Post-vasectomy pain syndrome

Post-vasectomy pain syndrome is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. When pain in the epididymides is the primary symptom, post-vasectomy pain syndrome is often described as congestive epididymitis.

Any of the aforementioned pain conditions/syndromes can persist for years after vasectomy and affect as many as one in three vasectomized men. The range of PVPS pain can be mild/annoying to the less-likely extreme debilitating pain experienced by a smaller number of sufferers in this group. There is a continuum of pain severity between these two extremes. Pain is thought to be caused by any of the following, either singularly or in combination: testicular backpressure, overfull epididymides, chronic inflammation, fibrosis, sperm granulomas, and nerve entrapment. Pain can be present continuously in the form of orchialgia and/or congestive epididymitis or it can be situational, such as pain during intercourse, ejaculation or physical exertion.

There is a noticeable increase in pressure within the vas deferens on the testicular side following vasectomy. The epididymides of vasectomized men are often swollen and distended from backpressure effects. The efferent ducts and seminiferous tubules of the testes are also impacted by backpressure, leading to an increase in area and thickness. Backpressure from blockage of the vas deferens causes a rupture in the epididymis, called an "epididymal blowout", in over half of vasectomy patients. Sperm sometimes leak from the vas deferens of vasectomized men, forming lesions in the scrotum known as sperm granulomas. Some sperm granulomas can be painful. Paradoxically, the presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus lessens the likelihood of epididymal discomfort.

...
Wikipedia