What are the Causes of Post Vasectomy Pain Syndrome (PVPS)

This article, by Dr. Sheldon Marks, addresses some of the possible causes of significant pain after vasectomy that can lead to debilitating Post Vasectomy Pain Syndrome (PVPS).

There are many theories as to what causes PVPS, each making some sense. The pain really is a variety of nonspecific problems from any one or many causes. People like to blame one particular thing, when more likely there’s a variety of factors that all manifest with several findings that cause the pain and other nonspecific variety of complaints, all similar to others but unique for that individual.

We often hear that doctors tell their patients that they have “nerve pain.” Technically, all pain is nerve pain, so this really doesn’t explain the cause of the pain. Nerves being stimulated and then firing the message of stimulation of the nerve cells up a series of nerves to the brain is how we become aware of a problem and what we experience and feel as pain.

Here are 4 possible explanations for PVPS that include one or a combination of issues (Tandon S, Sabanegh E., Jr. Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU Int 2008;102:166-9).
–Congestive epididymitis, which is a build up of fluid and sperm in a suddenly closed system under pressure stretching the delicate tissues lining the epididymis and testicle, which stimulates nerves to fire
–Damage or injury to nerves, often specific to each person’s own genetics, to include rare nerve degeneration which is thought to be somehow triggered by the vasectomy
–Sperm granuloma (a very painful lump or nodule) that develops at the vasectomy site where, after the vasectomy, sperm leak into adjacent tissues which are walled off by the body in a very tender inflammatory mass
–Scarring at the vasectomy site, which can be extensive, often cause by excessive electrocautery or the man’s genetically mediated reaction to the surgery, cautery, sutures or metal clips.

Quite often, the causes may be a combination of any or all of the above possible explanations. We often find a sperm granuloma or extensive scarring, as well as a significant build up of fluid within the epididymis. This would explain why a well performed vasectomy reversal by a top expert usually results in total or dramatic resolution of the pain in more than 95% of men.

Dr. Marks and Dr. Burrows here at ICVR are two of the top vasectomy reversal surgeons with dramatic successes performing reversals on men with PVPS. It is important to know that we are not pain doctors. We are not trained in the evaluation and management of chronic pain, nor do we manage PVPS before or after the vas reversal. That is what pain specialists are trained to do. We just perform reverse vasectomies, with the hope that the relief of the pressure and removal of a sperm granuloma or dense scarring will dramatically reduce or eliminate the pain (Myers SA, Mershon CE, Fuchs EF. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol 1997;157:518-20).

We believe that if conservative treatments fail, then of the remaining options available, one logical choice is a microsurgical reversal, which is the only definitive treatment that offers a reconstructive, restorative approach rather than destructive procedures that so many others recommend (Horovitz D, Tjong V, Domes T, Lo K, Grober ED, Jarvi K. Vasectomy reversal provides long‐term pain relief for men with the post‐vasectomy pain syndrome. J Urol. 2012;187:613‐617). Here at ICVR, we see a success of 95% of men who achieve a total, complete resolution or dramatic reduction of their pain so that they can move on and live a normal life (Smith-Harrison LI, Smith RP. Vasectomy reversal for post-vasectomy pain syndrome. Transl Androl Urol. 2017 May; 6(Suppl 1): S10–S13).

With so much at stake, why settle for anything less than the very highest chances for resolution of the pain?

For those suffering from continued PVPS, we encourage a call to arrange for a phone (888) 722-2929 or Face Time, Zoom, Skype or an office consultation to help get back on the road to recovery. At that time, with of our world-class vasectomy reversal doctors can review the pros and cons of various conservative as well as more invasive options to include a state-of-the-art microsurgical vasectomy reversal at our full time, vas reversal only Center of Excellence.

Because of the nature of PVPS, please note that there is a small charge for the consultation which is applied to the cost of the vasectomy reversal.

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