Vasectomy and Vasovasostomy - Long-Term Complications

In a few men, however, problems of poor self-image persist and require counseling. Some may experience depressed and angry emotions. They may actually require a mourning period over the loss of their reproductive ability (similar to what some women go through during menopause). These negative feelings usually resolve over time as the patient moves on to the next stage of his life.

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A small percentage of couples experience serious difficulties with the adjustment. Their emotional distress most often manifests itself in sexual dysfunction, such as impotence, premature ejaculation, or painful intercourse. In such cases, however, the vasectomy is probably the catalyst but not the cause of such extreme reactions. Studies have indicated that men who experience impotence after vasectomy are more likely to have female partners who are unable to accept the operation.

Chronic Pain

Research has indicated that up to a third of men has some pain in or around the testes that lasts longer than three months. In a study of 700,000 vasectomized patients in the Netherlands, up to 10% reported long-term chronic pain around the testicles. In one survey, 19% of subjects reported chronic pain that was simply a nuisance and 12% reported more severe pain. Another study that followed men for an average of 19 months reported that 27% had some pain in the testicles, although in the great majority, the pain was brief.

Causes of Chronic Pain. In many cases the source of the pain after vasectomy is not known, although some of the following conditions may be a source of pain:

Scarring from the surgery.
Obstruction of part of the epididymis that causes swelling in another section.
Pinched nerves.
In about one percent of all vasectomies, the epididymis becomes so congested with dead sperm and fluid that the patient feels a dull ache in his testicles. This condition, called chronic orchialgia, usually disappears within six months.
Some experts believe that granulomas may cause more chronic pain than generally believed. Other experts point out, however, that open-ended procedures, which increase the risk for granuloma production, result in less pain than closed-ended techniques that produce fewer granulomas.

Treatments for Chronic Pain. Surgery may be required if time or more conservative measures fail to relieve pain. Procedures may include the following:

Removal of the epididymis and surrounding tissue tends to be effective if the pain is in the scrotum (the sac that contains the testes) and if abnormalities in the epididymis can be observed using ultrasound.
A surgical procedure that blocks nerves in the sperm cord can bring relief in severe cases.
Surgery to reverse vasectomy (vasovasostomy) may relieve chronic pain. In one study nearly 70% of men became pain free, although researchers were unable to discover any biologic differences after the procedure that might explain such relief.