If It Works, Don't Fix It: Forum

Remember, this is not intended as a forum for medical advice, only discussion.

From: MB
Date: 5/25/02
Subject: Tight what-cha-ma-call-it muscles and pain after vasectomy

I’m just looking for some advice if you’re still giving it. On December 4, 2000, I had a vasectomy done, and could actually feel the tubes being cut and knew what the doc was doing, by feeling but did he cut the correct tube? I believe so but I have pain, not terrible pain but soreness in pelvic area deep in and at what feels like the vas tube near the testicle. I have returned to the same doc and he wants me to come back to re-do the vasectomy, this time go under completely because I have an over active what-cha-ma-call-it muscle that keeps testicles up tight half the time. The sperm count after 4 months was very low-(a few). Went to get a second opinion from a doc that didn’t have the time of day to explain what is going on, and then on to a third doctor who I am much happier with. The third Doc explains it like this: all people that have vasectomy have granulomas and I have one. There are 2 things I can do: #1. Wait 6 mos. see if all heals without soreness then re-do the vasectomy. In the mean time if I have soreness I should continue to take Advil 800mg every 8 hrs for two weeks. #2. Operation time- inject the numbing agent give me 3-4 valium to relax that crazy what-cha-ma-call-it muscle, expose the jewels from the sac and re-do vasectomy as well as remove granuloma. He believes that I might have had some bleeding at the time of orig. vasectomy and would like to check it out. All this is not only a pain in my balls but now a pain in my butt. For the 200th time what should I do? What would you do? Jumped off a ladder the other day and I felt something pull, later that night some tube in the scrotum was as hard as a rock for about 8 hrs. What’s up? I am trying to make the correct decision this time. Thank You

Response: I think the what-cha-ma-call-it muscle you’re referring to is the Cremaster muscle, which normally contracts whenever it’s cold, whenever you’re about to ejaculate, whenever your balls are in pain, or whenever you’re within 10 feet of a doctor. It sounds like the last two items are at issue here. Frankly, I understand completely about the pain causing a retracting, muscle guarding response. Everything I have found out so far about healing says that over the long term this is not helpful to the healing process, or to normal testicular function. As far as the prospect of drugs and surgeries goes, remember this: your body has already receive a substantial trauma to the genitals when the original vasectomy was done, and it didn’t do well with that. Re-traumatizing the area with more extensive surgery holds about a 50-50 chance of working at best to resolve pain according to many of the best pain specialists I’ve seen, despite many claims of greater success in the literature by surgeons. In general, try the gentlest approach you can first that will remove whatever aggravating influences exist. Remember, urologists are surgeons, and surgeons are trained to cut and paste to try to get what they are looking for. The old adage of “When all you have is a hammer, everything looks like a nail” applies here. I know I don’t want my balls nailed any more, and I’m sure you don’t either. If another surgery doesn’t work, you get to live with the results, not the doctor. Plus you get to pay the bill regardless. I always start to get nauseous at the idea of “opening up the sack to look around,” having been on the receiving end of this idea several times in the past. This is not a good area for tourists. Take the gentlest approach on yourself first. Consider testosterone therapy and/or anti-inflammatory meds to mitigate the cause of the pain, if in fact it is inflammatory in nature. If the pain you have is a result of nerve and tissue damage from the surgery, as mine is, you may have a more difficult road, in which case, we need to talk more.

From: BM
Date: 4/14/02
Subject: Vasectomy failure

I am 29 years old and I had a vasectomy in October of 2001. My wife and I have decided on this measure because of health risks in both; her being pregnant, and being on the pill. We have 2 perfect daughters and we don't take being fortunate for granted. Last month, my wife miscarried, which would have been our 3rd child. We got pregnant in January of 2002 (yes by MY actions we are sure of). I am also fortunate not to be experiencing any pain or discomfort because of my surgery. I had a sperm test about 3 weeks ago and it came back loaded (which further confirms that I am still capable of fertilization). I met with my surgeon yesterday and he says we have to do it again. He scheduled me in 2 weeks time. My first one took 1 year to schedule. How can it be done again? My tubes were burnt closed. Am I at risk? Rolling the dice again on this table makes me a little nervous after reading some of these forum posts. What are my options? Retest later? Redo later? Get cable TV? Any info or help is greatly appreciated. Thank You

Response: Here are some facts you need to know about vasectomies. Documented failure rates run from zero to six percent depending on whose data you read and how much pride and vested interest they have in the data. Most failures are due to chronic inflammation occurring such as granulomas or vasitis nodosa that can form a channel for the sperm to bridge the cut ends of the vas. This can make you a loaded gun again. It can also make you hurt like crazy in the long run as these cystic inflammatory responses can become very tender and cause pain during ejaculation or even at all times by putting pressure on nerves. That's the good news. The bad news is that these types of inflammatory responses are normally a sign of an autoimmune process that has begun in your body as a result of the vasectomy. This is very difficult to stop (believe me, I've been trying for three years myself), and probably won't stop even after you have a reversal. A second vasectomy may take care of the fertility issue, but in all likelihood the autoimmune response and chronic inflammatory response that has resulted will continue or worsen. You might consider testosterone therapy to get you sperm count down as has been done in various World Health Organization studies and see if this reduces or eliminates the autoimmune and inflammatory responses. In my opinion, this is a far better approach than having your genitals cut on again.

I'd be glad to discuss this further with you over the phone at 805/459-8844 if you like or get you a copy of my book that details issues regarding vasectomy failures, autoimmune responses, etc. Just ask.

From: TG
Date: 4/13/02
Subject: Options after three years of post-vasectomy pain

I would like to thank Kevin for all of his help and providing this website for victims of PVP. In Oct. 99 I had a closed-ended vasectomy. I started developing pain three days after in the testicle area. It started as a tingling sensation which progressed to a feeling of being kicked, and finally, dull pains on both sides of the testicles as well as the bottom area around the scrotum area. I finally got completely well after 11 months. I was pain free for 6 months until one day I was jumping and playing basketball, followed by a leg hamstring work out. A couple of hours later the pain sensation returned. The only diagnosis I have received is scar tissue nerve entrapment. My condition has improved some but with any minor activity the pressure, swelling, and pain sensation returns. My treatment approach has been very conservative, hoping that time will help me heal. Other non-invasive treatment consists of medications, physical therapy, swimming etc. Nothing has worked. Sometimes my pain is severe and i miss work. Other times i just grind it out. My ultrasound indicated some swelling in the right testical region. My blood test was positive for autoimmunity to my on sperm. PVP has changed my life. I have two kids that I can’t play with, I can’t do any house work or yard work. I can no longer work out or golf. I cannot walk or sit for an extended time. Everything I do revolves around PVP. This has not only affected me, but my family as well. I would like to explore some treatment options, but I have not heard of any treatment options that work. It sounds like everything causes more discomfort. I am currently consulting with Dr. Thomas at the Cleveland clinic. He wrote a research article in the Medical Journal of Urology July, 2000 issue. He has performed several reversal surgeries for people with PVP.

Response: Here’s another difficult situation. It sounds like the pain you experience was originally cyclical, and has now become constant. This is a frequent complaint of the men I have communicated with. If you do in fact have nerve entrapments, your options are to try to gently break them up by massaging them from the outside, which is often a big ouch, hoping they will heal over the long run, or have reconstructive surgery and a reversal performed. The latter is risky, painful, and expensive. I know: I’ve been there. The best news is you are seeing Dr. Thomas who has a good success rate in treating post-vasectomy pain patients. I also know what you mean about how this situation affects your family. It is enough to break a guy’s heart, especially when he has had the vasectomy with his family in mind to begin with. My prayers are with you, and please stay in touch.