Top 4 Common Reasons For Pain After Vasectomy

The most common fear of men considering vasectomy is how much pain and discomfort will I experience during and after? Men are often surprised even when I see them in follow up at how trivial it was. I had a patient who went kite-boarding the next day despite my advice to rest for 7 days. This only goes to show that while some men weeks to fully heal, some men seemingly only take days. It all varies and it is all within the spectrum of what is normal healing time. So listen to your body and use some common sense. You will heal at your own speed. In an attempt to review some of the most common causes of post vasectomy pain I have outlined them here below.

Procedure pain

While a vasectomy is considered a minor operation, it is still an operation nonetheless. I use a local anesthetic with either a no-needle spray applicator or a traditional needle approach. Most men prefer the no-needle spray applicator which has been scientifically shown to be less painful and result in less post-vasectomy pain and hematoma. Everybody metabolizes anesthetic at different rates however, which is why some require top ups. On average I find out of 200 men I see a month, only 1 to 2 require additional top ups and even then only about 1-2 cc’s. Keep in mind this ain’t the finger or the toe and so pain in this region sometimes feels more than what it really is – and that is why I move ever so fast (6 minutes) to ensure a pain-free experience.

Early pain

Recovery Pain. As healing starts to kick in, it is normal to experience local pain secondary to inflammation. Pain can occur at the surgical site or the testicle itself. In fact, we encourage our men to avoid any kind of anti-inflammatories the first two days as we want to encourage the process of inflammation which is important for healing. This recovery pain can last from 1-2 weeks up to 3 weeks. Remember every man is different and healing times will vary. It is alright to take Ibuprofen as needed during this period and if its significant taking it for 7 days straight is usually preferred. Some men will find this pain radiates into the abdomen; this is quite normal. We tell our patients they will feel a “kick in the nuts”. Be patient – I have had some men take up to 8 weeks to fully heal from their procedure before they became pain free.

Later Pain

Granuloma Pain. About 1% of men may contact me anywhere from weeks to months after a vasectomy with the concern: “There is a lump down there and it hurts when I touch it.” This is inflammation around the vasectomy site likely due to the exposure of the body to sperm that either leaked out at surgery or afterwards. There is a ball of white cells that is actively recycling your sperm which results in higher levels of inflammatory mediators in this region. It is self-limited and resolves soon enough, and may be helped by taking ibuprofen regularly for several days. Rarely some men require steroids to relieve this inflammation.

Congestive epididymitis. Rarely (1-2%) men present with an episode of scrotal pain a few months or years after vasectomy.  There may even be swelling, but no fever and no granuloma are present. This is classic congestive epididymitis where increase in sperm production (which can be cyclical) is at its peak and thus there is distension in the epididymis. I try to perform a vasectomy higher up from the epididymis to leave lots of “piping” to relieve the distension. Ice, ibuprofen and time help the most. We encourage the use of heat baths to reduce sperm production and ice for comfort. Ibuprofen to reduce the inflammation. Very rarely, a vasectomy reversal is required to relieve this phenomenon. 

So there you have it! The top causes of pain after a vasectomy – remember, virtually all of my patients heal just fine but some men will invariably experience some of the findings above. If its you, do not panic and do not start getting advice from Dr. Google – we are always here to help.