Most men are told the pain will pass.
For a small number of them, it does not. It settles in, and it stays, and after a while they stop bringing it up because of the way people look at them when they do.
Sometimes the pain is so bad that it interferes with your marriage, your relationships with your children and coworkers, and your ability to do the activities you love (1,2).
Post vasectomy pain syndrome is chronic pain in the testicle, the scrotum, or the groin that continues long after a vasectomy should have healed. It is uncommon (1,2). It is also physical, it is well described in the urologic literature, and in most men it can be treated successfully, so you can have your life back.
Dr. Sheldon H. F. Marks and Dr. Peter Burrows treat it. Not as a side interest, but as part of a full-time international practice that does nothing except microsurgical vasectomy reversals.
What PVPS Is
A vasectomy cuts and blocks the vas deferens, the tube that carries sperm out of the testicle. The testicle does not stop working after that. It keeps producing sperm at the same rate it always did, and that sperm now has nowhere to go.
In most men the body absorbs it quietly and nothing comes of it. In some men it does not. Pressure builds behind the blockage. The epididymis swells. Scar tissue forms at the vasectomy site and can trap or irritate the small nerves that run alongside the vas deferens (1,3).
Pain that persists beyond three months after a vasectomy, with no other explanation, is what urologists call post vasectomy pain syndrome (1,4).
The timing catches men off guard. It is not what they signed up for. Some never get relief from the day of the procedure. Others feel fine for months, or for years, and then it starts (3).
Dr. Marks writes about the condition in more depth in the first part of his PVPS article series.
Symptoms
Men describe it differently, which is part of why it gets missed or ignored.
- A dull ache in one or both testicles, or a sharp pain that can be constant or can come and go
- Pain that worsens with exercise, with lifting, or after a long day standing
- Pain during or after sex, and pain on ejaculation (3)
- Tenderness at the vasectomy site itself
- A heavy or congested feeling in the scrotum
- Pain that radiates into the groin, the lower abdomen, or the upper leg
What rarely gets written down is what comes with it. Broken sleep. Irritability. Avoiding sex, then avoiding the conversation about avoiding sex. Falling libido. Low mood that a man will usually explain away as stress at work.
Chronic pain of any kind keeps the body in a low, constant alarm state, a perpetual fight-or-flight response, and that has its own consequences over time. Wives and partners often notice the change before the man admits to it.
Causes
There is no single cause, and that matters, because the right treatment depends on which one is driving it.
The usual sources are back pressure and congestion behind the blocked vas deferens, inflammation and swelling in the epididymis, scar tissue at the vasectomy site, an inflammatory sperm granuloma where sperm has leaked into surrounding tissue, and nerve entrapment where healing tissue has caught or damaged the tiny nerve fibers that travel with the vas deferens (1,3).
Often, more than one is present in the same man at the same time.
Dr. Marks covers each of these in detail in the second part of his PVPS article series.
The Four Categories of Treatment
Every treatment offered for post vasectomy pain syndrome (PVPS) falls into one of four groups. The difference between them is not how aggressive they are. It is what they leave behind.
Ideally, we recommend a stepwise progression, starting with the more conservative options in the hope that they work and you will not need more aggressive treatment (1,5). What works for one man may not work for another.
Some men want to try every conservative option and give each a reasonable time to work. Others want to move more quickly to more definitive treatment.
A common concern we hear is: if surgery caused the problem, how can more surgery be the solution? The answer is that a vasectomy is a very quick cut, burn, clip and get out kind of procedure. It converts an open system into an instantly obstructed one. A reversal is just the opposite. It is a delicate, precise microscopic reconstruction that restores the body to the way it was, removing scar tissue and allowing sperm and fluid to flow back through the vas deferens into the semen.
The key is to understand the pros and cons of each of these options, so that you can work with your doctors to make an informed, shared decision about what is best for you.
That is where we come in. When you are ready, we can walk you through the pros and cons of a microsurgical vasectomy reversal, the only option that is restorative and reconstructive, taking you back to the way you were before the vasectomy.
Conservative Care
Time, first. Some men improve over weeks or months without any intervention, and no reasonable doctor rushes past that.
Then trials of heat, cold, supportive garments, and changes to activity. Pelvic floor physical therapy with a therapist who treats male pelvic pain, a small field but a growing one, may help (1,5). Anti-inflammatory supplements. Anti-inflammatory medication, nerve pain medication, possibly testosterone or other treatments, and in some cases a short course of something stronger, though narcotics are a poor answer to a problem measured in years (6).
Conservative care is where every man should start. For many, it is where treatment ends, when the pain resolves or drops to a level that no longer interferes with their quality of life.
Cord Blocks
An anesthetic injection into the spermatic cord that numbs the area temporarily.
Its main value is diagnostic (4,5). If a block takes the pain away for a few hours, that tells the surgeon something useful about where the pain is coming from. As a treatment, the relief usually does not last, and the evidence behind repeated blocks is thin. As with everything, there are potential risks. Some doctors recommend a spermatic cord block; others do not.
Destructive Procedures
This is where a man deserves to be told exactly what is being proposed.
Nerve stripping and microsurgical neurolysis remove the nerves running alongside the vas deferens. Epididymectomy removes part or all of the epididymis. Orchiectomy removes the testicle.
Each of these can work for some men (7,8,9). Each of them is also permanent, and none of them can be undone. A man who has an epididymectomy has given up the possibility of a future reversal on that side. A man who has an orchiectomy has lost that testicle, and the pain does not always leave with it (9).
There is a question worth asking any surgeon who recommends one of these: what happens if this does not fix the pain, and what have I given up in the meantime?
For some men, these procedures are genuinely the right answer and work well. But surgery should always be the last answer, not the first (1).
Microsurgical Vasectomy Reversal
A reversal is the only treatment on the list that rebuilds what the vasectomy took apart, taking you back to the way you were before the vasectomy.
The surgeon removes the damaged, scarred segment of the vas deferens, along with the trapped nerve fibers, and reconnects it, restoring the pathway. The pressure behind the blockage is relieved and the system is decompressed. Any sperm granuloma is excised.
Nothing is sacrificed to achieve it. The testicle stays, and so does the epididymis, and so do the nerves. The goal is to return you to the way you were before the pain, and the chance of success is high.
Dr. Marks reviews all eleven options side by side in the third part of his PVPS article series. Which reconnection a man needs, vasovasostomy or vasoepididymostomy, is decided in the operating room. Your body tells us what the right thing to do is.
Results After Reversal
In our experience, 90 to 95 percent of men who undergo a microsurgical vasectomy reversal for post vasectomy pain syndrome have their pain resolve completely or drop dramatically. Published studies from other centers also report meaningful, lasting pain relief and better quality of life after reversal for PVPS (3,10,11,12).
The surgery is done as an outpatient procedure under mild sedation, with no general anesthesia, and takes roughly two to two and a half hours. Men go home, or back to their hotel, the same day. There is more on what to expect and on recovery after a reversal.
Relief is not usually immediate, though some men feel great right away. The surgical site has to heal first, and the pressure that built up over months or years takes time to settle. Nerves that have been inflamed and firing nonstop will often heal slowly. Most men know within a few months whether it has worked.
There is a second outcome that surprises some men. A reversal performed for pain is still a reversal. Fertility usually returns with it, and some men who came to Tucson only to stop hurting have gone on to have children.
We understand that it is not the reason you want to have the surgery. It is worth knowing before you have it, and important to discuss with your wife or partner beforehand.
Doctors Who Dismiss PVPS
Nearly every man who reaches us with post vasectomy pain syndrome has already been told some version of the same thing.
That the scans are clean, so there is nothing there. That the anatomy looks and feels normal, so the pain must be anxiety. That vasectomies are safe and routine, which is true, and therefore this cannot be happening, which does not follow. Some doctors simply say, “I’ve never seen this before.” Some men are quietly treated as though they are seeking medication, or told it is “a psychiatric thing.” But you know the pain is real.
Listen for what a doctor does not say. A physician who has no experience with post vasectomy pain syndrome will rarely tell you that. He will tell you the problem is somewhere else.
The condition is uncommon enough that a general urologist may see it only a handful of times in a career, if at all. That is not a failing on their part. It is a reason to be evaluated by someone who sees it regularly and understands it.
The PVPS Consultation
A PVPS evaluation is not the same as a standard reversal consultation, and we do not schedule it the same way.
It takes longer. The history matters enormously: when the pain started, what makes it worse, what has already been tried, what other doctors have found and ruled out. Bring your records. Bring your wife or partner if she wants to come, and most do. Most importantly, bring your questions.
The purpose is to work out which of the causes is driving your pain, and whether a reversal is the right answer for you. Sometimes it is not, and we will say so. Occasionally we will ask you to give it more time, and there are times when we will recommend conservative options. Surgery should always be the last option, when you have had enough.
Consultations are available in the Tucson office, by video, or by phone. The PVPS consultation carries a fee because of the time it requires, and that fee is applied toward the cost of surgery if you proceed. Full pricing is on our cost of a vasectomy reversal page.
Call (520) 412-5559, or use the button at the foot of this page to request a consultation.
Men Who Came to Us in Pain
Dr. Marks literally saved my life after getting a reversal for post vasectomy pain syndrome in April 2024. It is now two years later and I am back to my normal self after enduring chronic pain resulting from the original vasectomy procedure. He is the most human, down to earth and caring doctor I have ever dealt with. I am forever grateful. The entire staff was top notch. He is one of a handful of urologists in the world that understand PVPS.
Roberto N.
I went in because I’ve been dealing with post vasectomy pain syndrome for years. Still too soon to tell, but I’m confident I’ll have my issues resolved. Great experience overall. Update: pretty much zero pain since the procedure! Update 2: We’re having another baby!
Christopher B.
5/5, white glove service the entire time. I initially went to ICVR and Dr. Marks after experiencing PVPS and also wanting to regain the ability have swimmers. I’ve traveled and lived worldwide and have yet to find a team of medical professionals like them. From their flexibility in scheduling to their bedside manner and constant follow-up, I know I made the right choice.
Amadeus H.
Not quite local for me (I’m from Norway) but I will not go anywhere else. Dr. Sheldon is now my hero and family. Can you imagine working to help people have a baby or help with post vasectomy pain syndrome like me. They either help make a life or save one like me. I am soo lucky that my wife found them online.
Magnus S.
More from the men and families we have cared for is on our testimonials page.
Common Questions
Is post vasectomy pain syndrome permanent?
Not usually. Some men improve on their own over months. Of those who do not, most get significant relief from treatment, and a microsurgical reversal resolves or dramatically reduces the pain in the large majority of the men we treat.
How long after a vasectomy can PVPS start?
Any time. Some men never have a pain-free day after the procedure. Others do well for months or years before the pain begins.
Will a vasectomy reversal for pain also restore my fertility?
Often, yes. A reversal done for pain reconnects the same pathway as a reversal done for fertility. Discuss this with your partner before surgery, because it is a real possibility and not a side note.
How common is PVPS?
It is uncommon. It is also underreported, because a number of men stop raising it once they have been dismissed a few times.
Do I need to have tried everything else first?
No, but conservative care is the sensible place to begin, and most men have already been through it by the time they call us. What we would ask is that you not agree to a procedure that removes tissue permanently before you have talked to someone who does reconstruction.
Can I be seen if I do not live in Arizona?
Yes. Patients come to ICVR from every state in the US and more than 85 countries. Consultations can be done by video or by phone before you travel.
Almost 8,000 vasectomy reversals. Every state in the US. More than 85 countries.
One reversal a day per surgeon, performed start to finish by Dr. Marks or Dr. Burrows. No doctors in training.
We Make Men Dads Again™. Some men come to us for that. Others come because they want the pain to stop, and that is reason enough.
References
- Sinha V, Ramasamy R. Post-vasectomy pain syndrome: diagnosis, management and treatment options. Transl Androl Urol. 2017;6(Suppl 1):S44-S47. PubMed · DOI
- Leslie TA, Illing RO, Cranston DW, Guillebaud J. The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int. 2007;100(6):1330-1333. PubMed · DOI
- Nangia AK, Myles JL, Thomas AJ Jr. Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. J Urol. 2000;164(6):1939-1942. PubMed
- Tan WP, Levine LA. Micro-denervation of the spermatic cord for post-vasectomy pain management. Sex Med Rev. 2018;6(2):328-334. PubMed · DOI
- Moreland H, Snipes M, Tranchina S, et al. Post-vasectomy pain syndrome: prevention and management utilizing current evidence and clinical pearls. Int J Impot Res. Published online October 14, 2025. PubMed · DOI
- Bettencourt A, Naelitz BD, Momtazi-Mar L, et al. Contemporary approaches and treatment perspectives for chronic scrotal content pain: insights from a national practice patterns survey of reproductive urologists. Int J Impot Res. 38(2):86-92. Published online June 4, 2025. PubMed · DOI
- Tan WP, Tsambarlis PN, Levine LA. Microdenervation of the spermatic cord for post-vasectomy pain syndrome. BJU Int. 2018;121(4):667-673. PubMed · DOI
- Chen TF, Ball RY. Epididymectomy for post-vasectomy pain: histological review. Br J Urol. 1991;68(4):407-413. PubMed · DOI
- Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990;143(5):936-939. PubMed · DOI
- Khalafalla K, Arafa M, Elbardisi H, Majzoub A. Non-pharmacological treatments for chronic orchialgia: a systematic review. Arab J Urol. 2021;19(3):401-410. PubMed · DOI
- Smith-Harrison LI, Smith RP. Vasectomy reversal for post-vasectomy pain syndrome. Transl Androl Urol. 2017;6(Suppl 1):S10-S13. PubMed · DOI
- 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(2):613-617. PubMed · DOI