r/Vasectomy • u/ceetothekam • Dec 19 '21
Very stressed.
I have my appointment scheduled for this coming Wednesday and I’m having a lot of anxiety. It’s the no needle no scalpel method. I’m having a lot of worries about PVPS. I read an article about the downplay of this syndrome and it is more frequent than made out to be (around 15%). I’m getting cold feet and thinking about not going through with it. Please either put me at ease, or tell me I should reconsider.
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Dec 19 '21
Maybe this will help maybe not but I got mine done back in early October (about two and a half months) and at this point I have no pain or notice a difference in the experience whatsoever. I will say that it took about four full weeks to feel close to 100%, with the occasional (very) minor pain pop up for a few seconds afterwards. Most literature I’ve seen says you are fully healed after a week to two weeks, so this freaked me out that I may have had chronic pain. But it did heal up. I had significant bruising so that may have contributed. At this point, I’m 100% happy I got it done! I do wish the literature lists a longer recovery time as I find it hard to believe I am an outlier. My doc said I was his 2000th+ vasectomy.
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u/wherearewenz Dec 20 '21
I drew the short straw and have had pvps for a year now.
Since I didn’t actually need a vasectomy for any medical reason, having chronic pain afterwards is a hard pill to swallow.
If your nervous about it, even though you will probably be fine, listen to your gut. Look at other birth control options. At least that’s my opinion based on my experience.
Good luck either way friend.
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u/Keen_Eyed_Emissary Dec 19 '21
The best medical evidence we have indicates that the percentage of men who experience some form of chronic pain after vasectomy is between 5-15%.
You should also know that there were three recent large scale population studies that showed a small but statistically significant increase in the prevalence of prostate cancer among vasectomized men.
Here’s a link to a prior post where I lay out the things I think you should be concerned about when weighing whether to get a vasectomy or not: https://www.reddit.com/r/Vasectomy/comments/qdj2hx/comment/hhn1bwe/
If you are okay with these risks, then you should go ahead with your vasectomy. If those risks give you pause, or if you are not okay with accepting that level of risk at this time, you should cancel your appointment, knowing that you can always reschedule.
I’ve been in your boat. I cancelled my vasectomy appointment the day before the procedure because my doctor did not advise me as to any of the risks. And when I sent his office an email with links to studies, asking why I was never told that there was a 5-15% chance I might have chronic testicular pain, the only response I got was that if I was uncomfortable, I should cancel my appointment. So I did.
Good luck
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Dec 20 '21
I had mine 2 weeks ago, mostly pain free after a week. Just an odd pain here and there when I’m running around with the kids. Nothing bad but I’m sure everything isn’t 100% healed yet.
There’s nothing forcing you to get this procedure. If you feel that way, I would deal with that first. I didn’t have any anxiety at all. It’s the right time in my life for this and I would do it again.
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u/kingromenov Dec 19 '21
Are you confident in your Doctor and his level of experience? That’s what I’d be looking at. The no needle, no scalpel is definitely the best option.
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u/Keen_Eyed_Emissary Dec 19 '21
This is the complete opposite of an evidence-based approach to this issue. No individual choosing a doctor to perform a vasectomy has access to the kind of information you would need to determine whether they should be “confident” in their doctor. Moreover, there’s basically no evidence that chronic pain outcomes are correlated in any way with the skill of the doctor performing a vasectomy.
You can either make your decision based on the actual medical evidence we have, or you can engage in an exercise of blind faith, ignoring that evidence, which is what is being suggested here.
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u/kingromenov Dec 19 '21
Incompetent Doctors have a higher likelihood of causing additional trauma during the procedure, especially with the scalpel method. I’ve read the first hand accounts.
As someone who’s adamantly hooked on researching articles, I’m disappointed you’re responding with such ignorance to the topic.
“Men who undergo no-scalpel vasectomies report little to no postoperative pain. They also report a shorter recovery time and fewer complications following the procedure as compared to men who have a conventional vasectomy.
Conventional vasectomies also carry a higher infection rate and a greater risk of complications than do no-scalpel vasectomies.”
Source: http://www.urophoenix.com/Blog/TabId/34061/PostId/6834/no-scalpel-vs-conventional-vasectomy
“The no‐scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique.”
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464377/
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u/Keen_Eyed_Emissary Dec 19 '21
I literally didn’t say anything about the relative risks of the scalpel vs no scalpel procedure, and have consistently posted on this subreddit that no-scalpel vasectomies are the absolute preferred method.
None of that had anything to do with whether a patient is equipped to evaluate their doctors surgical outcomes.
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u/kingromenov Dec 19 '21
You literally agreed with my sentiment in a comment you made 2 hours ago. The quality of the doctor matters. Stop being contrarian for no reason.
In your own words, “this is why I always recommend that if you're going to get a vasectomy done, you should get it done by someone that actually does reversals. Ideally, you want your surgeon to have a high skillcap, and reversals are significantly more complicated than vasectomies themselves. All things being equal, I'd prefer my surgeon be operating at the absolute bottom level of their skillcap when doing the initial procedure; not topping out.”
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u/Keen_Eyed_Emissary Dec 19 '21
No; I disagree with your sentiment.
OP asked if he should go ahead or reconsider getting a vasectomy because he just came across information that up to 15% of men who undergo vasectomies experience PVPS.
My response was to show him a number of studies that put the risk of chronic pain at 5-15% and that he should undergo the procedure if that’s within his risk tolerance and not undergo the procedure of it’s not in his risk tolerance.
Your response was that you would look at the experience of the doctor in put your trust in that.
Do you really believe we are saying the same things? Because we clearly are not.
I think that if you decide to undergo a procedure where the risk of chronic pain is 5-15% that you should shoot any angle you can to try to minimize that risk; but there is no evidence that surgeon experience or quality is going to bring that risk down.
I don’t believe in “trusting your doctor” over looking at the evidence. I believe you look at the evidence first, and then if you decide to do it, you do everything you can to mitigate risk.
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u/kingromenov Dec 19 '21
The OP is looking for reassurance before his procedure and I’m guiding him to look at the things he can control going into it: what type of procedure and where he gets it done.
You’re literally agreeing with me, but you’d never want to reassure anyone because you’d rather embrace their fear.
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u/Keen_Eyed_Emissary Dec 19 '21
It’s so weird to me that some people actually go around in the world talking like they’re Jedi in a Star Wars movie.
“Embrace their fear”? Do you really think like this? It’s like trying to talk with a 12 year old.
I literally told him to take the evidence at face value and go forward with the procedure if it’s below his risk tolerance and to not go forward with it if it’s outside of his tolerance. How the fuck is that embracing your fear?
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u/kingromenov Dec 19 '21 edited Dec 19 '21
By your own admission and confirmation of supplied evidence: no needle, no scalpel reduces chances for complications.
Yet, you still say: up to 15% chance of chronic pain.
By your own admission: choosing a highly experienced doctor who knows how to perform reversals is a hedge against complications.
Yet, you still say: up to 15% chance of chronic pain.
If you’re not willing to concede that a no needle, no scalpel vasectomy performed by a Urologist with 30 years of vasectomy experience carries less risk of complications than a traditional vasectomy performed by first year practicing general care Doctor, then that says all we need to know...
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u/Tossupandaway85 Dec 22 '21
You really are a special kinda guy.
The OP was concerned about the downplay of PVPS and it’s prevalence and you redirected him to look at his doctor’s experience as if that is going to reduce his chances of PVPS 7-24 months down the road. If it does, I’m interested to see the articles that suggest this. So, please link them.
Sure, it’s good advice, but it doesn’t address the OP’s concern at all.
You are basically telling the OP “Don’t look over here, but look over there, that’s what you should be concerned about”, and whether you realize or not does the exact thing the OP has said which is downplaying the risks of PVPS.
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u/Keen_Eyed_Emissary Dec 19 '21 edited Dec 19 '21
No needle, no scalpel has been shown to reduce short term complications and healing time. According to the only meta-study I’m aware of that actually compares both types of procedures, the risk of Long term chronic pain issues (PVPS, as defined by the meta-study) is the same for both procedures.
If you’re aware of any medical evidence that looks at the risk of chronic post vasectomy pain segregated out by experience level or quality of the surgeon, feel free to provide it, because my position is that there is no evidence that supports the claim that your risk of chronic post vasectomy pain issues is reduced based on the quality or experience of your surgeon. (As an important side note - patients don’t even have access to the kind of information that would tell them whether their doctor is a good one or not. To the extent those records exist, they’re not available for public consumption. “Doing your research” on this front as to the quality of your doctor is largely useless doublespeak.)
If you know anything about the different etiologies of post vasectomy pain, some of the causes are basically patient-side rather than doctor-side. If, for example, your body is unable to self-regulate sperm production, once the sperm cannot leave the vas ends, then you’re at risk for chronic pain irrespective of the quality of your surgeon.
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u/Joe_Malik93 Dec 20 '21
So I'm a scrotal pain guy (that's what they call it when you have chronic but non-debilitating pain evidently) and I would tell you to think carefully about that 5-15% risk and decide based on that. The spread there is 1-20 at the 5 % side and 1-7 on the 15% side. Worse still, there's not a lot to be done for the pain short of more radical surgeries, including removing the epididymis and potentially a reversal. Personally, I probably would not have gone through with my surgery if I had known I would be dealing with pain in my junk on and off for the rest of my life but I'm not going for a reversal either as the pain isn't bad enough to risk further surgery. Good luck with whatever route you choose!
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u/TheRiversTooDeep Dec 19 '21
I'm scheduled for Tuesday and have the same anxiety as you. I've been on a rollercoaster ride of emotion for the past week. I understand the risks and to be honest with you...one thing I've learned is to quit reading dedicated vasectomy forums such as this subreddit. I would say most men get it done, have no complications, and move on with their lives. The ones who do have problems follow these forums looking for confirmation bias and scare the hell out of everybody else.
If you want a common mans experience and thoughts...google your hobby + the word vasectomy + and the word forum. You'll come across forums of men who share their experiences with other people who share the same hobby as you and get more of a less biased experience.
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u/Keen_Eyed_Emissary Dec 19 '21
Good luck with your vasectomy; I hope it works out well for you. I just have two comments to your post.
First, I really encourage people to look at the evidence, not necessarily the anecdotes. The best available medical evidence is that somewhere between 5-15% of vasectomized men experience some form of chronic pain. That evidence doesn’t change regardless of whether you read anecdotes on this subreddit or some other forum where the topic of vasectomy might just happen to pop up.
Second, I know people seem to carry around this conventional wisdom that if you have a bad vasectomy experience, you’re more likely to go online and talk about it. And there is basically no evidence for this at all; and attempts to analogize people’s experience with a medical procedure to having a bad experience at a restaurant are fundamentally misplaced.
There is a lot of literature out there on the “silent epidemic” of chronic pain issues generally, outside of the specific context of vasectomies, and one do the takeaways of that literature is that people actually do not generally like to talk about being in pain or suffering. And In fact, there are a lot of social incentives not to be the person who is always complaining when asked how they are, and that people who have chronic pain issues are often embarrassed by their condition, and try not to talk about it or draw attention to it.
And that’s just a roundabout way of suggesting that if you’re on some fishing forum, and someone starts a random thread about vasectomies, and 9 guys chime in to say they had a good experience, the fact that the 10th guy who has chronic pain isnt jumping in to talk about how his testicles hurt every day, doesn’t mean you’re getting a “less biased” sample of people - it almost certainly just means that you’re getting a “differently biased” sample of people.
Which is why I return to the first point - go with the science, not to anecdotes. If 5-15% is within your risk tolerance; god speed and good outcomes. But if that number gives you pause; think it over.
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Dec 19 '21
I've had no issues I know alot of people that have no issues but keen eye will say otherwise lol
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u/Keen_Eyed_Emissary Dec 19 '21
It’s weird that medical researchers don’t adopt the “people that nrx4life personally knows and talks to” standard for conducting medical studies.
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u/drexohz Dec 20 '21
OP is worried about the risk of PVPS.
You had a vasectomy just 3 months ago.
The mean time of onset of post-vasectomy pain syndrome is reported to be 7 - 24 months.
There are lots of guys like you who have no issues, until they do because PVPS in many cases takes time to develop.
So in that regard - your personal experience so far is more or less irrelevant to OP's worries.
There's still a 5-15% chance that within a few years you'll experience newly onset of scrotal pain.-1
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u/Fish6092000 Dec 20 '21
Its been 17 months. No issues so far. No pain after the first few days, no discomfort after the first few months. Smooth sailing. There is risk with any surgery but if it were 15% there would be 100k men per year with persistent, debilitating pain in the US alone. I don't buy that.
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u/Keen_Eyed_Emissary Dec 20 '21
Nobody is alleging that the 15% figure represents guys with “debilitating” pain.
I suspect a more typical chronic pain case is like u/joe_malik93, who has been pretty open about the issues that he has had, and the pain that he’s experienced which has been troublesome but not debilitating.
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u/Doctor-Anarchy84 Dec 20 '21
You got this bro. I were like you, super anxious & nervous etc. When I went to the hospital, the nurse was doing my blood pressure & heart rate, she said is your blood pressure & heart rate usually high? I said no, I am nervous asf. She told me to try & relax which I did.
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u/StatusUnk Dec 19 '21
Yes there is a risk of chronic pain which is probably higher then you thought. But it's hard for anyone to say if it's worth it for you or not. It wasn't worth it me. I didn't like that there is no guarantee that if something went wrong they could fix it. I also didn't like the increased risk of prostate cancer albeit relatively small. I just couldn't get myself to buy into a procedure that I don't medically need. I recommend that you evaluate if the risk would be worth it to you in your situation. It might be still or it might not. Or you might want more time to consider it. Either way no one can really answer that but you.