Post-vasectomy pain syndrome (PVPS) is a condition that can occur after a vasectomy, a surgical procedure to prevent the release of sperm during ejaculation. PVPS is characterized by chronic pain and discomfort in the scrotum and/or testicles that persists for at least three months after the procedure.

The exact cause of PVPS is not known, but it is thought to be related to the inflammation of the vas deferens or epididymis, which can occur after a vasectomy. Other possible causes include nerve damage, sperm granuloma (a lump that can form at the site of the vasectomy), and psychological factors.

The symptoms of PVPS can vary but may include chronic pain, discomfort, or tenderness in the scrotum, testicles, or penis, as well as pain during intercourse or ejaculation. Some men may also experience swelling, lump, or sensitivity in the affected area.

Diagnosis of PVPS is typically based on a physical exam and medical history and may include tests to rule out other possible causes of pain, such as infection or injury.

Treatment for PVPS may involve pain management techniques such as medication, nerve blocks, or physical therapy. In some cases, additional surgery or reversal of the vasectomy may be necessary to relieve symptoms. In addition, psychological counseling or support groups may also be beneficial for men experiencing PVPS.

It is important to seek medical attention if you experience persistent pain or discomfort in the scrotum or testicles after a vasectomy, as early diagnosis and treatment can help prevent long-term complications and improve quality of life.

The causes of PVPS are not well understood. They may include:

• Infection. Inflammation can damage the scrotum, epididymis or other structures along the cord that carries blood vessels and nerves to the testicle (spermatic cord).
• Nerve compression. A narrowing of nerves to the testicle may cause symptoms of PVPS.
• Back pressure. Sperm that are unable to travel through the tube that carries sperm from each testicle and is cut during vasectomy (vas deferens) may cause back pressure.
• Scar tissue. Scar tissue (adhesions) may form and cause pain.

Treatment for PVPS depends on your symptoms and how much pain you have.

Medications

• Pain medications. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after ejaculation can take these medications prior to intercourse. Prescription pain medications also may be used to treat pain.
• Other medications. If anti-inflammatory medications do not help after four weeks, your provider may consider a tricyclic antidepressant or an anticonvulsant. These drugs can be helpful in treating nerve pain, although they have not been studied extensively in men with PVPS.

Therapies

• Supportive underwear. Wearing a jock strap or compression shorts may help reduce pain in the testicles.
• Ice or heat. An ice pack or a warming pad may help reduce pain. Sitting in a warm bath also may be helpful during a flare-up.
• Physical therapy. Men who have pain in the pelvic area or when they urinate may benefit from pelvic floor physical therapy to learn how to relax certain muscles in the pelvis.
• Nerve block. Your provider may suggest a nerve block, which uses numbing medication to target the nerve that goes to the testicle. This will probably only temporarily relieve your discomfort. Pain often returns once the numbing medication wears off.

Surgery

• Removal of sperm granuloma. Some men develop a small ball of scar tissue on the vas deferens without pain in any other part of the scrotum. Those men may experience pain relief after a procedure to remove the scar tissue.
• Microdenervation of the spermatic cord (MDSC). In this procedure, the surgeon separates nerves and veins that go to the testicle from other parts of the spermatic cord to reduce or eliminate pain signals. MDSC appears to be most effective in men who experience temporary relief from a cord block. When successful, MDSC can significantly improve quality of life. Complications may include ongoing or worsening pain, development of fluid buildup in the sheath around a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.
• Epididymectomy. For men with pain of the epididymis, removing the C-shaped structure that stores sperm behind the testicle may relieve the pain. The procedure seems to be most effective in relieving pain in men who have a cyst, a granuloma or a mass on the epididymis.
• Vasectomy reversal (vasovasostomy). Reversing the vasectomy will restore sperm to the ejaculate and may restore fertility. This procedure may relieve pain and pressure that occur with ejaculation. For some men, vasectomy reversal is more effective than the MDSC approach in relieving pain.
• Orchiectomy. Removal of the testicle is a last resort for men who do not respond to more-conservative treatments. Even after the testicle is removed, men sometimes feel a phantom limb pain in the area where the testicle used to be.