Post-Vasectomy Pain Syndrome (PVPS)

Patient selection: post-vasectomy

Clinical findings may include:

(1) tender vas deferens

(2) tender epididymis

(3) orchalgia

(4) pain with ejaculation

(5) pain with straining

(6) dyspareunia

The cause of PVPS is uncertain and may be multi-factorial (vascular congestion, nerve entrapment, sperm granuloma, other).

Diagnosis:

(1) The patient has clinical findings consistent with the post-vasectomy pain syndrome for >= 3 months.

(2) The findings may be severe enough to cause disability and/or poor quality of life.

(3) There is temporary relief of pain by spermatic cord/nerve block.

(4) The findings are not explained by acute post-procedural pain or complication.

(5) The findings are not explained better by another diagnosis.

Management:

(1) Some patients can be managed conservatively.

(2) Some patients improve with microdissection of the spermatic cord or epididymectomy.

(3) Some patients improve after reconnection of the vas (vasectomy reversal).

(4) If all else fails then orchiectomy may be performed.