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Suggest Treatment For Pain In Scrotum Post Vasectomy

Posted on Wed, 17 Dec 2014

Question: Hi, I am 40 days post vasectomy. I am really struggling as I was not expecting to be in pain still. Just a total shock. My symptoms are sensitive and at times sore testicles and moderate to uncomfortable abdominal pain. I also feel at times that if i had stitches they would burst or a pins and needles feeling in the scrotum. I am doing the typical hot baths, Advil, scrotal support. My urologist (actually the PA since he sends the PA in) put me on Bactrim and scheduled me for a U/S on Friday of this week.

I would say it is more discomfort than pain and it varies.....earlier this week I felt like I was getting over it and then the last 36 hours have been pretty uncomfortable (e.g. I decided to wear a jock strap today).

My question is how scared should I be? I know this is not normal but is it possible this nightmare can resolve itself or do I have a very long and painful road ahead? Also what in the world will the U/S tell me?

Again I had no idea this was even remotely possible - of course now friends are telling me how they struggled......

Answered by Dr. Dr. P. T. Patil (2 hours later)

Brief Answer:
Could be due to inflammation of spermatic cord.

Detailed Answer:
Hello
Thanks for your query,based on the facts that you have posted it appears that you have discomfort and pain in scrotum even after forty days following Vasectomy .

This could be mostly due to inflammation of spermatic cord or tissue reaction to the suture material used to ligate Vas Difference.

Please get your Ultrasound Scanning of the scrotum done .This will help to find out the cause of discomfort and pain.

This should get cured with antibiotics and anti inflammatory drugs like Diclofenac .

Hope I have answered your query. Please feel free to write if you have more questions I shall be happy to help you .
Thanks and Regards .
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (9 minutes later)

Dr. XXXXXXX

Thank you. I will get back to you when I get my U/S results. Also if that is the case should I not be working out, having sex or straining myself in anyway? I could not get clear direction on that and do not know if it helps or hurts. I have been working out and wonder if that is smart (does not bother me when I work out right now but maybe that causes cord inflammation?)

Thanks - you have given me hope that there is fixable root cause here. I definitely have swollen Epididymitis on examination (both sides but more on right). I also believe I feel a couple sperm granuloma down there. Not sure if that changes your initial thought.
XXXXXXX

Answered by Dr. Dr. P. T. Patil (12 minutes later)

Brief Answer:
Ultrasound will reveal the cause.

Detailed Answer:
Hello
Thanks for follow up.
There is no possibility of sperm granuloma as both the severed ends of Vas Difference are ligated with suture

In majority of cases it is local tissue reaction to suture materials that causes inflammation .till suture material gets absorbed which normally takes 4-6 weeks for Vicryl.The swelling that you palpate could be fibrosis formed at the site of ligation .

Do not worry this will definitely get cured within 6-8 weeks .till then continue taking antibiotics and anti inflammatory medicines .

There is no harm in having moderate exercise and sex .

Thanks and Regards.
Dr.Patil.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (10 days later)

Dr. XXXXXXX

Hi I am back with an update and question. First I felt the last 10 days I was improving. Even to point where I forgot about this for hours at a time. I also had an u,trashing that was scheduled during my last visit to urologist. Ultrasound was November 15 and I got results Nov 22 which was "normal" (all they told me).

Today (Sunday) I was sore in my testicles and slight abdomen pain. It got more uncomfortable thought day. Most uncomfortable I have been in a couple weeks really.

My question is why I am going up mostly with set backs? Any thoughts? Also with ultrasound normal what do you suggest I do? Just wait it out? I am taking Advil (worried I am taking too much) and Bactria course still has 10 days left.

Appreciate your thoughts.
XXXXXXX

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
It could be due to ild infection of Testicles.

Detailed Answer:
Hello
Thanks for follow up.
Your present problem is not related to Vasectomy and could be due to mild infection of Testicles (Orchitis).

Please take antibiotics and anti inflammatory medicines for a week I think it should get resolved.
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (6 hours later)

Dr. P

Thanks. A few questions:

1) Would Orchitis be causing abdomen discomfort?
2) I am currently on Sulfamethoxazole-TMP DS - assume that is treating any infection?
3) I am very active on weekends with 4 young kids - and notice weekends are worse? is that because I am on my feet all day - should i try to rest more?
4) I read online about "back-up or pressure" and "sperm granuloma" - curious why it is not those things when you say "not related to vasectomy"

Thanks again. My Urologist is has been poor in getting back to me and I am now seeking a replacement Urologist and plan to check in with my GP.

Thx
XXXXXXX

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Read details answers bellow

Detailed Answer:
Hello
Thanks for writing again.I would answer your queries point to point.
1) Yes Orchitis causes abdominal discomfort as testicles have same nerve innervation like kidney Hence one gets abdominal discomfort which is called as referred pain..
2)These drugs are also anti bacterial drugs and help to control infection
3)You should have have adequate rest to keep yourself fit all the time.
4) Your Ultrasound scanning has not revealed any swelling or Sperm Granuloma It could be due to back pressure in Epididymis However the treatment remains the same like to take antibiotics and anti inflammatory drugs
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (38 hours later)

Doc

What is your perspectice on post-vasectomy pain syndrome (pvps). Seems to me to be a diagnosis when no one knows what to say in order to have a diagnosis. I ask as i read a lot on it and frankly it is scary.

I see my urologist friday (finally) so we will what he says after exam etc.

Thanks

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
It is very difficult to prove Sperm Granuloma .

Detailed Answer:
Hello
Thanks for follow up.
Incidence of sperm granuloma after vasectomy is from 3 to 5 percent and there is no test that can give definitive diagnosis about presence of granuloma .

As I have mentioned in my earlier reply the treatment remains the same and most of the time it gets resolved over a period of time .

Please do write if you need my help.
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (16 hours later)

Doc

Thanks. One last question. The abdominal pain is also in the upper abs and very cramping/sore muscle like. I am back to working out and I focus on the core due to back surgeries in the past. Does the referred pain go this high or is it a coincidence?

At times my scrotum feels tingly and almost like IF there were stitches they would burst open.

Weird feelings to be honest I had not head in this nightmare 8+ weeks after surgery.
XXXXXXX

Answered by Dr. Dr. P. T. Patil (41 minutes later)

Brief Answer:
Read Detail answer below.

Detailed Answer:
Hello
Thanks for follow up. Refereed pain due to testicles is always just below the ribs at the upper abdomen where kidneys are located .

Stitches have been by now got absorbed .There areno chances of bursting out the stitches.

Thanks and Regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar