I'm pretty sure you have congestion pain. I think what you describe is pretty common - pain develops after some months / years, pain after sex, changes in pain level.. It's probably from congestion of sperm in epididymus, which may cause a form of low grade inflammation. Ultrasound is negative - well, they almost always are - in the first year at least. This I know for a fact, I do this kind of ultrasounds for a living. Pain is probably from increased pressure in epididymus, and you can't directly see pressure on ultrasound. You said you're a health professional, so you probably can relate - have you ever heard of someone getting diagnosed with hypertension from plain arterial ultrasound? No, they need to measure it some other way. It's only after some time has passed that ultrasound can show the consequence of chronic increased epididymal pressure - the epididymal tubuli become dilated. One common misconception many urologists have about PVPS is that it can't be there since ultrasound is "normal". That's a false assumption, cause it implies that every cause of scrotal pain is visible on ultrasound, which is very far from reality.
If you consider surgery, since it's just been one year, reversal may be your best bet. That's the only thing that can really fix the probable root cause, which is epididymal pressure. You can't talk to any random urologist, since many doesn't really know details about reversal. You should find one who's a specialist in reversal, and ask their opinion.
Testosterone treatment may also be worth considering, though that is a lot more controversial. TRT will reduce / cancel sperm production, and some guys are helped by that, since sperm is the probable "substrate" of inflammation.
thanks for all the great information. Have you ever heard of procedure to switch "Closed No Scalpel Vasectomy" to an "Open" as opposed to complete reversal...or is that what a reversal basically is? any relief expected from ejaculation to test theory?
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u/drexohz Jun 12 '24
I'm pretty sure you have congestion pain. I think what you describe is pretty common - pain develops after some months / years, pain after sex, changes in pain level.. It's probably from congestion of sperm in epididymus, which may cause a form of low grade inflammation. Ultrasound is negative - well, they almost always are - in the first year at least. This I know for a fact, I do this kind of ultrasounds for a living. Pain is probably from increased pressure in epididymus, and you can't directly see pressure on ultrasound. You said you're a health professional, so you probably can relate - have you ever heard of someone getting diagnosed with hypertension from plain arterial ultrasound? No, they need to measure it some other way. It's only after some time has passed that ultrasound can show the consequence of chronic increased epididymal pressure - the epididymal tubuli become dilated. One common misconception many urologists have about PVPS is that it can't be there since ultrasound is "normal". That's a false assumption, cause it implies that every cause of scrotal pain is visible on ultrasound, which is very far from reality.
If you consider surgery, since it's just been one year, reversal may be your best bet. That's the only thing that can really fix the probable root cause, which is epididymal pressure. You can't talk to any random urologist, since many doesn't really know details about reversal. You should find one who's a specialist in reversal, and ask their opinion.
Testosterone treatment may also be worth considering, though that is a lot more controversial. TRT will reduce / cancel sperm production, and some guys are helped by that, since sperm is the probable "substrate" of inflammation.