than three months. For some of these men, the pain was severe enough to offer microsurgical denervation of the spermatic cord to treat the pain.

5) Manikandan et al - Surveyed two groups, A. Ten years after vasectomy and B. One year after vasectomy. In group A 460 surveys were sent, 182 responded and 14% had chronic pain. Four percent of the men rated their pain as greater than five on a scale of one to ten (VAS>5). In g
roup 460 surveys were sent, 220 responded and 16% of men complained of pain. Six percent of these men rated the pain as greater than five on a scale of ten.

Leslie et al - 625 patients were approached, and 593 completed the preop survey, while 488 completed a postop survey seven months later and 15% of men reported chronic pain. Four percent of these men reported pain with sex and fourteen percent rated their pain as greater than five on a scale of ten (VAS>5).

Some methodologic flaws could have affected these results which may also be subject to self-selection bias and response bias, however, the numbers are still concerning. If one assumes that ALL of the men who did not return the surveys had NO pain, the pooled incidence of persistent pain from the studies cited above would still be 289/3026 or about 10%.

Most of these authors suggested that chronic pain after vasectomy be included in the vasectomy consent process. This recommendation has not been universally adopted. Chronic pain is the most common post-vasectomy outcome that can affect quality of life.


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  2. Hi Dr. Tony,

    If you are still interested in getting the word out about PVPS, I have created a subreddit that you might find interesting at