PVPS Article

I read an interesting review article from the Canadian Journal of Urology regarding post vasectomy pain: (Morley, et al. Post-vasectomy pain syndrome: clinical features and treatment options. Can J Urol 2012 Apr. 19(2):6160-4).

In it the authors from West Virginia state very clearly that there are meaningful vasectomy side effects. The purpose of the article was to review the available scientific literature from a big picture perspective on the entirety of PVPS. It starts out with a definition for post vasectomy pain syndrome as follows: a chronic epididymal pain that is continuous or recurrent in the absence of proven epididymal or testicular infection.

The authors, from the Robert C. Byrd Health Science Center at West Virginia University, state this syndrome is occurring with increased regularity, as the number of vasectomies performed in the US escalates. Their research tells us that 4,000,000 vasectomies are performed annually. That seems like a lot of sterilization surgeries to me and quite the income stream for a budding urologist.

Sadly still, nobody understands the etiology of the condition. This is what makes it so frustrating, the lack of knowledge in this area. Why does it occur? Who is at risk? At this point, all we have are working theories. With these theories come a multiple of proposed treatment modalities. This is what the article focuses on, the varied aims of treatment.

To begin with, the authors look at the surgical option. Here they include spermatic cord denervation and vasovasostomies (reversals). There is a physician in Florida who is doing some exciting work in the world of spermatic cord denervation. His goal is to not entirely strip the nerve, but rather take a more selective approach, thus preserving much of the spermatic cord. 

Regarding the reversals, technique varies greatly, as does expertise. Most people on the PVPS forum recommend seeking out a urology specialist who has performed multiple reversals for men who suffer from PVPS. 

A medical treatment mentioned in the article includes testosterone. Morley mentions "promising results" with its use. 

In the end, the article is quite clear about one thing, and I'll quote their own words, "Nevertheless, the importance of counseling patients of the risks of PVPS with vasectomy cannot be overstated."

There are two take home points to make here.

1. You'll notice this article was published in April of 2012 and is a review article. This means they have reviewed the whole of scientific literature to look specifically for relevant articles related to vasectomy side effects. So this article represents the most up to date and clear ideas associated with PVPS.

2. The authors basically echo what we've known for quite some time, that PVPS is a debilitating syndrome that has no known starting point, other than some men who undergo vasectomies end up with it. But it is not "all in your head"; this is not some made up story to express your sour grapes about having a vasectomy; and if you suffer from this, you're not alone. 

I hope to find and review more articles like this one in an effort to make this blog a little bit more about vasectomy side effects global, and transition it away from being just an online journal of symptoms. However, I will still journal as the cause and need arises. 

Then the Pain Returned

Do I sound like a broken record yet? Sometimes you have pain with PVPS and other times you are simply threatened with the pain. When you don't have pain, you're just waiting for it to creep around the corner. Thus, why should today be any different?

I woke up in the middle of the night with a burning or tingling sensation behind my scrotum, where it attaches to your body, I think they call that the 'perianal' region. I've had this sensation before, but it was so subtle, I just hoped it was a temporary thing and would go away. Last night though, it woke me up. I reached down there to adjust the boys and the sensation went away.

Whenever I wake up in the middle of the night because of the PVPS symptoms, I know the next day is going to be tough, either physically or mentally. Okay, so I woke up feeling okay, but then I noticed another subtle pain on my left side, like a racking sensation. Not too bad, light at first. But then the pain grew and grew, so now when it hits, I would rate it a 2 on a pain scale. While taking my shower, my right side started to act up. Something in the right of my scrotum started to feel all tied up and firm. Kind of like when I've had my epididymitis scares.

Then my mind started racing. Was this because of my walk yesterday? Was it because I was sitting last night before I went to bed? Was it because my wife and I haven't been together since that horrible pain I had almost 2 and a half weeks ago. Do I need an e.j.? Am I having a little congestion? Should I have a release or wait for my wife and I to hook up 'ala naturale'?

Your mind will drive you crazy with scenarios about what to do and what not to do. To be honest, I'm afraid to be with my wife because I fear the pain that might rear it's ugly head. But, I think I should be with her because: 1) I like to be with her and, 2) physically I should probably have a release.

Hopefully, we'll hook up tonight and all will be well. But this is just another example of how post vasectomy pain syndrome messes with your head. I just keep praying for all of us who suffer from this syndrome that our pain will be lessened, taken away even, and that we can all move forward, leading productive, pain-free lives.

The Uneasy Feeling You Get When Something Isn't Quite Right

I think the title of this is perfect. PVPS gives you that uneasy feeling. Even when it isn't flaring up, you still get little reminders throughout the day that all isn't quite right. Yesterday for instance, I was trying to find a comfortable position at the computer from which to get some continuing education - 6 hours of credit. So needless to say, sitting for 6 hours will not do my PVPS any good. I tried laying down, sitting on a bean bag, etc. Throughout the day, my pelvis and scrotum gave me little reminders that something was wrong. My body was rebelling against the idea of such prolonged inactivity and sitting. I tried to move around during those six hours. I stood, stooped, knelt, walked around, but the uneasy feeling just wouldn't leave me.

I've said it before, but PVPS is as much mental as it is physical. Little reminders are always shooting up your nervous system into your brain to remind you that yep, you still have vasectomy pain. After a while, the regret over having the vasectomy in the first place starts to creep in. Then the depression and questions about whether you'll ever get better.

It seems like we've had a new member join the support group every week for the last several weeks. I hate that because they all say the same thing. It starts with, "I had a vasectomy a few weeks ago and the pain just won't go away. The doctor tells me it's normal, but this pain seems different." My heart just goes out to each and everyone of them. Some are in the US, some are in Europe, but the symptoms and experience and sense of desparation are all the same.

Seriously, why would you want to put yourself through this. Trust me and others in the same boat as I, just don't get the vasectomy in the first place. Condoms and the pill will work just fine. Why put yourself at risk?

I believe this is why I chose to have an "online vasectomy journal". I want to get the word out to the unknowning public. Shine a spotlight on this thing so others won't make the same mistake I did. Granted, the risks of developing this are 1 in 10. But that 10% carries a debilitating lifestyle. Full of pain and doctor's appointments. Mental anguish, stress, pharmaceutical dependence and all the other "stuff" that comes with a chronic pain-like life. Hey, I'm giving you an out that you can tell your wife about. I don't think any guy wants a vasectomy in the first place, I know I didn't. So here's your excuse - PAIN spelled with PVPS: that is post vasectomy pain syndrome.

Thoughts of Getting Happy with the Wife

The kids are at their uncle and aunts. This mean my wife and I have the house to ourselves. We always joke about how liberating that makes it for us to be "together". The entire house is available to us: the living room, den, heck even the kitchen table (just kidding). We thought we had time before we were supposed to meet with her sister for a dinner out. That moment suddenly turned into us not having enough time.

My body was all ready for a release (E.J.) but it didn't happen. Then when we got back from dinner, I thought, "okay, now it'll happen". But she was too tired from our house projects earlier in the day. So I'm curious how my boys will handle the frustrations. So far this morning, I've had a little nerve pain on the left and my right side continues to be achey. Not sure if it's because they were all fired up to go last night but then was called off by mission control.

Hopefully, we'll have some together time today before we get the kiddos and I can have a release. I think I need one. If not from my wife, then ...I guess I'll have to take things into my own hands, sort-of-speak.

Before I had a vasectomy, this would have been no big deal. A little frustrating, but it wouldn't cause pain. Just one more way post vasectomy pain makes your life crazy. It causes your brain to be all consuming about your pelvis region. Little things affect it in really bad ways. It basically sucks!

What's Going On?

I'm getting a little nervous, because yesterday was a pretty decent day. I'm not sure exactly what's going on. I had a somewhat vigorous activity day and I didn't feel but just the slightest of twinges yesterday. Now granted, I didn't do a lot of sitting down. In fact, I was painting pretty much all day. But that usually means I have to take tylenol sometime during the afternoon or evening. To further add to my confusion, I was on the computer for about 3 straight hours last night before going to bed, trying to organize our insurance appeal letter. I was sitting on a pillow on my computer chair, but still, that usually brings a ton of pain.

So, is this just some sort of good day mixed in with bad days? Is it a sign that things are looking up for me? I did take the Rapidflo med, could that have anything to do with it? I took another Rapidflow last night and so far today, things are pretty good.

Regardless, I see this as an answer to my prayers. Even if I only have 2-3 good days to be followed by a couple of not so good days, I'll take it. Then I hope to have 4-5 good days followed by maybe 1-2 bad ones. Then, of course, I hope to have weeks and months of good days, and so on. It's hard to not be hopeful when a day goes so well, but I also have to be realistic (which I hate).

The realist in me tells me to not get on the roller-coaster of good and bad days. However, the faithful and hopeful me wants to take a good day and run with it. I've already been planning on getting back on the treadmill and thinking that perhaps life will become normal again.

I know I speak a lot about this post vasectomy pain syndrome and the side effects of a vasectomy, but it's so true - you just don't know what you're going to get. Maybe you're one of the lucky ones who have a vasectomy and don't experience any problems. Now you can have unprotected sex with your wife and not worry about getting her pregnant.

However, what if you're like me and countless untold others who get some kind of problem as a result of the vasectomy? Now your life is completely turned upsidedown. Now you have to take pain medication regularly. Now you have to see your urologist multiple times a year for flare-ups and treatments and tests. Now you can't have sex at all because you're afraid the pain may be too excruciating or you think it may cause a flare-up of your symptoms.

Man, I'm telling you, it's just not worth it. Don't have a vasectomy - PERIOD. Use other forms of birth control that don't have a risk profile associated with it. Continue with the pill and condoms, creams, etc. Trust me, that may be a little messier or may stop down the intimate moments a minute or two, but it's okay.

Sure, the percent of men who have side effects after their vasectomy is low (somewhere between 5-15%), but those of us who do have them, suffer in ways you can't even imagine. Simply go to the forum listed in the links section and you'll see what the conversations are like. Or go to some of the other links and you'll see what I'm talking about.

Sadly, I'm Not Surprised - Just a Little Disappointed

So after I blogged yesterday, about how I was feeling better, it happened. I began to have knifing nerve pain on my left inguinal side. I haven't had that kind of pain over there in quite a while. But as I continue to discover, this fickle syndrome has a mind of it's own. It likes to leave you guessing.

I thought the pain would strike and then disappear. It likes to do that, keeping me on my toes, so I won't know when to expect it next. However, this time, it was pretty much continuous. Non-stop knifing pain in my left inguinal area. Finally, I had enough. I remember someone on the forum telling me that he takes pain medicine, even when the pain is tolerable. He says, "Why sit there and be in pain if the medicine will take it away?". So armed with that information, I took 2 tylenol. Like magic, the pain was gone in about 1 hour. I had a restful nights sleep and woke up this morning with only a slight remnant of the pain. Kind of like an aftershock. I can tell something is there, but it's not painful.

Score one for post vasectomy pain syndrome. It got me yesterday quite unexpectantly. This just goes to show me that I'll never be completely out of the woods, with regards to pain. That kind of information can break you down mentally. Knowing that pain will be your constant companion. However, the verse..."Greater is He who is in me, than he who is in the world" keeps playing through my brain. Maybe I'm being taught how to be an overcomer in the face of adversity. I usually just crumble and become a sad sack of suds reaching out to anyone who will show me a little sympathy.

So I need to get my act together and not allow this PVPS to define me or what I do. Sure, it may change how I do things, but I should still be able to do things.

By the way, I didn't stretch out last night or do any "exercises" just in case that was contributing to my pain. I think I'll go for a walk today and do some light stretching, minus the leg lifts and pelvic tilts.

Vasectomy Side Effects and Vasectomy Reversal Surgery

Yesterday brought with it a return of the nerve pain on my right side. I had a good night sleep and this morning I feel only a slight little twinge on the right side. We have some landscaping to do tomorrow and I have a lot of errands to run today (that means lots of car time), so we'll see how I'm doing on Monday.

Someone asked me the question if I was happy that I had the vasectomy reversal surgery. I told them I wasn't sure yet. The new pains are just as worrisome as the pre-surgery symptoms of swelling and pain. My activity levels are still dictated by pain. But I feel better mentally. They say your testosterone levels drop off with vasectomy surgery. My level two years ago was 441, which might be on the low side for someone who is 41 years old.

So perhaps my levels are higher than before my surgery and that is causing my energy to perk up a little bit. I won't know for sure unless I get it tested. Still not sure I'm going to do that yet.

Just remember, before you have that vasectomy, there is a chance you can have horrible nerve pain which can manifest as the following: continuously, when you ejaculate, intermittently, every once in a while and the pain can be anywhere from a dull ache to such intensity, you want to cry all the time. I've heard stories of people who have suffered all the above.

Or you could have epididymitis like I did. That means your epididymous swells and you feel like you have a third testicle. The pain radiates into your stomach region and makes it very uncomfortable. This swelling can be intermittent or continuous. Mine was intermittent and then turned continuous after 5.5 years. It also was one sided and then became bilateral after 5 years.

So, have a vasectomy if you are willing to take the risk. I would say that if you've had a previous pelvic surgery (hernia repair, appendix removal, etc.) or if you have had lower back pain, you definitely don't want to have the vasectomy. Lots of guys in my support group have had these, however, lots haven't. So there may not be a correlation, but nobody knows. That's the problem, it isn't studied in the urology community, despite it being such a devastating syndrome.

Imagine, your pain ranking an 8-9 on a 1-10 pain scale. Imagine, the pain being continuous and you requiring a pain management doctor to help you get through your life. Your activity becomes nothing, your testosterone sinks to low levels, your sex life becomes almost non-existent. And you did all this in the name of birth control. Trust me, if I had to do it over again, I'd never had the vasectomy in the first place. And neither would thousands of men who suffer various degrees of post vasectomy pain syndrome.

Please, don't have it done. I know, thousands of men have it done and nothing happens to them. But if it does happen, your life will be turned upside down and your regret will last a lifetime.

Journal Entry

I had a good night's sleep. Woke up with no pain to speak of. I haven't done a lot of sitting today, which usually exacerbates the pain sensations. Interestingly though, when I pushed on my right inguinal area as I was leaning against a counter, I had an extremely distasteful nerve pain shoot through me. It lasted about 5 seconds.

I'm constantly amazed how this PVPS pain expresses itself from day to day, moment by moment. I have had something like 10 distinct pain sensations in my pelvic/scrotal region in the last 3 days. Each one with its own unique brand of discomfort.

Anybody who thinks vasectomies or vasectomy reversals are benign procedures ought to think again.

If I told you that you had a 1 in 10 chance of developing debilitating pain that was almost impossible to manage, as a result of having a vasectomy; would you have it done? I think the answer might be different from person to person. Some might feel lucky while others might think they're due for something bad.

The problem is, very few urologists discuss this possible side effect related to vasectomies with their patients. The other problem is, many urologists perform vasectomies, however, they don't specialize in men's health. For example, the doc who did my vasectomy, specializes in women's bladder issues. Now he does everything else a urologists does, but his specialty and passion was not related to men's health.

Somethings to think about before you decide to have a vasectomy.

Vasectomy Side Effects First Blog

Welcome to my first blog about vasectomy side effects. I know, you thought there weren't any side effects, right? You thought a vasectomy is no big deal; everyone else in the office has had one; your wife might even be pressuring you to get one. Well, there is a little dirty secret that nobody talks about when it comes to vasectomies.

The secret is called Post Vasectomy Pain Syndrome or PVPS for short. It usually takes on two forms.

1. Varying degrees of nerve pain - from debilitating to inconvenient.

2. Epididymitis (epi-did-i-my-tus). I know, that's a mouth full.

I will start by telling you my story. I had a vasectomy 5.5 years ago. Six months later, I had swelling in my scrotum which was not very comfortable. After a scrotal ultrasound - yep, I didn't know they could do that either - I was diagnosed with epididymitis. No big deal my uro doc told me, just take some antibiotics and a steroid dose pack and I should be ship shape in no time. Then every 6 months, this pattern would repeat.

It turns out, somewhere between 7-15% of all men who have a vasectomy end up with some sort of pain syndrome. That's 1 out of every 10 guys that have a vasectomy. Lucky me I guess.

Okay, now I've had a reversal to see if that will fix my problem. Now since the reversal, I have a nerve pain that feels like a dull ache on the right side of my scrotum. I also have a flash of pain that hits me out of the blue in various places between my belly button and groin. I would rate it a 7 on a 1-10 pain scale where 10 is the most intolerant pain you could imagine.

So basically, there is no simple fix to this problem. Once you have it, you have it. Sometimes the surgical treatments work, sometimes they don't, sometimes they make it worse. Sometimes leaving it alone and treating it conservatively it the right thing and sometimes it's the wrong thing.

This is a very insidious syndrome because it is so poorly understood. Most urologists who perform vasectomies never experience patients with this problem.

Because vasectomies are such a big business, very little information gets out about this syndrome, but believe me, it's very real. I joined a support group a couple of weeks ago and now I am trying to do my part to get the word out, about what many of us suffer from. Post vasectomy pain syndrome can be just as debilitating as any other disease you can think of. It may not cause death, but I'm certain many men would have preferred it.

Please visit the forum's link if you want to get real information about this painful phenomena. I will invite others to post their stories here as well as provide information about this dreaded problem.