Post-Vasectomy Pain Syndrome
A vasectomy has been found clinically to be the most effective form of sterilization for men, with a 98% success rate, with approximately 500,000 vasectomies performed each year in the United States. (1)
Anatomy of the Spermatic Cord (2)
The spermatic cord exits the inguinal canal in the lower abdominal wall above the inguinal ligament, a fibrous band which connects the abdominal oblique muscles to the pelvis (i.e. the abdominal “V”). The point where it exits the abdomen is known as the superficial inguinal canal, most commonly known secondary to being the location of inguinal hernias.
The spermatic cord contains the vas deferens, which transports sperm from the testicles and their supporting structures to allow for inclusion in the composition of ejaculate to biologically aid in fertilization of an ovum (egg). The vas deferens is the structure which is severed during a vasectomy procedure. The spermatic cord additionally contains multiple blood vessels, nerves and lymphatic vessels that help optimize sexual and reproductive health.
The spermatic cord is covered by a membrane, known as the tunica vaginalis, which is an extension of the lining of the abdominal cavity, the peritoneum. FUN FACT – Each testicle develops embryologically within the abdomen, at the level of the lower thoracic and upper lumbar region, with testicular descent into the scrotum in the majority of fetuses by 33 weeks gestationally.
Vasectomy Surgical Procedure
Surgical procedure may vary dependent on the surgeon and their education/training but usually occurs within an outpatient setting under local anesthesia. Two small incisions are usually made between the base of the penis and the scrotum/testicle with the left and right vas deferens severed thereby preventing sperm from entering the ejaculate with ejaculation thus preventing potential fertilization of an ovum or egg. Technique to prevent reconnection of the vas deferens will differ dependent on surgeon.
Post-vasectomy your surgeon should provide you with educational material regarding expectations for a normal post-surgical recovery and instructions regarding follow up. A “semen-check” will be completed to ensure success of the surgical procedure. Post-vasectomy it is normal to experience mild discomfort, swelling and bruising to the region. Most people are able to return back to work in under a week, with some exceptions based upon the physical demands of your occupation.
As with any surgical procedure there are potential risks and/or unexpected complications associated with performance. Secondary to the close proximity of the structures within the spermatic cord, damage to these structures can occur. Additionally post-surgically you may develop a painful lump along the spermatic cord, known as a sperm granuloma. This “lump” may be the result of “leaking” sperm from the severed vas deferens. Most often this will be absorbed by the body with resolution of symptoms post-absorption. Lastly scrotal congestion may develop secondary to the continued sperm production. This is often noted as a sense of fullness or pressure within the scrotum and often resolves independently post-surgically. (3)
Persistent Pain Post-Vasectomy
Post-vasectomy pain syndrome (PVPS) is defined as either constant or intermittent testicular pain for greater than 3 months post-surgically with a prevalence of 1-2% in those who have undergone a vasectomy, although this number is believed to be under-estimated. (1) PVPS is often a diagnosis of exclusion meaning prior to formal diagnosis your medical provider will often attempt to rule out other potential causes of persistent symptoms to include infection, hydrocele (swelling in the scrotum), varicocele (enlargement of the veins within the testicles secondary to poor venous return), inguinal hernia, testicular torsion, and neurogenic pain. If symptoms persist >3 months post-vasectomy it is crucial that medical attention is sought after. (1) Your medical provider will complete a thorough medical examination to differentiate reason for symptom origin thus allowing for the development of an appropriate treatment approach.
Pelvic Physical Therapy Post-Vasectomy
If you are greater than 3 months post-vasectomy and are experiencing symptoms such as testicular/penile pain, perineal and inner thigh numbness, tingling and/or burning, pain with intercourse (dyspareunia), pain with ejaculation, and/or urinary incontinence you may benefit from evaluation from a pelvic physical therapist. With completion of a subjective and thorough objective examination your pelvic physical therapy specialist will help identify the factors which may be contributing to your persistent symptoms post-surgically and help develop a treatment approach to address these symptoms and help you regain back control of your pelvic health! Dependent upon examination and symptom presentation a multi-professional approach to treatment may be necessary with your pelvic physical therapist having the education and medical screening capacity to help you traverse through this recovery.
Sinha, V., & Ramasamy, R. (2017). Post-vasectomy pain syndrome: diagnosis, management and treatment options. Translational Andrology and Urology, 6(Suppl 1), S44–S47. https://doi.org/10.21037/tau.2017.05.33
Tuma, F., Lopez, R. D., & Varacallo, M. (2019). Anatomy, Abdomen and Pelvis, Inguinal Region (Inguinal Canal). StatPearls.
Vasectomy: Procedure, Recovery & Effectiveness. Cleveland Clinic. (n.d.). Retrieved May 3, 2023, from https://my.clevelandclinic.org/health/treatments/4423-vasectomy