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Every person is different and each person responds differently to the changes that occur after a
vasectomy. Each person responds differently to each treatment. Some work immediately, while
others don’t work at all and require you to consider the ext option.
Okay, so what to do about the pain?
First you should try conservative therapy. This includes
| Elevation (such as very tight bike shorts or athletic supporter), all the time, for one to two weeks or
more. Some men need them for months. |
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| Heat or cold, as needed for comfort. |
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| Avoiding heavy lifting or straining. This includes avoiding straining with weight lifting and
constipation. |
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| Avoid sexual activity for 10 to 14 days initially. |
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| Anti-inflammation medications (ibupreofen, Advil, Motrin Aleve,
Anaprox, Vioxx, Celebrex or Bextra). These can cause upset stomach and stomach ulcers so don’t take if you have a history of
ulcers or irritable stomach. If you have any problems while taking these, stop them immediately and
call your primary care doctor. |
If conservative therapy doesn’t help, then it may be time to try a “spermatic cord block.”
This involves your doctor injecting a small amount of a local anesthetic “numbing” medicine into the
tissues surrounding the vas (the spermatic cord), high up in the scrotum. Most of the time, this will
result in almost immediate disappearance of the pain. Some times it comes back. Other times it
doesn’t. If it does, we can do longer lasting blocks or even refer you to a full-time pain
specialist who can try a permanent cord block. The rare risk is damage to the tiny artery that provides blood
to the testicle, resulting in injury or even loss of the testicle (very, very rare).
Since this pain and pressure results from a build up of pressure following the vasectomy, there are
two ways to relieve this pressure.
One way is to have a mini-vasectomy again where the testicular end of the vas is sut but not sealed.
The thought is that the fluid under pressure will leak out. Some specialists have tried this and have
been disappointed as this fluid that leaks out can cause a large, tender knot called a granuloma that
may require surgery to remove.
The preferred option is to have a vasectomy reversal. This is very effective, and almost always
results in dramatic resolution of the pain. The down side is that you have to have a another
procedure, and that you most likely will become fertile again and will have to deal with birth
control. The best results are seen when your reversal is preformed by an experienced and skilled
microsurgeon.
The next option to consider might be “spermatic cord stripping”. Here the thought is that if a cord
block works, the urologist can surgically peel the nerves off of the vas. This has been shown to be
very effective as well for many men. As with all procedures, sometimes it doesn’t work.
The final options include removal of part of or the entire epididymis, hoping that the pain will
resolve. If this is unsuccessful, then some men even require removal of the testicle which most often
works.
There are some rare cases where surgical removal of the epididymis or vas are not effective.
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