What is Post Vasectomy Pain Syndrome – PVPS

This is the first of a 3 part series by Dr. Sheldon Marks about post-vasectomy pain (PVPS) and the possible role of vasectomy reversals for treatment, updated in 2023. Of course, surgery should always be a last option when all conservative treatments have failed.

Part 1 – What is PVPS?
Part 2 – Causes of PVPS
Part 3 – Treatment options for PVPS

Part 1 of 3
What is Post Vasectomy Pain Syndrome (PVPS)?
Rarely, men can develop significant, life destroying pain with a variety of problems after an otherwise uneventful vasectomy. This pain can start up immediately or develop after days, weeks or months and even years later. PVPS pain can be sharp or dull, constant or intermittent, steady or fluctuating or any variation or combination.

Sometimes exercise makes the pain less while for some men it can make the pain worse. Sexual activity and ejaculation can be associated with a flare up of the severe pain before, during or after sexual activity. Of course, this pain can seriously interfere with a man’s quality of life – his marriage, how he interacts with his children, family, friends and co-workers (Sinha V, Ramasamy R. Post-vasectomy pain syndrome: diagnosis, management and treatment options. Transl Androl Urol. 2017 May; 6(Suppl 1): S44–S47).

To make it worse, many doctors have never seen or heard of PVPS and so often tell the patients that:
1. it’s “in their head” and so they need to see a psychiatrist or
2. that it’s obviously drug seeking behavior or
3. that they need to have their testicle removed.

Of course, experts know the pain and other complaints are real and treatable with high chances for success.

What makes this challenging for the doctors is that there is no standard description or pattern of the post-vasectomy pain. Each man will have his own unique constellation of pain and associated issues that may or may not be similar to other men in different ways, specific to that person.

Men with longstanding PVPS often complain of generalized feelings of fatigue, exhaustion, irritability, and a loss of joy. Many often describe symptoms of depression and a lack of sex drive. Family members and spouses often note that their loved ones have become grouchy, irritable, short-tempered and hard to be around. Friends and coworkers describe the same personality changes. In the worst situations, some men have been divorced or lose their jobs and friends because of the disabling pain and associated problems (Tandon S, Sabanegh E., Jr. Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU Int 2008;102:166-9).

All of these complaints make sense if the man and his partner understand that chronic, long-standing pain has a ripple effect throughout the entire body. Constant pain pushes the body into a constant fight-or-flight response, with a perpetual adrenaline release and depletion.

Chronic pain is often associated with a significant drop in testosterone. So, it makes sense that men with PVPS will also be aware of the common symptoms of low testosterone such as fatigue, irritability, lack of sex drive and mood swings.

First, it is important to know that the pain is real. Just as important, it helps if a man’s wife, children, friends and coworkers understand that this is a true medical problem and a known but rare complication of a vasectomy. Because it is so rare, no doctor really can predict who will get it and if there’s any particular things a doctor can do to cause PVPS or to prevent the pain.

It is critical to know that the doctors and staff of ICVR are vasectomy reversal experts. We are not experts in nor trained in the evaluation and management of pain. There are many top doctors that are trained pain experts. The reason we are writing about pain is that many men have this pain because of blockage of fluid within the epididymis and testicles with a buildup of pressure, so having a reversal to decompress the system and restore the flow is a reasonable option to consider (Smith-Harrison LI, Smith RP. Vasectomy reversal for post-vasectomy pain syndrome. Transl Androl Urol. 2017 May; 6(Suppl 1): S10–S13) when other conservatives treatments have failed.

Our staff of senior medical professionals is available to answer any questions about having a vas reversal to treat post-vasectomy pain. Just call us at (888) 722-2929

Please note that there is a charge for consultations with a doctor for PVPS, which is applied to the cost of the vas reversal.

This page was reviewed, edited and updated January 4, 2023 by Sheldon Marks, MD.