Post-Vasectomy Pain Syndrome

Post-Vasectomy Pain Syndrome (PVPS, PVP, CPTP, CPVSP) is a long-term chronic pain condition that affects between 5% to 33% of vasectomized men.Ahmed I, Rasheed S, White C, Shaikh N. "The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management." British Journal of Urology. 1997; 79:269-270. PMID 9052481] McMahon A, Buckley J, Taylor A, Lloyd S, Deane R, Kirk D. "Chronic testicular pain following vasectomy." British Journal of Urology. 1992;69:188-191. PMID 1537032 ] Choe J, Kirkemo A. "Questionnaire-based outcomes study of nononcological post-vasectomy complications." The Journal of Urology. 1996; 155:1284-1286. PMID 8632554] The pain syndrome is caused by a combination of testicular backpressure, chronic inflammation, fibrosis, sperm granulomas, nerve entrapment, and electrical activity changes in the vas deferens. When pain in the epididymides is the primary symptom, Post-Vasectomy Pain Syndrome is also known as congestive epididymitis. This pain can be present in several fashions: orchialgia (chronic testicular or scrotal pain); pain during intercourse, ejaculation or physical exertion; pain due to full or tender epididymies.

One survey found that 2.2% of vasectomized men experience pain that significantly affects quality of life and causes them to regret their vasectomy decision because of the pain.

Mechanisms of Pain

Backpressure and Distension

There is a marked increase in pressure within the vas on the testicular side following vasectomy.Jarvis L, Dubbins P. "Changes in the epididymis after vasectomy: sonographic findings" American Journal of Roentgen. 1989;152:531-534. PMID 2644777] 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. Shafik A. "Electrovasogram in normal and vasectomized men and patients with obstructive azoospermia and absent vas deferens." Archives of Andrology. 1996; 36:67-79. PMID 8824668 ] The backpressure caused by blocking the vas deferens will cause what is called an "epydidymal blowout" in over half of vasectomy patients. [cite journal| author=Christiansen C, Sandlow J| title= Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome| journal=Journal of Andrology| year=2003| volume=24| issue =3| url = http://www.andrologyjournal.org/cgi/content/full/24/3/293 ]

Inflammation and Fibrosis

As part of the reaction of the body to the injury of vasectomy, the body produces hard scar-like tissue. Clamping the vas deferens can produce muscle disruption and fibrosis. Shandling B, Janik J. "The vulnerability of the vas deferens." Journal of Pediatric Surgery. 1981;16(4):461-464. PMID 7277139] As the diameter of the vas lumen is less than the thickness of the wall, the thick muscle layers can easily become disrupted, leading to sperm accumulation and extravasation. Cysts often form from the fluid that spreads between the muscle layers.

Escaping sperm and sperm granulomas

Sperm leak from the vas deferens and epididymides of vasectomized men, forming lesions in the scrotum known as sperm granulomas. Some sperm granulomas can be painful. Schmidt S. "Spermatic granuloma: an often painful lesion." Fertility and Sterility. 1976;27(3):271-274. PMID 761679] Interestingly, sperm granulomas can actually reduce the likelihood of PVPS by serving as a pressure valve. Shapiro E, Silber S. "Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia." Fertility and Sterility. 1979;32(5):546-550. PMID 499585 ]

Nerve Entrapment

Nerves can become trapped in the fibrous tissue caused by vasectomy. This pain is often heightened during intercourse and ejaculation because, with arousal and ejaculation, muscles elevate the testis. A large number of nerves that run parallel to the vas are easily cut or damaged during vasectomy.Pabst R, Martin O, Lippert H. "Is the low fertility rate after vasovasostomy caused by nerve resection during vasectomy?" Fertility and Sterility. 1979;31(3):316-320. PMID 437166 ]

Depression

Undiagnosed depression can cause a somatization disorder that results in pain.cite web
url=http://www.vasectomymedical.com/vasectomy-pain.html
title=Vasectomy - Post Vasectomy Pain Syndrome
accessdate=2008-06-20]

Electrical Activity Changes

According to Ahmed Shafik of the Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, the vas deferens has two forms of electrical activity, pacesetter potentials and action potentials, and after vasectomy, while the action potentials are completely diminished, the pacesetter potentials on the testicular side exhibit an irregular rhythm, or vasoarrhythmia..

Treatment

Treatment depends on the proximate cause. In some cases, reversal of the vasectomy may provide relief.cite journal
author=Nangia AK, Myles JL, Thomas AJ JR
title=Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation
journal=J. Urol.
volume=164
issue=6
pages=1939–42
year=2000
month=December
pmid=11061886
doi=
url=] Nerve entrapment is treated with surgery to free the nerve from the scar tissue, or to cut the nerve. Inflammation is treated with anti-inflammatory drugs.

References

See also

* Male contraceptive

External links

* [http://www.vasectomypain.org/home Vasectomypain.org]