Some of the vasectomy information sites on the Internet are not up to date. Many don't mention chronic post-vasectomy complications that men should know about before they make the decision to pursue a vasectomy. The information I found on medical websites generally did not explain the significant risk of chronic pain after vasectomy. However, if you do a search for post-vasectomy pain, you will now find dozens of sites, forum posts, and articles listed to bring this issue to light. Fifty percent of men keep their vasectomy a secret, so it is not surprising that men would not talk about these issues until the anonymity offered by the internet became widely available. What man wants to tell others about problems having to do with his genitals or sexual function. I believe this has led to under-reporting of cases of pain or sexual dysfunction after vasectomy.
Despite the number of studies to date, the actual incidence of persistent pain after vasectomy is hard to state reliably and can only be estimated from survey data. The available studies suggest an incidence of any persistent post-vasectomy scrotal or testicular pain of approximately fourteen to thirty-three percent. Around 2 to 5% of men complain of pain severe enough to affect quality of life or have affects on sexual function.
The only prospective study available surveyed men preoperatively, and again six months later. In this study, 488/593 (82.2%) completed both surveys and 65 (14.7%) reported new onset scrotal pain with an average visual analog score of 3.4/10. Four men (0.9%) reported pain “quite severe and noticeably affecting their quality of life." I contacted the author of this study and he told me 19/488 men (4%) had pain with intercourse. Given the mean time to PVPS onset of two years (Nangia et al, 2000), an obvious limitation as to eventual incidence was this study’s duration of only six months. Many of these survey studies have incomplete response rates and there is a possibility that men with symptoms are over represented in responses. In a large retrospective postal study of CPTP (560 surveys sent, 71% response rate), they reported an incidence of any testicular pain of 27.2%, but when using pain duration of three months or greater, the incidence was 19%. A smaller unfortunate group of patients report having more severe pain that affects quality of life or sexual function. This outcome was reported in two to five percent of patients. Well-designed prospective studies with duration substantially greater than two years would be required to gain a better estimate of true incidence and may not be practical given the low incidence of PVPS. This comprehensive review of vasectomy complications mentions an incidence 2.5 to 15% for pain that "affects quality of life".
In another study regarding chronic pain, they included a control group and still found a higher incidence of testicular pain following vasectomy. (J Fam Plann Reprod Health Care. 2002 Jul;28(3):142-4.) The numbers were as bad, with 37/101 reporting occasional, “non-troublesome discomfort” (whatever that is) and 10/101 reporting “occasional discomfort which was a nuisance”. In the control group (no vasectomy) these numbers were 21/101 and 3/101 respectively. Of note was the “6% of post-vasectomy patients with pain severe enough to seek medical advice.”
Following vasectomy, spermatogenesis continues, the human epididymis and ductus deferens may distend and leak, and the extravasated spermatozoa stimulate formation of a sperm granuloma. Granulomas may occur at 60% of vasectomy sites and are usually asymptomatic and relieve intraluminal pressure. About 3-5% of patients experience pain. Intraluminal phagocytosis may explain why some reproductive tracts become depleted of spermatozoa. Distension of the epididymis is common after vasectomy and may lead to granuloma formation there. Up to 6% of patients have symptoms, but many with epididymal changes have no discomfort. Most episodes of painful epididymitis and granulomas resolve with conservative treatment, but < 1% require vasectomy reversal or, if this is ineffective, excision of the epididymis and obstructed ductus deferens. Clin Anat. 1996;9(5):337-42.
In this study, (Br J Urol. 1992 Feb;69(2):188-91.) the incidence of chronic testicular pain was reported to be 33%, with about half of these men reporting it to be “troublesome”, and about 5% of patients reported testicular pain related to intercourse. Three of the 179 survey respondents regretted having the vasectomy due to chronic pain. The incidence of regret (1 in 60) for an essentially irreversible procedure seems high and merits mention in the informed consent for this procedure. In fact, this study’s conclusion was, “Prior to vasectomy, all patients should be counseled with regard to the risk of chronic testicular pain.”