Response: Your question regarding vasectomy leading to erectile dysfunction has been asked quite a bit lately by several men, so it deserves a complete response.  There are several medical journal articles you may want to refer to:  Buchholz et al (1994), Post-vasectomy erectile dysfunction, Journal of Psychosomatic Research, 38: 7, p759-762 discusses the phenomenon.  A good discussion of erectile dysfunction in general can be found in Benet et al, The epidemiology of erectile dysfunction, Urology Clinics of North America, 22:4, p699-706, November, 1995 where the authors discuss several possible causes including surgical trauma, hormonal changes, aging, medications, etc., and also discusses the larger issue of impotence including ejaculatory dysfunction, libido changes, and orgasmic changes.

If you want copies of any of these articles and can't get them locally, let me know and I can get copies for you. 

You may find a more reader-friendly text in Dr. Malcolm Carruthers' book Maximising Manhood, Beating the Male Menopause (Harper Collins, London 1997).  In his book, Dr. Carruthers discusses the autoimmune response that commonly occurs following vasectomy and how these antibodies start attacking testicular tissues, including the cells that produce testosterone.  As testosterone levels fall, erectile function often results.  Dr Carruthers states that a disproportionate number of his patients who have seen him for erectile dysfunction concerns had vasectomies as part of their medical history.  A complete hormone profile is recommended including a "free androgen index" test.  He advocates various forms of testosterone therapy to combat this problem. 

You may want to correspond with Dr Lou Zaninovich (lzanin@cyllene.uwa.edu.au) who runs a male health clinic in Australia and has offered to advise men writing to this web site.  I am also attaching an article I wrote titled "What Happens to a Man After Vasectomy" that discusses some of the responses that can and do occur, which will hopefully add to your understanding.
 

From: MS
Date: 6/12/01
Subject: Erectile dysfunction immediately following vasectomy

I am a very healthy 37 yr old male and I had a vasectomy 6 weeks ago.  Everything is healed and I feel fine other than I cannot get an erection.  I am positive that I'm not mentally protecting the area or that it’s psychological and my penis is smaller and softer and it DOES feel somewhat desensitized.  The Urologist told me I was fine and just needed a "jumpstart" and gave me Viagra, which did not do anything after attempted stimulation.  Could there be something in that area that because of the trauma/procedure some nerves may have been slightly/temporarily damaged or scar tissue restricting normal blood flow?  HELP!  Thanx!

Response: First, I empathize with your dilemma.  I've heard of many similar accounts from doctors and patients in the research I've done, just usually not as soon after the procedure.  What you have described sounds a lot like the symptoms of testosterone deficiency described by Dr. Malcolm Carruthers.  He recommends a test called a Free Androgen Index to assess blood levels of hormones and how the body is metabolizing them.  This may be worth pursuing. 

Other approaches you may consider include several supplements recommended to me by numerous sources: zinc is purported to be good in general for male genital health, as are various types of ginseng.  There is a form of testicular massage you might try in attempting to improve blood flow, hormone production, and disperse dead sperm cells.  It might not be a bad idea to have a testicular ultrasound done to track the atrophy you describe.  This would also help doctors to assess the possibility of structural damage, inflammatory responses, etc.  

Above all, though, I would recommend being as patient as you can with yourself.  I know that this situation can be tremendously stressful, and will challenge every self-concept you have about your masculinity.  I hope you experience a speedy recovery.
 

From: Dr. “Z”
Date: 5/16/01
Subject: A doctor’s concerns about vasectomy

My name is Dr. Lou Zaninovich.  After 30 years as a busy General Practitioner, I moved 4 yrs ago to specializing in Men's Health Problems.  My particular interest is "Male Menopause" and Testosterone replacement
therapy.

I soon noted, as have other docs such as Dr Carruthers and Dr Diamond, that I had a disproportionate number of problems in men who have had their vasectomy done many years ago.

I then started researching the post vasectomy problems, and like you found many reports on problems. I myself have also written a book including numerous references, which I completed a few weeks ago.  So far I have been agonizing over whether to publish it or not because of the predictable "flack " I will get.  There are certainly a lot of reports and recommendations from very erudite circles recommending vasectomy as a very safe procedure.

I have read all these also.  I hear all the many guys who think it is wonderful and without problems.  Yet, I wouldn't have it done to myself and certainly have advised my sons and any of my patients not to have it done.

One does not have to be a "rocket scientist" to realize that there is a huge difference between tying off a female tube where the ovary produces ONE EGG a month, to tying off the Vas where the Testicle produces and keeps on producing up to TWO HUNDRED MILLION SPERM EVERY DAY!  Yes, of course there is backpressure, and ruptures, and leakage and testicular atrophy etc.

I give you permission to post my message.  I agree with you that guys should know more.

What I hope to do is collate as many personal negative experiences as possible.  I would like to hear from every guy out there who has had problems.  I still wonder how big the problem is. Such data would be good ammunition for me against all the doubters.

I saw a 63 yr old patient the other day.  I went through my routine questions, which include: "Have you ever had an operation?"  His answer was no.   I then ask the specific question: "Have you had a Vasectomy?"  His answer: "Oh Yes, twenty five years ago." "Did you have any problems with it?" "No, none whatsoever."

I then find out he has symptoms associated with low testosterone levels and has a past history 5 years ago of "swollen testicles/epididymitis or something like that".

He saw a urologist and it settled with treatment.  Neither he nor the urologist would report this as a post vasectomy problem.  My bet is the urologist didn't even ask about vasectomy because doctors in general don't consider it relevant.  Maybe it was coincidence but I don't believe so.

 Dr. Lou Zaninovich
16 Ventnor Ave
West Perth
Western Australia
Australia, 6005

Email: doctor@medicine4men.com

Response: Thank God for doctors who are willing to see and speak the truth.
 

From: DB
Date: 5/16/01
Subject: Vasectomy pending

I'm scheduled for a vasectomy on 5/25/01, and frankly, I'm just a little scared...after reading through some of these forum comments.  Since there is not a guarantee that I, too, could have complications, I would be unwise to go ahead with it.  My fiance is pushing me to go for a vasectomy as she feels the risks are highly unlikely.  Quite honestly up until now I have only heard positive things from men (no regrets) who have had the vasectomy procedure.  For the first time last week I was introduced to the topic of "post vasectomy pain syndrome," as a local T.V. station [KCBS, Los Angeles] ran a story on it.  The story featured a former professional dirt bike racer who recently went through a reversal procedure to alleviate years of suffering and pain.  I would welcome additional feedback from you as I wrestle with my decision on whether to get "cut" next Friday.  I have reread the CBS News story [ www.channel2000.com, see special assignment] on the risks of vasectomy, and it's stated that these risks are "very rare."  How would you define rare?  Because doesn’t it boil down to me hoping to beat the odds if I go ahead and have my vasectomy on 5/25/01?? Thank you for this forum.

Response: If you had time to read all the literature on the subject prior to your vasectomy, as I wish I had, you would find the following:  You are virtually guaranteed that by sealing off the vas, you will experience congestion and ruptures in your epididymis sooner or later.  In more than three out of four men this leads to an autoimmune response wherein your body starts an antibody war on it’s own cells that will not stop as long as you are producing sperm cells, which is likely to be a long time.  The more fertile you are, the more likely you are to have a significant antibody response.  There is no way to predict how your body will react to the production of these antibodies in the long run, but there are plently of dire possibilities.  The autoimmune response leads to chronic inflammation conditions in the scrotums of more than two out of three men resulting in conditions such as sperm granulomas and vasitis nodosa.  Nerve damage and lymph vessel damage can occur during the procedure, as can blood supply damage that can cause eventual testicular atrophy and removal of the testicle(s).  Want more?  Surveys have shown up to one third of vasectomy patients have experienced some sort of chronic testicular pain as a result of their procedures.  My sense is that most of this pain is at he nuisance level, and the more severe cases such as mine and the other men who have written to the forum are a smaller percentage, but even a little of this type of pain stinks.  Doctors often use that them “rare” in reference to complications without defining what that means.  So the real question in response to yours is do you care about these kinds of reactions occurring in your body, and how lucky do you feel?  Knowing what you know now, what do you think?  By the way, I wouldn’t advocate your fiancé having a tubal ligation done either.  If you check out www.tubal.org you may find some good reasons why she should stay away from this procedure also.  My opinion is that reproductive functions are some of the most basic that our bodies perform, and bodies don’t adapt well to having the natural flows we have shut off.  Plenty of research and experiences back up this opinion.  Get creative with your sexual practice and proficient with your use of barrier forms of contraception.
 

The following correspondence was subsequently received from DB:

 My heart truly goes out to you for all the suffering you've had to deal with as a result of your vasectomy; but because of your story and the story that other men are sharing on your website, I've decided not to proceed with my vasectomy.  By the grace of God, I saw the KCBS news story on the "Risks of Vasectomy" which prompted me to do a search on the computer for additional information on post vasectomy pain syndrome.  This led me to your site, dontfixit.org just days prior to my scheduled May 25th vasectomy.  After reading the New Times article and all the input from your forum, I just knew I didn't want to go through the ordeal.  I had my fiance read everything including your personal email to me {with attachment: What Happens to a Man...}, and she wholeheartedly is on my side, even though she was the one that encouraged me originally to seek a vasectomy.  Thank you from the bottom of my heart for sparing me from what might have been!  Again, I am very sorry for the pain you and many other men have had to endure, but please know that your work and suffering have not gone for naught.  May God Bless YOU in all things.    Sincere Thanks, DB

Response: My thanks and blessings go out to you too.  I'm glad you were able to find out what you needed to before having the procedure, and not the hard way after.  There are some sites that address natural forms of birth control.  If you and your fiancé are interested, I can get the addresses to you.  Best wishes to you both for good health and a loving marriage.
 

From: PM
Date: 5/15/01
Subject: Pain worsens after epididymectomy

I had a vasectomy four and a half years ago and was in constant pain.  The end of the vas on my left testicle and epididymis were always swollen and was in pain.  After a year of different options, my urologist removed the epididymis.  He told me it would help.  I wish I never had that done.  The pain has gotten worse.  Do you know of any options?  I take 20-30 Vicodin a month.  Usually the intense pain hits and is there for a few days and then goes back [down].  I am very rarely totally pain free.

Response: Ouch!  It amazes me that doctors so often want to do more irreversible surgery when surgery failed in the first place.  Epididymectomy was suggested to me by several doctors, then I had one doctor who has been honest with me all along tell me that this procedure often damages the nerve and blood supply to the testicle and can result in long-term testicular atrophy and eventual removal of the testicle.  I have a friend who is facing just such a dilemma.  The bottom line is that bodies that have been traumatized by a surgery gone awry on a delicate organ like a testicle often don’t get better when traumatized by another surgery.  Dr. Malcolm Carruthers makes this point repeatedly in his publications.  The testicular massage I have mentioned can help break up blockages of sperm cells and increase blood flow, both of which are good ideas.  If your pain started right at surgery, you may be experiencing pain as a result of nerve damage, which further surgery is unlikely to resolve, as you have noted.  I would suggest contacting Dr. Steve Mangar at the Stanford Hospital Pain Clinic at 650/723-6238.  He has been extremely helpful to me in assessing and treating the nerve damage related pain I have experienced.  This is not easy though, as you might expect.  The cyclical pain response you mentioned has been observed by numerous patients and doctors as being part of an autoimmune reaction to continued sperm production, which will continue even though your epididymis has been removed.  Personally, I have had good success in mitigating this response with testosterone therapy to shut down my sperm production without removing the testicles altogether.  I’m sure you can understand my motivation.  If you want to pursue the possibility of testosterone therapy, contact Dr. Philip Werthman at 310/277-2873.
 

From: DT
Date: 5/14/01
Subject: Faulty sewing

My friend (Joe) had an in-office vasectomy (scalpel w/ stitches) in December by a general M.D.   He has had pain ever since and is convinced that the doctor sewed his tube (when closing the end of the tubes) to his scrotum.    He remained in bed for the first week and couldn’t return to work until 10 days post.    He has a pulling sensation whenever he does any activity, which he describes as stretching and pain of his right testicle.     He further describes that the tube, where it was sewn to his scrotum, is visible on the front side of his right testicle.      He returned to Dr. that performed surgery 6 days afterwards complaining of intense pain, and again returned w/ concerns and complaints two months later, and from what we can make from the doctor’s notes, it states:  “In w/ discomfort right testicle – could have prox. [likely this means proximal] vas attached to foscia adhered to undergenvice ??? [I have no idea what this might be] of skin”     Dr. told him if problem continued in two months to return and they’d consider another surgery!    Joe has no intentions of returning to this M.D. and went to a urologist, who could render no opinion and also said if problem continued, to return for another surgery.  

Have you ever heard of the tube accidentally being sewn to scrotum when closing off end of tube?     Thanks for your help.

Response:  Many problems have occurred from faulty stitching following vasectomies.  Blood vessels have been closed off and ruptured, nerves and lymph vessels damaged, etc.  I’ve heard from several men who had constant pain in the area of the staples and/or stitches used by the doctor.  Try to get an ultrasound done before any further surgery takes place.  Since so much chronic inflammation takes place after vasectomy, there could quite possibly be granulomas, vasitis nodosa or other conditions to treat instead of or in addition to the stitching issue.  Let me know what area of the country you are in and I’ll try to get a recommendation for you of a urologist who may be of more help.