Post-vasectomy pain syndrome
|Post-vasectomy pain syndrome|
Template:Search infobox Steven C. Campbell, M.D., Ph.D.
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Post-Vasectomy Pain Syndrome (PVPS, PVP, CPTP, CPVSP) is a chronic pain condition, marked by severe and unremitting pain, that affects between 5% to 33% of vasectomized men.   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.
Mechanisms of Pain
Backpressure and Distension
There is a marked increase in pressure within the vas 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. 
Inflammation and Fibrosis
As part of the reaction of the body to the injury of vasectomy, the body produces hard scar-like tissue. Simply clamping the vas deferens can produce muscle disruption and fibrosis.  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.  Interestingly, sperm granulomas can actually reduce the likelihood of PVPS by serving as a pressure valve. 
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. 
Electrical Activity Changes
The vas deferens has two forms of electrical activity, pacesetter potentials and action potentials. After vasectomy, while the action potentials are completely diminished, the pacesetter potentials on the testicular side exhibit an irregular rhythm, or vasoarrhythmia .
- ↑ 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
- ↑ 4.0 4.1 Jarvis L, Dubbins P. "Changes in the epididymis after vasectomy: sonographic findings" American Journal of Roentgen. 1989;152:531-534. PMID 2644777
- ↑ 5.0 5.1 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
- ↑ 6.0 6.1 Shandling B, Janik J. "The vulnerability of the vas deferens." Journal of Pediatric Surgery. 1981;16(4):461-464. PMID 7277139
- ↑ Schmidt S. "Spermatic granuloma: an often painful lesion." Fertility and Sterility. 1976;27(3):271-274. PMID 761679
- ↑ Shapiro E, Silber S. "Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia." Fertility and Sterility. 1979;32(5):546-550. PMID 499585
- ↑ 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
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