What is post-vasectomy pain syndrome and how is it treated?

Question

Hello doctor,

I had a vasectomy nine weeks ago. The first few days were fine but on the 6th or the 7th day, I started to feel a sense of fullness in my left testicle and I then experienced swelling. I rang my doctor and he prescribed me Difene which brought the swelling down but I still had tenderness in my testicle. He brought me in for an examination and told me that I had epididymitis and that I had a special granuloma on the right and a developing one on the left. He prescribed me steroids Deltacortril 5 mg for 13 days as follows. This was started at 30 mg a day for five days then 20 mg a day for five days, and 15 mg, 10 mg, and 5 mg respectively. This seemed to get me rid of any tenderness in my left testicle although I was experiencing throbbing pain at the vasectomy site. A couple of days after the steroids were over, I started to experience pain again this time at the vasectomy site and it was very much a burning and stabbing pain. I left it for a week taking the Ibuprofen which frankly I did not find it great. But, I could not take the pain anymore as it was extremely uncomfortable. So, I went home hoping that having a bath would give me relief. I rang the doctor and he told me to keep going with hot baths for some days. It did give me relief for an hour or so. So, he decided to put me back on the steroids for four weeks. I was again on 40 mg a day for the first week, 30 mg a day for the second week, 20 mg a day for the third week, and then tapered to 10 mg a day for the fourth week. I am at the end of the first week and I am definitely feeling much better. But, today and yesterday I felt a little burning stabbing feeling at the vasectomy site. There is nothing major. I have not had any erection or ejaculation issues and my sex life is pretty good but I am concerned as to why I am still not 100 % alright after nine weeks. Also, I want to know if I am off of steroids, will this pain return? I am just terrified of this PVPS and I am reading about it. Should I worry? My doctor has mentioned that if this does not work, he may have to inject the area with steroids. I am wondering if this will work. Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

Relax and do not worry. I am extremely concerned about your problem. I think you have PVPS (post-vasectomy pain syndrome) but it is a diagnosis of exclusion. It happens because of congestion of epididymis and various other reasons. There are some tests to be done to rule out infection in the testes or prostate before a diagnosis of PVPS. If possible talk with your doctor and get an ultrasound of the scrotum done and a semen culture and sensitivity. Regarding PVPS, a long period of steroids is not good. Apart from the steroids, I suggest you try another medicine for neuropathic pain like Gabapentin. Consult your specialist doctor, discuss with him or her and take the medicines with their consent. If there is no response then you may require surgery. There are various surgical options like microsurgical denervation of testes, excision of sperm granuloma, and excision of the epididymis. PVPS also gets cured spontaneously with time. So, I think there is no need to rush for any surgery now. Continue medications and if possible get the above tests done.

Thanks.