What is the one thing that most men fear about vasectomy? Nope, it is not about firing blanks, it’s the pain. Does vasectomy cause pain? It does cause some short-term pain and in rare cases longer term pain. But your urologist will try to make your procedure as pain-free as possible.
Why Painful Ejaculation Post Vasectomy Occurs
It is advised to refrain from sex or ejaculation for atleast a week after vasectomy, otherwise the tissues could get irritated and cause pain and sometimes even complications.
Indeed the first 3-5 ejaculations after the procedure could be somewhat bloody and you could feel some pain for a week or two, but no longer than that.
If even after a month post the vasectomy procedure, the patient experiences pain; then a visit to the doctor is important. This could be a complication known as post-vasectomy pain syndrome (PVPS), which is an intermittent testicular pain that lasts for more then 3 months after the procedure.
PVPS may be a result of compressed spermatic cord nerves, injury to spermatic cord structures, perineural fibrosis, or backpressure resulting from epididymal congestion.
This pain can interfere with your life and may require medical treatment. While cases of PVPS are difficult to establish, approximately 1-2% of men are said to suffer from it.
Types of Pain and Ways to Address Them
Every procedure does cause some pain even if it is performed under anesthesia. Vasectomy is no different. Once the effect of the anesthesia starts wearing off, you might feel pain. Let’s look at different types of pain a person could have after vasectomy and how it is addressed.
For easy understanding, we will divide this into two types:
- Early Pain
- Later Pain
Any operation in the scrotal region is a bit complex due to the presence of family jewels in the region. Even though it is an outpatient procedure, the urologist will either use a local or general anesthesia.
Many urologists may also use a spermatic cord anesthetic block or SCAB, which combines the use of a steroidal anti-inflammatory and numbing medicine to relieve the discomfort.
Once the anesthesia wears off, you will start feeling pain in the operated area. This might be mild or even severe pain. You urologist can prescribe a painkiller and advice wearing supportive underwear, like an athletic supporter or a jockstrap, for at least a week or two to relieve the scrotal pain. This support plays an essential role in the recovery process.
Sometimes, weeks or months after undergoing a vasectomy, some patients report feeling a pea-sized bump which is painful to touch. This pea-sized bump is nothing but inflammation around the procedure site which may have developed due to sperm that sometimes leaks out either during or after the surgery.
This is self-limited and typically resolves on its own. However, to ease the recovery process and address the pain, your doctor could prescribe a course of ibuprofen.
Occurring in less than 1% of patients, congestive pain starts with a feeling of mild discomfort in the scrotal region. which increases over time. This might not be caused due to a granuloma, but the urologist can feel the distended epididymis upon examination.
Often associated with vasectomy done nearer to the testicle (and not higher in the scrotum), distention happens as the sperm and fluids start building up over time after the vasectomy.
The best way to prevent this is by performing a “high” vasectomy and leaving a lot of “pipes” in order to relieve any possible distention. Vasectomy reversal is sometimes the only good curative option to restore the flow.
Pain Due To Epididymal Blowout
Less than 1% of men suddenly develop scrotal pain several years after vasectomy. There might be swelling, without the presence of any granuloma. This is what we call an epididymal “blowout,” which happens due to prolonged backpressure after the vasectomy.
This is not infectious, so a course of antibiotics won’t help. Icing the area, a course of ibuprofen and time is the best treatment protocol. This sort of pain tends to go away on its own.
Though extremely rare (0.004%), some unlucky patients are more prone to developing neurogenic pain after vasectomy. It may start with a less-than-optimal experience and a pain that does not go away but tends to worsen. The patient might have a lot of anxiety, but a physical exam might be normal. A common view among neurologists is that the most plausible cause for this is a pinched nerve, but the jury is still out on this.
It is my firm opinion that a simple inline vasectomy procedure, which does not entail any risk of damage to nerves or the surrounding tissues is the best way to prevent this from occurring.
Urologists also provide their patients with multimodality treatment that consists of nerve blocks, pain therapy, neuromodulators, and anti-inflammatories. This approach has been known to help patients get rid of their neurogenic pain.