Right Away

Syncope. That’s the medical term for fainting. One particular subtype, vaso-vagal syncope, happens to certain prone individuals when they experience a noxious stimulus, like the sight of blood, the smell of cautery, the idea of vasectomy, to cite but a few examples. It’s like a sudden panic attack, when the nervous system over-reacts to its own adrenaline and pumps out a bunch of vasodilators (chemicals that relax blood vessels). This results in the pooling of blood in the extremities and abdomen, the blood pressure drops and the person feels faint, dizzy and clammy or may even pass out briefly. If any of this happens to you we just have you wait comfortably in the clinic for 15 minutes until the reaction naturally subsides, after which you are fine again.

In The First 10 Days

Hematoma. This results from bleeding into the scrotum. It can get large and painful, and turn the scrotum black and blue. Incidence with conventional vasectomy is around 3%. The NSV literature puts it at 0.3%, but I’ve only seen 5 “big ones” in 10,000 cases(0.05%).

Infection. Minor infections occur in about 2% of patients. Serious infections, requiring intravenous antibiotics or drainage of an abscess occur in less than 0.1% of cases. Even the rare serious infections usually resolve completely in a few weeks.

Vasitis or Epididymitis. Inflammation and swelling of the tissue surrounding the vas or extending down around the epididymis (the part just below the vas that joins it to the testicle) occurs about 2% of the time. It’s usually mild and transient, no bigger than a grape.  Needless to say, it can be painful, but this too will settle with religious use of anti-inflammatory drugs (NSAIDS such as naproxen). It can sometimes take a few weeks to settle down. Given that swelling is what the male genitalia like to do best, all this is not surprising. In fact, inflammation and erection both produce swelling through almost identical biochemical pathways. That is why I encourage the liberal use of naproxen or other NSAIDS for a full week post-op, even if you’re not having pain.

Later

Sperm Granuloma. This is a small inflammatory lump which can occur near the cut end of the vas or in the epididymis weeks or even months after surgery. It can be painful, but it’s not serious and usually resolves with a short course of an NSAID like naproxen.  The incidence is about 1 in 1000.

Chronic Post-Vasectomy Pain. This is rare. Most pain settles within 1 – 2 weeks with NSAIDs (such as naproxen.) If this doesn’t work then a longer course of a stronger NSAID is required. In about 1 per 1000 pain will persist beyond six months, which defines ‘chronic’. A number of other approaches may be tried, including anti-depressant meds or other “pain modulating” drugs. An exact cause of the ongoing pain is usually not obvious, but this condition appears to be similar to other chronic pain syndromes, in that pain pathways in the spinal cord and brain appear to remain activated in the absence of any apparent ongoing stimulus. Surgery to reverse the vasectomy is said to be 85% successful for pain resolution. Converting a “closed-ended” vasectomy to an “open-ended” vasectomy has been recommended by some but this has not been shown to be effective.

Note!
If you are still experiencing pain or discomfort after a month, don’t ignore it. Come and see me.