Testicular pain is a distressing symptom that is usually short lived but can become chronic and disabling.
PVPS is an abreviation for Post Vasectomy Pain Syndrome
Anatomy & Physiology of the Testes.
It helps to understand why there is pain by looking firstly at the anatomy and physiology. The testicle comprises the testes, epidydimis and the spermatic cord. The testis is formed in the developing child in tissue just underneath the kidney. It then embarks on a journey along the back of the abdominal wall to reach the inguinal or groin region where it emerges through the inguinal canal before settling into its normal position in the scrotum at around the time of birth. During this extraordinary journey, it drags its blood supply, nerves ad associated structures along with it which form the spermatic cord. Pain in the the testes is sensed by nerves travelling in the spermatic cord such as the ilio-inguinal nerve, the genital branch of the genitor femoral nerve and a plexus of autonomic nerves present within the spermatic cord.
The testes produce sperm which travel through the epididymis and out towards the male genitalia in the vas deferns. Sperm production is optimised at 35 degrees centigrade, 2 degrees lower than body temperature which is thought to be the reason why the testes are located in the scrotal sack.
The testes also produce testosterone (the male hormone) which is important for male sexual development and function.
Why Testicular Pain After a Vasectomy?
Studies have show that up to 40% of men may experience chronic testicular pain occuring up to 10 years after vasectomy. Approximately 5% of men regard this as a serious problem and regret having the vasectomy performed. The pain may occur due to the formation of sperm granuloma where sperm leak from the cut end of the vas into the tissues and form a discreetful, painful lump. The epididymis can become tender due to engorgment with dead sperm and the immune reaction resulting in chronic epididymitis. If the epidiymis is demonstrated to be the site of the post vasectomy testicular pain it may be removed with a small surgical procedure.
Testimonial: Hi Mr Harriss, Further to my left side vasectomy reversal on the 8th of August I’d like to update you on my progress three months post op as requested by yourself
As the operation was performed to treat PVPS I will ignore the general pain associate with surgery and concentrate on the post vasectomy pain.
Overall it’s been a very slow but steady progress and I’m pleased to say (touch wood) that we moving in the right direction. The first month was very uncomfortable in the epididymis area and walking any significant distance 100m plus was difficult without pain, month two and three have seen steady progress with less and less pain and now only mild discomfort.
The testicle is now pain free and lost its hard sensitive sensation and feels normal again and this happened in the first month. The testicle is also now unaffected by hot baths or any sexual activity. Any sexual activity is best at night as there is a prolonged recovery period of discomfort in the epididymis which is slowly shortening.
In line with recommendations I commenced ejaculation after two weeks and have tried to continue on a daily pattern ( where possible) to flush out the congested bits and get the plumbing working, It’s difficult to maintain this level of enthusiasm so I need to know when it would be reasonable to cut back without upsetting the progress. I have seen no blood or noticeable change in the semen color or texture since the operation? The epididymis continues to remain prominent in size on the top of the testicle larger than I would suggest normal but can be touched without pain? This is only very noticeable in the bath or when very relaxed.
The nerve pain in the legs, hips and across the stomach has receded and my general state of health has improved. This is a big improvement in my quality of life! The low intensity fever has gone away and my immune system appears to be returning to normal. PVPS can drain up to 50% of your energy level and this is no longer such an issue.
Despite the positives I am not pain free and discomfort confined to the epididymis is still apart of everyday life but nothing like the months prior to the operation. If pain and discomfort was on a scale of 10 prior to the operation its now 3 or 4 and hopefully in the next few months will be 1 or 2. You did say 3 to 6 months but I think it may be more
In retrospect did we choose the right option? Definitely yes from my point view I only wish I had elected for the reversal on the right side before removing the epididymis and then later the testicle. Would it be the right decision for other PVPS sufferers? Unless there’s something else causing pain I would say generally yes
My fear continues to be that it hasn’t worked and the operation released enough pressure for a temporary respite now building up again or that the vas will become scarred and closes up again? Time will tell but I’m trying to be positive.
However I am very optimistic with the progress so far as the signals for recovery are good despite getting the award and photo for the most congested epididymis ever!
Although I don’t really care if I’m fertile again I would like to know if live sperm is getting through which would indicate at least the plumbing is working again. How do I go about this?
Thanks for all you’ve done for me, you’ve given me hope which is more than I had before – chronic PVPS is a terrible disease.