From DF
Date: 11-16-01
Subject: Alternatives to vasectomy for birth control

I really enjoyed my conversation with you by phone yesterday. I am truly sorry that you have been 'part of the experiment,' but am very thankful for the good that is coming of it due to your research efforts and willingness to speak out.  I don't know if you are familiar with Natural Family Planning (NFP). It is a form of birth regulation that is scientific, inexpensive, can be used at the 99% level of effectiveness to postpone or achieve pregnancy and there are NO harmful side effects. Plus, it is completely reversible at any time. When recommending birth regulations on your website, you may want to include this one, as there are no harmful side effects.

I have read scientific articles stating that the condom (which seems like a harmless little device!) can cause early miscarriage due to the fact that the woman's body does not recognize the sperm initially and attacks the newly conceived baby. But, with repeated exposure to the sperm (which you won't get with a condom) her body learns to recognize the sperm as a 'friendly.' So, any form of unnatural birth regulation device is going to have some kind of harmful effect.

The Couple to Couple League has a lot of really good information on all forms of birth regulation and is in the forefront in the Natural Family Planning movement.  Their website is: www.ccli.org

Good luck, God Bless and keep up the good work. 

Response:  Thank you for your feedback and the information.  I hadn’t heard or read any information about negative side effects of condoms, other than failure, of course, but that is interesting information.  I actually included a reference to the Couple to Couple League web site in my book, and discuss natural family planning as an alternative.  It has been my experience both personally and in reading the research on the subject of birth control that surgical sterilization for either men or women causes the most significant long-term reactions in the body, followed by any chemical (hormonal) form, and finally that the use of barriers leads to the least reactions.  This makes me wonder if the type of reaction you speak of would be less prevalent with a diaphragm.  Any input or other references on the subject would be useful since most of the people accessing this site are concerned with contraception to some extent.  My take: Natural Family Planning is a great idea if you let your head do the thinking for you consistently, and not just your desires.
 

From: DK
Date: 11-10-01
Subject: What Happens To a Man After a Vasectomy 

I would like a copy of your article "What happens to a man…."  My husband had a vasectomy 2 years ago after deciding 9 children were enough.  A lot of the side effects you have described he has had.  Thanks

Response: You can get a download of this document at http://dontfixit.org/files/What_Happens_to_a_Man.pdf, or through the homepage itself.  By the way, if you would like direct responses to your emails instead of waiting for the messages to be posted, please give your email address when you post your question or comment.
 

From: DF
Date: 11-07-01
Subject: How to get If It Works, Don’t Fix It book

How can I get a copy of your book?

Response:  Thanks for asking.  Did you ever start off with an idea and then find that some of you basic presumptions were backwards.  I have.  I started this web site assuming that it would be an adjunct to the book.  What I have found is that the web site is getting 3-400 visits per day and the volume of work for the web site has slowed the progress of publishing the book.  I have sent the If It Works Don’t Fix It: What Every Man Should Know Before Having A Vasectomy manuscript to a few editors, most of whom think the market is too small.  I find this hard to believe when this can be an issue for up to half of the population given the equipment discussed, and the other half of the population who is in relationship with us, but everyone is entitled to their opinion.  I have turned my focus now to completing some updates and revisions to the book, and plan to send it to more publishers in the near future.  If that doesn’t work in a reasonable timeframe, I’ll self-publish over the Internet to get it out and available.  In the meantime, if a manuscript copy would be of benefit to anyone needing the information, I’ll be glad to send one, just ask, and make sure I know how to get it to you.
 

From GS
Date: 11-03-01
Subject: Help!

I am a 26-year-old male who had a vasectomy on April 13, 2001.  After the procedure my penis swelled up to the size of a coke can and was black from the base to the head.  My nut sack hung to my inner thighs, and my butt cheeks were bruised.  My wife called the doctor the next day and told him what I looked like it told me that was normal and that I needed to go back to work on Monday.  I did what the doctor told me and my work sent me home because I could not stand and I was in so much pain.  I called the doctor again and he said that it was normal.  After a few weeks I went and seen a urologist against the wishes of the doctor (my Primary Care Physician who performed the vasectomy) and the urologist did exploratory surgery on me.  He laid my sack wide open he removed a water sack and a bunch of other stuff.  He treated me for about 3 months giving me every thing from Loretabs, to Perkiset.  He then told me it was time for me to go back to work, and that the moving around would get rid of the pain so I did what he said and I was in so much pain that my work sent me home again.  Both of the doctors I had seen up until this point were affiliated with the Baptist Health.  My wife told me she wanted me to go see a doctor that was not affiliated with the Baptist Health System, and my made me an appointment with a different urologist when I went to this doctor he told me immediately that I had permanent nerve damage.  He knew this from the ultrasound that the last urologist took just the week before. The first urologist had told me that nothing was wrong, and the second urologist came up with the conclusion that I had permanent nerve damage, and said there was nothing that he could do and sent me to a pain management doctor.  The pain magnet doctor has given me 3 spinal injections and a trial spinal cord stimulator put in me.  Next, week a neurosurgeon will be putting a permanent spinal cord stimulator in my back from the #10 to the #2 lumbar.  I will have to carry a little pager like thing that will give me electric shocks.  If I don't do this then they will burn the nerve out and I will loose all control of being able to use the bathroom, and have sex.  I am currently taking Neurontin, and Oxycontin (this drug is all over the news because of how highly addictive it is also it is used for terminal ill cancer patients) and these drugs have helped to make me be able to walk, not upright, but walk.  I have a 7-month-old son that lives with me, and a 4-year-old stepson with whom I am not able to play.  My wife and I got married in July and I was sick.  Do you have any idea what I am going through?  I feel like I am the only person in this whole world who feels like this.  I would love to be able to talk with someone else who has some idea of the pain that I feel both physically and mentally.  There is much more to this story but I was just trying to give you the small version of it.

Response:  First off, you are definitely not alone, as the testimonies of so many men writing to this forum will demonstrate.  The kind of pain, procedures, drugs, and frustration you have described are far too common.  My message to you is this.  Keep working on finding the best way to cure the cause of the nerve pain you are experiencing, not just to cover it up.  Painkillers and spinal cord stimulators are OK if you can be functional with them, but they don’t deal with the cause of the pain, they just mask the symptoms in various ways.  I’m well acquainted with this dilemma since I deal with it daily.  The two doctors that I know of who offer the most promise in this regard are Dr. Connie Haber in Pittsburgh (412/372-7900) who specializes in “photon therapy” that has been shown to be quite effective in helping to heal damaged nerves in a non-invasive manner.  Also consider talking to Dr. Lawrence Levine in Chicago (312/563-5000) who has written the most comprehensive information I have found on this type of nerve damage and the surgical treatment for it, that is if you are willing to consider more surgery.

From:  JP
Date:  10-24-01
Subject:  Pain and depression for four years after vasectomy 

Dear Kevin, firstly, thank you for providing such a site for us men out there with problems that seemingly no modern doctor can fix. It is comforting to know that unfortunately I am not alone in the development of adverse symptoms after having a vasectomy. Can you please consider the following information?

Age 31
Vasectomy 4 years ago and subsequent reversal 1 year later due to the following symptoms;
Pain in left testicle and pelvic region
Reduced ejaculate and shooting power (this is the biggest problem!!)
Recently white blood cells found in prostatic fluid (DIFFICULT IN GETTING SPECIMEN)
Recently, frequent urination but no blood or pain
SEVERE DEPRESSION 

I have seen numerous doctors and natural healers, over the past 4 years and none can identify my symptoms- it is in your head?? Well, I was fine before the vasectomy operation so what has happened??  I seem to have...? Symptoms of an infection of some type.  Can an operation cause an infection of the prostate or vas deferens for that matter and can an infection last for 4 years? Can this infection reduce the volume and shooting power of ejaculate?  Are there others out there with similar problems? Can you shed some light on this matter for me and suggest possible treatments?  

Thank you for listening.  Maybe others have found some cure.

Response: (From Dr. Lou Zaninovich) Jeff:  Yes, you are more likely to get an infection after vasectomy, more so than after other types of operations.  I would have thought, though, it would have been evident even before the reversal. 

Your present symptoms of frequency + white cells in the prostatic fluid does suggest infection.  Depends on how many white cells. Was the fluid cultured for bacteria? Cultures should be done aerobically and anaerobically (anaerobic bugs are bugs that only grow where there is no oxygen so you may not pick them up on normal cultures). 

Usually infection in the prostate causes pain at the tip of the penis and when it is examined with a finger it is quite tender.  Infection of course could be higher up in the seminal vesicles or in the epididymis: are you tender on top of the testicles? 

Yes, infection could affect your ejaculation mechanisms.  Yes, prostate infections are notorious for being chronic and can persist often intermittently for years.  Yes, other guys do have problems; Kevin can vouch for that. 

The depression could also be related.  One of the common symptoms of low testosterone levels is depression.  There have been cases where the damaged testicle, post vasectomy has been found to produce less testosterone.  Have you had your total testosterone and free androgen index tested?  Even if these are normal unless they are high normal it is worth a trial of Testosterone Therapy in case it is causing the depression. 

Depression of course can also be due to other causes.  If there is a family history of depression then better treatment would be anti depressants such as Prozac (SSRI type drugs). 

Please note I am only thinking aloud and you can only accept medical advice by a Doctor who has obtained a full medical history, full examination and blood tests but it is something to go on. 

Let me know how you go. 

Regards,
Dr. LOU
 

From: PM
Date: 10/16/01
Subject: Still in Pain 

I've posted here before. I am 45, had a vasectomy just over 4 years ago by a general doctor. After a year of pain, I followed my urologist's advice and had an epididymectomy. The pain after that was worse than before. Sometimes there is no pain, more often there is mild to strong there pain, and sometimes the pain is strong enough that it severely impacts me and I take Vicodine. Depending on the month, I take anywhere from 6 to 20 Vicodine. I start with one, but it usually takes two to kill the pain now. Recently I went to a pain specialist. First he tried me on Clonidine, a high blood pressure medicine. It did nothing for the pain and I could not sleep while taking it. I averaged 3 hours per night waking every 20 to 40 minutes. Next he tried Zonegran, a medication for epilepsy. I had slurred speech, and it did nothing for the pain. Next was a nerve block using Femoral. The two days after, I had no pain most of the day, but when I did have pain, it was very intense, more than usual. The following week I had more pain than usual. He now wants to try Phenol 6% solution. This strips the outer layers of the nerve, supposedly stopping the pain sensation going to the brain. He said it may take 1 to 3 times to work but I'm a good candidate for this. Obviously, I don't want to do this because I haven't had good luck in the past. I'm trying Quercetin 500mg twice a day. Once in the morning and one at night. Doesn't seem to be helping. How much did you take when you used it? After the Quercetin is gone, I'm going to try the Wobenzym. It says to take 3 pills twice a day. Did that amount seem to work for you or did you take a different dose? If that does not seem to help, the next step is to see another doctor down towards L.A. or up to S.F. Who would you recommend seeing first? 

Response: In regards to your questions, since your pain comes and goes, I would normally investigate a reversal first, since most of the guys who I've talked to that have had success with reversal had that type of cyclical pain.  The epididymectomy you had makes this impossible though, which is why I cringe every time I hear of a guy going down this type of path of no return.  You cant put parts back in once they’re out, and many surgeons don’t consider this. 

Treating what must be injured nerves is a likely path to pursue.  I can make several recommendations in this regard: Dr. Steve Mangar (831/751-3334) is a pain specialist now in Salinas who has been quite helpful to me.  Dr. Robert Kessler at Stanford Urology (650/725-5546) was quite helpful to me in confirming the neuropathy diagnosis.  I will be seeing Dr. Lawrence Levine in Chicago (312/563-5000) soon to discuss the possibility of eventual nerve stripping of my spermatic cords, since he is arguably the most expert doctor on the subject.  Prior to pursuing any further surgery, however, I will be seeing a Dr. Connie Haber in Pittsburgh (412/372-7900) for a course of “Photon Therapy” which is reputed to be a very effective treatment for chronic nerve pain. 

If it were me though, before contemplating any surgery I would try six months or so of hormone therapy first if your system can tolerate it to see if lowering your sperm production helps to mitigate the symptoms, before cutting you open in any way and potentially starting another inflamed episode of autoimmune response.  Take my word, that kind of reaction is not fun and can immobilize you for months.  I know, I've lived it, and I’m sure you can relate.  Dr Werthman (310/277-2873) has been very helpful with me in regards to the hormone therapy, and has a good handle on the combinations of initial anti-androgen, plus Androgel or other testosterone therapy to follow on a regular basis.  Philip Werthman is also the best man I know to see about a reversal, even though that is not applicable in your case. 

My experience with the nerve blocks is that they may have good diagnostic value, but have had no lasting effect beyond several hours and, in fact, tend to aggravate the already traumatized nerves for at least several days afterwards.  Pain medications may make life more bearable, but they only cover symptoms and don't promote healing.  You have to consider the dependency and addictive properties of whatever you are taking, too.  In the words of my dentist when I told him about what medications I had to take regularly, "They're all selective poisons," which is why you can't eat them like food.  Quercetin has had good results in treating prostatitis in the studies I have read, but as for post-vasectomy pain syndrome, neither the literature nor my personal experience has given any indication of long-term benefit.  However, as an anti-inflammatory, Quercetin and Wobenzym are as good as you can get for natural substances that can be easier on your system than other medications.
 

From: JP
Date: 8/13/01
Subject: Considering a vasectomy 

I have read several months' worth of posts and have searched the Web fairly extensively, so I have a firm grasp on the issues: if I have a vasectomy, open-ended or otherwise, there is a high likelihood that I will develop an autoimmune response as the sperm enter my bloodstream. Various side effects can occur as a result of the antibodies my immune system throws at these perceived "invaders", right?

As I consider my upcoming appointment for my vasectomy, what I really want to know is - what are the numbers? In what percent of patients do problems develop, how many years in the future, etc.? Without these data, stories like yours and the others on this site, while certainly regrettable, really are merely anecdotal, in that they cannot be compared to the "larger picture" of the whole set of patients undergoing this operation. It's like the warnings on medications - some percent of women taking birth control pills experience major side effects...but most take them with little or no problems arising. So rather than considering only the real-but-minimally-likely risks, I believe a fully informed consumer must also consider the probability of harmful side effects.

I agree with you that the medical industry tends to minimize the harmful potentials of most (if not all) of the procedures and drugs they sell to the public, and then they tend to deny culpability when their almost-mystical beliefs in the dogma to which they blindly adhere prove to be erroneous. I trust doctors about as much as I do politicians.  What I do put my trust in is the methodology doctors claim to follow – science.  Maybe vasectomies cause severe problems often enough that they should be discontinued completely, as with so many procedures lauded by doctors throughout recent history as “scientifically proven”, like circumcision, lobotomy, or the gender-reassignments at Johns-Hopkins.  And certainly I agree that a procedure should be proven to be safe before it is allowed to be performed indiscriminately, and yet the opposite often occurs.  However, since vasectomy is obviously performed on a vast scale, surely somewhere numbers of reported complications have been assembled?

I don’t want to appear dismissive of your plight, or of the difficulties many others have experienced; I just want to know my own odds of experiencing those same risks as I consider undergoing this procedure.  Thanks for caring enough to have provided a thought-provoking and informative Website. 

Response: I appreciate your well thought out questions and the concerns you have about what is "real" in this situation.  It has taken two years of research for me to determine how a man in perfect health, such as myself and many of the others who have written to this web site, could go in for a "simple" vasectomy and end up as a chronic pain patient.  Rather than telling stories, though, let me quote the figures from the medical research on the subject.  If you would like assistance in obtaining any of these journal articles for your further reference, just let me know: 

• Urologists know that pain is men’s top concern in considering a vasectomy (ABC News, 2001), yet men have consistently “experienced more pain and discomfort during and after the procedure than they had been led to expect by the operating surgeon” (Campbell’s Urology- 6th edition; also Li et al, 1991).  This was certainly the case in my procedure(s).
• Urologists know that pressure build up and congestion in the epididymis following a vasectomy will almost certainly lead to “blowouts” in the epididymis and or vas (Campbell’s Urology- 6th edition; also Shapiro et al, 1979).  Knowing this alone would have been enough to cause me to reconsider the procedure.
• Urologists know that 75% or more of men will develop autoimmunity to their own retained sperm cells following vasectomy (Campbell’s Urology, 6th edition; numerous other articles quote autoimmune reactions occurring in as high as 84% of vasectomy patients). Doctors will often dismiss this as no big deal saying that this reaction is "harmless," but then again it's our bodies the reaction is happening in, not the doctor's, isn't it?  This autoimmune reaction can be life-long, and there is no proven way to stop it, short of removal of the testicles, which may be offered to you repeatedly if you start having problems.
• Research has shown that the likelihood of developing an autoimmune reaction can be predicted by a pre-vasectomy sperm count test (Linnet et al, 1977).  So, the more fertile you are, the more likely you are to have a reaction.  What can't be predicted though is exactly how you body will respond.  A good deal of research has been done by Dr Kenneth Tung and others regarding vasectomy creating a condition known as autoimmune orchitis, which is a degenerative disease of the testicles.
• It is commonly quoted in the medical literature that up to 1/3 of men have experienced some degree of chronic testicular discomfort following their vasectomy (Choe et al, 1996; also McMahon et al, 1992), some estimates go as high as 70% (Levine et al, 2001).  Choe et al, 1996 also found chronic testicular pain to be the “most common post-vasectomy complication that may adversely affect quality of life in men undergoing vasectomy,” and “the high litigation potential of this procedure warrants thorough counseling of factors that may affect quality of life.”  Similar warnings are found repeatedly elsewhere in the literature.  No such discussion ever took place in my case, despite the fact that “Pain syndromes, in general, frustrate all physicians” (my original urologist, New Times, 2/8/01), not to mention the frustration the pain causes the patients.  Chronic testicular pain following vasectomy can start days, months, or even many years after the procedure.
• No standard protocols exist for either the treatment or diagnosis of post-vasectomy pain syndrome, and physician knowledge of this condition, even among urologists, is surely lacking in many cases.  Beyond this, it is not a subject that urologists like to discuss openly, often due to the liabilities involved.
• Chronic inflammatory responses are to be expected following vasectomy.  Sperm granuloma form in up to 97% of vasectomy patients (Shapiro et al 1979).  Vasitis nodosa has been found in 66% or more of vasectomy patients (Taxy et al, 1981) and has been shown to contain various qualities of benign tumors.  Painful traumatic neuromas have also been found in cases where vasitis nodosa was present following vasectomy.
• Hormone and sperm production are affected by vasectomy (Carruthers, 1996), despite the numerous claims you will hear to the contrary.
• Nerves are commonly cut during vasectomy (Pabst et al, 1979), and there can be damage to blood and lymph vessels (Carruthers, 1996).  The facts and ramifications of this were surely not made clear to me, and this has been the major source of neuropathic pain I have experienced.
• Vasectomy has commonly led to behavioral and psychological changes in 1/3 or more of men undergoing the procedure (Vaughn, 1979).
• Vasectomy has been repeatedly linked to increased incidences of numerous serious diseases, including prostate cancer.  The controversy surrounding the prostate cancer issue continues, but when Bernal-Delgado et al (1996) reviewed 14 studies on the link between vasectomy and prostate cancer, 11 of those studies found a link to increased incidence due to the procedure.  Despite this, you will find numerous protestations within the urology industry that there are no proven links. You'll have to look at the evidence for yourself on this one and make up your mind.
• Failure to disclose these and other facts regarding vasectomy, both verbally and in writing, is a common source of litigation following the procedure when complications set in (Preston, 2000).

Does that give you enough to go on?  There is a lot more, and if you would like a copy of my book, If It Works, Don't Fix It: What Every Man Should Know Before Having A Vasectomy, I'd be glad to offer you a copy if you want to delve deeper.  I hope this information helps you in your decision process.  If you do decide to go ahead, let me know what the results are.
 

From: LE
Date: 8/8/01
Subject: Treatment options 

I have looked over your web site with great interest. I wish I had known this information 10 years ago before I got my vasectomy. I saw a couple of mentions to a form of self-testicular massage to alleviate pain, but I didn't find a description of it. Could you point me to a description? Also, could you point me to more information about the "testosterone treatment" that is mentioned a few times. 

Response: The information on testicular massage is available in the article on post-vasectomy treatment options.  You'll find the link near the bottom of the www.dontfixit.org home page.  The descriptions are accompanied by diagrams that are sure to make you wince if you are in pain, but the idea of this still beats surgery. 

The testosterone treatment I pursued has been the use of 7.5gm of Androgel daily to get my sperm count down to zero and ease the aggravation that sperm production causes on the immune system and the tissues that get attacked subsequently.  This has actually been quite successful so far, and I would be happy to discuss the idea further.  You'll probably want to consult an endocrinologist about this in conjunction with whatever urologist you can talk into the idea if you want to pursue it.  I can give you several names if you need.
 

From: LJ
Date: 8/07/01
Subject: Two years of pain after vasectomy 

After much cajoling, my husband had this procedure 2 years ago.  He used to say, "My soul shrinks at the thought of a vasectomy."  I wish I had listened.  He has been in constant pain for 2 years, although, sometimes much more severe than others.  This pain has caused him to feel "emasculated."  It has ruined a great sex life, and has ruined our 17-year marriage.  No one we've spoken to (urologists) have patients that have successfully been treated.  We have no idea how to proceed and find someone who can help us.  We live in Atlanta and are desperate for some help.  My husband seems to think reversal is the answer, but the urologist says no; he doesn't think that is going to make any difference.  Any advice would be very appreciated. 

Response: You will get mixed opinions about surgery to mitigate post-vasectomy pain syndrome.  Many pain specialists I have consulted with say that more surgery to correct the damage that was caused by a prior surgery is a highly questionable course of action, and that it is just as easy to end up in more pain as to relieve it.  Their premise is that once a body is traumatized in a particular area, re-traumatizing the same area is not good.  My experience with the reversal I had done would back this up since I became fertile again, but in enough pain to where it really didn't matter, if you understand my meaning. 

Many urologists will propose various surgical solutions, since that is what they are trained to do, some better than others.  Of the men that I have had contact with, those with delayed onset of pain, weeks, months or years after their vasectomy, seemed to respond best to reversal of their vasectomy to relieve the pressure build up and ruptures that resulted.  Many have had to have the more involved version of a reversal, called a vasoepididymostomy, because the rupturing was extensive enough to need to be bypassed in reattaching of the vas. 

The other popular surgical solution proposed by many urologists is surgical denervation (nerve-stripping) of the spermatic cords.  Be forewarned though, more than just the nerves are removed, including the vas, lymph vessels, cremaster muscle, veins, and any other connective tissues.  This has a claimed high success rate for men with nerve damage pain from their vasectomies that started immediately after the procedure, such as I have experienced, but it is a path of no return, since once the parts are gone, they're gone whether it fixes the problem or not. 

In regards to who to contact for more information, Dr. Mike Witt in Atlanta has been recommended by one of the men contacting me.  Dr. Philip Werthman in Los Angeles (310/277-2873) would be a good contact about the prospect of a reversal. Dr. Laurence Levine in Chicago would be a good contact about the prospect of surgical denervation.  Dr. Levine has also authored several medical journal articles on the subject, which I would be glad to share with you in addition to articles on the subject of reversals for relief of pain.
 

From: DC
Date: 8/1/01
Subject: Running out of options to cure pain. 

I had a vasectomy in the UK in Nov 1999, and have had chronic pain in my right testicle ever since. I was not told about the possible pain side effects of this operation. I was told that there was no link between a vasectomy and prostate cancer.  Within days suffered from an infection, then later had a granuloma removed. One year later I had my epididymis removed and have recently had a nerve block. None of these procedures have relieved the pain.

I have positively refused any more surgery. It was suggested I have the testicle removed! My research on the net and my pain specialist have changed my mind.

I am now following alternative paths. Can anyone make any suggestions? I read somewhere reflexology or acupuncture may benefit?

If I can be of any help to anyone, please pass on my e-mail address. 

Response: The article on post-vasectomy treatment options is available on the home page of the web site for your reference.  You have already been through many of the surgical options that are listed, and I don't blame you for not wanting to undergo any more procedures. 

In the article on post-vasectomy treatment options, you will find a list of several alternative therapies including yoga, massage, and an acupuncture protocol that may be beneficial.  Here's wishing you the best of luck in treating your condition.