The Affects of Post Vasectomy Pain on Sexuality and Quality of Life

Several post-vasectomy surveys document chronic scrotal or testicular pain that can interfere with sexual function or enjoyment and causes some men to regret their vasectomy decision (McMahon et al 1992, Choe and Kirkemo, 1996, Ahmed et al, 1997, Morris et al, 2002, Manikandan et al 2004, Leslie et al 2007). A study by Choe and Kirkemo concluded that chronic scrotal pain was the most common post-vasectomy complication that could adversely affect quality of life (Choe and Kirkemo, 1996). The very nature of the affect of chronic genital pain on a patient’s quality of life necessitates its inclusion in pre-operative dialogue and written consent. Several studies have concluded that a discussion of chronic post-vasectomy testicular pain should be included in the pre-vasectomy informed consent process (Morris et al 2002, Manikandan et al, 2004). Post-vasectomy pain syndrome (PVPS) is usually characterized by chronic or intermittent testicular and/or epididymal pain and is frequently worsened by intercourse or ejaculation. PVPS can be exacerbated by vigorous physical activity, and is frequently accompanied by tender or full epididymides (Nangia et al, 2000). Symptoms can be unilateral or bilateral and the pain can radiate into the groin or abdomen along the course of the spermatic cord structures. There are no studies in the literature that explore the specific sexual effects of post-vasectomy pain (pain associated decrease in libido, changes in orgasmic response or ejaculation, decrease in sexual enjoyment, or pain related erectile potency issues). It seems likely that any significant genital pain associated with sex could affect sexual response, potency, or sexual enjoyment, and in this way affect libido and mood. The psychological morbidity of chronic genital pain after vasectomy is not well represented in either the psychiatric or urological literature. This paper explores the psychological and sexual symptoms of PVPS and their affects on quality of life.

There are several studies that describe the location of and characteristics of chronic genital pain after vasectomy. In a series of thirteen cases discussing vasectomy reversal to treat chronic post-vasectomy pain by Nangia et al, the patients had a variety of genital pain complaints: nine had testicular pain, epididymal pain was present in two, four had pain on ejaculation, and eight had pain during intercourse (Nangia et al, 2000). In a similar series of thirty-two patients, all of the patients complained of unilateral or bilateral testicular pain characterized as a dull ache that increased with sexual arousal, intercourse or ejaculation (Myers et al, 1997). In a retrospective postal study of 172 post-vasectomy patients, 56 (33%) had chronic testicular discomfort and 26 of these considered it to be “troublesome”. In this series, the pain was primarily described as an intermittent and unilateral “dull ache”, but some described a “sharp severe pain”. Five percent of the patients surveyed had pain associated with intercourse (McMahon et al, 1992). Other patients with post-vasectomy pain have required epididymectomy for relief of pain. In a series of ten patients, nine had constant pain in either the testes or epididymides. Four of ten had pain with activity, and three had pain during intercourse (Chen and Ball, 1991).