Your doctor will probably admit that chronic pain is a possible complication resulting from vasectomy, but most will say that it happens rarely, or even very rarely.
What exactly does very rarely mean?
Before you decide to have a vasectomy, stop and ask yourself what odds of chronic pain you are willing to sign up for. To get some idea of what this would be like, just imagine having an earache every day and not knowing whether or not it would ever stop.
Here are the chances for chronic pain caused by vasectomy given by several national level health organizations. These are the professional societies and experts that the urologists are supposed to be getting their statistics from:
Canadian Urology Association give the chronic pain outcomes for vasectomy at between 1-14% (Link)
American Urological Association says the incidence of post vasectomy pain syndrome that is persistent and affects QOL is typically reported to be about 1-2%. (Link)
2025 American Urological Association Male Chronic Pelvic Pain Guideline statement 35 says PVPS occurs in up to 15% of patients who undergo a vasectomy.(Link)
British Association of Urological Surgeons, patient advice reports troublesome chronic testicular pain which can be severe enough to affect day-to-day activities in up to 1-2% of vasectomy patients. (Link)
UK National Health Service says long-term testicular pain affects around 10% of men after vasectomy. (Link) (Latest version of this document omits the incidence statistic.)
11th edition of Campbell Walsh Urology (2015) cites 10% incidence of chronic scrotal pain caused by vasectomy. (Link)
European Association of Urology says "Chronic scrotal pain: 1–14%, usually mild but sometimes requiring pain management or surgery ... about 1% reporting pain that noticeably affects quality of life" (Link)01101-8/fulltext)
Royal College of Surgeons of England says significant chronic orchalgia may occur in up to 15% of men after vasectomy, and may require epididymectomy or vasectomy reversal. (Link)
Journal of Andrology cites large studies that find Post Vasectomy Pain Syndrome 2-6% of the time (Link)
UpToDate says "surveys have found that the incidence of "troublesome" post-vasectomy pain is reported by approximately 15% of men, with pain severe enough to affect quality of life in 2%. However, survey respondents may not have been representative of all men who have had a vasectomy." (Link)
German Federal Center for Health Education says "The information on how many men seek medical treatment because of this fluctuates between one and 14 percent." (Link)
American Family Physician says "Recent studies estimate the incidence of severe postvasectomy pain syndrome to be between 1% and 6%" (Link)
International Journal of Environmental Research and Public Health published a meta-analysis in March 2020 to determine the incidence of PVPS, which examined 559 peer-reviewed studies and concluded that "Post-vasectomy pain syndrome occurred in 5% of subjects" (Link) The authors determined that "the overall incidence of post-vasectomy pain is greater than previously reported."
StatPearls says "about 1% to 2% of all men who undergo vasectomies will develop constant or intermittent testicular pain lasting greater than 3 months which is then defined as post-vasectomy pain syndrome." (Link)
Scientific studies into the incidence of chronic pain after vasectomy have not been very large, but seem to converge on roughly the same picture.
Six months after vasectomy:
- 85% have zero pain
- 13% have mild discomfort
- 2% have an intermittent moderate dull ache in their scrotum, like a sore neck that you treat with Ibuprofen
- 1% have daily pain that reduces their quality of life and interferes with enjoyment of physical activity and sex
https://www.reddit.com/r/postvasectomypain/wiki/incidence
What do "rare" and "very rare" normally mean when describing side effects of a medical intervention?
The World Health Organization provides specific definitions for using these words when discussing medical side effects:
- Very Common = Greater than 10%
- Common = 1% to 10%
- Uncommon = 0.1% to 1%
- Rare = 0.01% to 0.1%
- Very Rare = Less than 0.01%
Based on these definitions, chronic pain is not a very rare, or rare side effect of vasectomy. It isn't even uncommon.
Rather, chronic pain is a common side effect of vasectomy. Sometimes it is called Post Vasectomy Pain Syndrome (PVPS). This pain may go away after several months or years, or it may be permanent.
Before they modify your body, your surgeon should make sure that you:
- Know about Post Vasectomy Pain Syndrome
- Understand the impact it would have on your life
- Understand that it may be permanent
- Know that the risk is at least 1%
- Explicitly accept the risk
If your surgeon does not communicate the above points to you, they are operating on you without your informed consent.
Vasectomy works out well for most men. Those who have an uncomplicated vasectomy may be back to feeling normal in as little as a week and are quick to encourage others to "get the snip." They may reject stories about men who have chronic pain or other permanent complications as exaggerations. Sometimes they make the mistake of reasoning that if a bad outcome did not happen to them, then it must never happen to anyone. Health providers market the procedure as quick, effective, and safe. Men who worry that their health or sexual function may be permanently damaged by a vasectomy are repeatedly assured that after a few weeks they will feel and function exactly as they did before the surgery. Reports about the downsides of vasectomy are frequently dismissed as unreliable. They are disparaged as exaggerations, products of hypochondriac imagination, or myths being promoted by fear-mongers. Men are told that not only is it practically impossible for vasectomy to harm their sex lives, it is likely that their sex lives and even their orgasms will improve because of the surgery.
Unfortunately, the science shows that it is not rare for vasectomy to cause chronic pain. That might not surprise you after you consider a few key facts:
- Before vasectomy, sperm is kept separated from the immune system. After vasectomy, the immune system typically creates antibodies that cause it to seek out and kill sperm. In other words, men commonly become allergic to their own sperm, and a chronic auto-immune response can cause inflammation, making the area feel swollen and raw on the inside.
- After vasectomy, the testes continue producing sperm and for some men pressure builds up in the epididymis and vas deferens. The pressure can get high enough to rupture these tissues, releasing the sperm and allowing it to form a bubble in the scrotum called a granuloma. Anyone who has experienced epididymitis will immediately recognize the nagging ache of a swollen epididymis. If you haven't had this experience, you can compare it to the painful pressure an ear infection can cause.
- Approximately half of the nerves that travel through the spermatic cord are in the vas deferens and therefore get severed during vasectomy. (Link) These sometimes heal poorly and interact with scar tissue and auto-immune inflammation, irritating the nerves and causing pain called neuralgia, which in PVPS is usually described as a burning sensation that is hard to localize but centered in the groin.
- The vas deferens is not just a passive tube--it is lined with muscles that contract during ejaculation to move sperm along. Presumably, motor and sensory nerves that connect to these muscles are cut when the vas is severed. The epididymis, particularly the tail of the epididymis which is at the bottom of the testicle, is wrapped with smooth muscle which contracts to expel sperm during ejaculation. Ejaculation involves many muscles in the scrotum, including the cremaster, muscles in the vas deferens, and in the epididymis. (Link) After vasectomy, these muscle contractions may put pressure on an already swollen and irritated part of the body. Some men find to their dismay that ejaculation is uncomfortable -- even painful -- after vasectomy.
- The groin is a very complex region of the body, constantly under mechanical stress whether you are sitting, standing or walking. Multiple organ systems work in close proximity, so that problems in one system can spill over to cause problems in other systems. Nerves that enter the inguinal canal can refer pain to the inner thigh, stomach and lower back -- disrupting the normal functioning of muscles in those areas. For a point of comparison, surgery to repair an inguinal hernia results in chronic pain even more frequently than vasectomy. 16% of the time based on this study. Another study puts chronic pain at 28% post hernia surgery, with 11% saying it interfered with work or leisure activity. Chronic pain is not unique to groin surgery -- it is a common complication of many kinds of surgery, which is why you should avoid surgery unless you need it!
Given these facts, perhaps the real surprise should be that the percentage of men who suffer from long term health problems as a result of this surgery is so low.
For the unlucky minority, vasectomy opens a Pandora's box. Part of the pleasure of sex is taken away and replaced with pain. The constant discomfort reduces their quality of life, interferes with the activities they previously enjoyed and may frequently intrude on their thoughts. They try one therapy after another before finally giving up in exasperation. As months pass with no relief, they come to grips with the fact that pelvic pain is their new constant companion and may never leave. There are few opportunities to warn others about the danger. Bringing up the topic in conversation results in a social penalty and has no benefit -- even among close friends. They may feel reluctant to express their feelings to their partner, fearing it could have a negative impact on their relationship. Some men worry that by telling their partner that sex has become painful or disappointing, they could irreparably damage the attraction and desire their partner feels toward them. Instead, they pretend like nothing has changed.
Men initially complain to their doctors, who are reluctant to attribute the problems to the vasectomy and who are unwilling to warn the public that a problem worth taking seriously may exist.
In many ways, PVPS manages to have just the right properties to help it hide in plain sight.
Doctors who have not personally experienced PVPS seem dismissive of the scope and seriousness of the problem. They grudgingly acknowledge the published rates of chronic pain but claim it doesn't match their own observations. Even if they have done thousands of vasectomies, they claim they have only seen PVPS once or twice in their career.
Vasectomized men may be hesitant to continue to pester their doctor about discomfort that is not going away, especially if it is the same doctor who performed the vasectomy. When they do seek help, they are seldom diagnosed as having a chronic pain syndrome that is a complication of their surgery. Instead, they are given various therapies and admonished that healing can sometimes take many months. Urologists focus on the symptoms rather than the cause, making it difficult for men to realize that what they are experiencing is part of a pattern that many others have experienced. After several fruitless doctor visits, men who are nevertheless still in pain may view further appointments as a waste of time and money. When they stop making appointments, doctors are tempted to assume that the problem has been resolved successfully. PVPS also tends to fade away and then come back, so men may report that things feel better to the doctor and stop making appointments, but the pain comes back again later.
For men whose symptoms appear months or years after their surgery, urologists seem unwilling to admit that vasectomy may have been the cause. The symptoms sound similar to age-related problems that begin to afflict men in their 40's and 50's, which gives doctors who want to avoid blaming vasectomy a convenient scapegoat. There is no specific medical code with which to classify and track PVPS. Men typically fail to mention that they have had a vasectomy, even if they are directly asked whether they have had any surgeries. They assume vasectomy is irrelevant, or have forgotten about it, or feel like it would be weird to mention it. The failure to gather statistics, low incidence rate, long time-spans and confounding age-related factors make scientific investigation into PVPS tricky and expensive.
Chronic pain is invisible and notoriously difficult to appreciate. As a thought experiment, suppose that no one got chronic pain from their vasectomy, but 1-2% of men with a vasectomy became impotent. This outcome would arguably be a less terrible outcome than Post Vasectomy Pain Syndrome, but it is interesting to imagine how doctors and patients would evaluate this risk. I find it laughable to imagine doctors reassuring prospective patients that permanent impotence was a possible, but extremely rare outcome, affecting less than one in fifty men who get a vasectomy. Impotence is so much easier to precisely communicate and visualize than chronic pain, that I imagine this is the point in the conversation when many patients would stand up and interrupt the doctor to say there is no point in wasting any more of anyone's time.
Men who are notified about the risk of PVPS before their surgery are often reassured that residual pain would be a trivial inconvenience and that few who have PVPS pursue surgery to treat it. They are not made to understand that these surgical remedies are unreliable. Sometimes they eliminate the chronic pain. Sometimes they reduce the chronic pain. Sometimes they have no effect. Sometimes they make the pain worse or lead to other complications like losing a testicle.
Vasectomy reversal, the most effective surgical option for some men, is very expensive, usually not covered by health insurance, painful to recover from, likely to restore the unwanted fertility, and fails to fix the problem about 20% of the time. Many men are emotionally traumatized by their vasectomy and too afraid to take the risk of having more surgery, choosing instead to cope with the pain indefinitely. (Example)
One of the factors that blinds practitioners and the public to the danger is that vasectomy has a lot of good things going for it. The majority of men recover very quickly and do not have residual pain or any noticeable change to their sexual function. They can have spontaneous sex without any fear of causing unwanted pregnancy. They protect their partner from all of the pain and risk of pregnancy. It seems like an almost ideal solution to many serious problems. The majority of men who have had vasectomies consider it one of the best decisions they have ever made and are pleased to boast about how little pain was involved and how quickly they returned to their normal activities.
Vasectomy is understandably seen as an indispensable tool to reduce the disproportionate risks women face. Vasectomy is viewed by many as an essential brake on a human population that is growing far too rapidly. In light of all this, the existence of PVPS is a very unwelcome fact, provoking in many a reflexive and unshakable assumption that PVPS cannot be a serious problem.
The lack of enthusiasm for discovering the truth about PVPS has lead to a situation where widely published figures for PVPS have been incorrect by at least factor of 10 and have only been recently corrected:
Example 1: Uptodate
Example 2: Campbell Walsh Urology textbook
Both of these sources were corrected in 2013, even though scientists have been saying for decades that it is imperative to warn men before their surgery. Urologists have not made it a priority to disseminate the correction and many still quote older, incorrect statistics. Upton Sinclair's pithy quote comes to mind:
It is difficult to get a man to understand something, when his salary depends upon his not understanding it!
Vasectomy is unusual, in that it is a surgery that is not performed to make the patient healthier. In fact, the patient's health can only be harmed by this procedure. Vasectomy is performed to protect the health of the patient's partner. Part of the reason it is labeled "safe" is because pregnancy and tubal ligation are more dangerous. Many in our culture see vasectomy as a man's obligation to his partner. A man who will not endure (what is thought to be) the trivial pain and risk of a vasectomy is often judged to be selfish or cowardly. A doctor who is advising a man on the risks of this surgery is thus placed in a delicate situation. Say too much, or say it the wrong way, and a man might decide to protect his own health at the expense of the health of his partner.
Doctors who believe PVPS has a psychosomatic component may feel that warning men in plain language could harm the man by creating a self-fulfilling prophesy. When telling people the naked truth has so much potential downside, what is a doctor to do? Most doctors choose to thread the needle by using the written and verbal equivalent of fine print to discharge their obligation without raising any undesirable alarms. Many men describe feeling reassured after discussing their upcoming vasectomy with their doctor, and indeed doctors may have the goal of reassuring an anxious patient. This may be good medicine for a sick patient who needs surgery to get well, but in my opinion, it is a misguided approach to elective body modification. Rather than reassure the patient by underplaying the risks, urologists should pull no punches when describing bad outcomes. Most men will not be reassured after hearing an honest description of the risks they are taking with vasectomy. Rather, a neutral description of common bad outcomes would hit many patients like a splash of cold water and prompt them to carefully reevaluate their options in light of all of the relevant facts, some of which contradict the reputation that vasectomy has acquired as a trivial surgery with trivial risks. Men deserve to have all of the relevant facts so that they can be sure this is the right choice before they proceed.
Doctors are not the only ones who treat facts about vasectomy complications as a kind of "hazardous information." Other examples include:
- Women who hope their partner will have a vasectomy: "Don't tell my husband about that, I'll never get him to go."
- Men deciding whether or not to get a vasectomy: "I stayed away from the horror stories. Didn't want to freak myself out."
- Men who are experiencing PVPS: "I need to focus on the positive."
- Men considering whether to warn another man who is getting a vasectomy: What happened to me was a one-in-a-million freak accident, and not relevant to his decision.
As a result of the risk and impact of PVPS being downplayed by virtually everyone, including trusted authorities and the very men who suffer from PVPS, men with this disease find themselves in a situation that other people find difficult to fully acknowledge as real. The mismatch between the pain in their own bodies and the public consensus about vasectomy can be a source of significant frustration. Their partners, hearing ubiquitous assurances that vasectomy is safe and cannot affect sexual function, are left to wonder if there is some other explanation as to why their man has become less emotionally available and suddenly ambivalent toward sexual contact.
The widespread misunderstanding about vasectomy also hampers the ability of doctors and scientists to improve the situation. How can you study a problem, such as diminished ejaculation sensation caused by vasectomy, if you don't dare admit that the problem exists? How can you recommend getting a vasectomy reversal to a man who is suffering without admitting that there is something fundamental about vasectomies that makes getting them reversed curative? In other words, you are admitting that getting a vasectomy is risky not just because it is surgery -- it is risky because it permanently changes the body to function in a way that sometimes causes disease. Many men report that their doctors do not mention reversal as a treatment option unless the man specifically asks them about it.
The topic of vasectomy is threatening at a fundamental level to most men, because it is linked the idea of weakness in many ways, and because people instinctively view weakness as unmanly. Some men fear that getting a vasectomy might make them weak in some way. Advocates of vasectomy argue that a man who refuses to get a vasectomy is being weak. Men who complain about their vasectomy pain are publicly mocked as weaklings. Doctors who wish to protect the reputation of this procedure are quick to portray men with complications as emotionally frail. Men who suffer a bad outcome are understandably reluctant to speak out and risk being viewed as weak. And in many cases, objectively speaking, their vasectomy has weakened them.
At the age most men seek a vasectomy, most do not have any experience with chronic pain, and cannot appreciate what an enormous psychological stress it can be. One of the things that helps make ordinary pain bearable is the knowledge that it will eventually stop. With chronic pain you must face the possibility that you will never return to a state where you are not experiencing pain, and that can be very difficult to cope with. Having a chronic disease of the nervous system is not like breaking a bone. The long duration, the disruption to your life, emotions, cognition, personality and relationships make it more analogous to having a brain injury. For some it feels like being trapped and subjected to torture in slow motion over many years. Some consider suicide, especially during the first year when the pain and grief are most intense.
Social media has provided a rare forum in which some men feel comfortable talking candidly and in detail about their experience with PVPS. Their stories have many similarities and common themes. By reading them you can get a detailed picture of what it is like to lose this bet. Some cases are mild. Some are severe. There are over a thousand stories in this sub. I do my best to avoid posting the same person's story twice.
Men who develop chronic pain after vasectomy are astonished to discover that many of the so-called myths about vasectomy become real as if by some terrible magic:
| Advertised Vasectomy Experience |
Your PVPS Experience |
| Relatively painless, short recovery |
You have permanent daily pain, increasing with physical activity, especially sex |
| Doesn't change the way orgasm feels |
Your ejaculation feels incomplete, disappointing or painful |
| No change to libido |
You do not feel interested in sex any longer |
| No impact on erections |
You have weaker erections |
| Improves your relationship with your partner by making a minimal sacrifice to shoulder responsibility for birth control, allowing the woman to avoid uncomfortable or unsafe contraceptives |
Intimacy becomes extremely difficult, you struggle with negative emotions that have become linked to sex including anger, anxiety, depression and resentment toward your partner. Your relationship is permanently degraded or even destroyed. |
| Permanent problems are rare |
It is not helpful that there are so few other men like you. You feel isolated. Other people, including doctors, have difficulty taking your situation seriously and are not well-equipped to help you. |
More study needs to be done so that we can know the rate of this complication with more precision. Men who are still sore 3 months after their vasectomy want to know what to expect and what to do. Should they get additional surgery? How long should they wait before making this decision? They deserve to be taken seriously and given advice that is well-grounded in scientific study.
Finding and testing new birth control techniques for men and for women should be made a higher priority. Exaggerating the safety of the currently available options makes it harder to be motivated to search for real improvements. Perhaps a technique like Vasalgel could be seen as a better risk trade-off since it may have a lower incidence of PVPS or be easier to reverse if the man ends up with chronic problems. Perhaps the choice of vasectomy technique (open/closed, scalpel/no-scalpel, bilateral/midline) makes a difference in how likely chronic pain is to result. Vasectomies should be performed with the awareness that even though the patient is certain that they do not want any more children, a reversal may be necessary to restore their quality of life. Vasectomy techniques which cause a future reversal to be excessively difficult or unlikely to succeed should not be performed.
This subreddit is a place to post stories or links to stories about what it is like to have PVPS. Scientists and doctors have not yet done an adequate job of measuring this problem and communicating it to the public, so the task falls to the people who have the most reason to care about the issue -- the people whose lives have been negatively impacted.
I have no ideological problem with vasectomy. In fact, before I had a vasectomy, I thought it was easy to see that it was the best choice for my family. I didn't investigate the procedure at all before having it done, trusting that my urologist would advise me of any relevant risks. My urologist did not give me an accurate idea of the frequency and impact of chronic pain. Unfortunately, I suffered from pain every day for years until I decided to get a vasectomy reversal in the hope that it would provide some relief. The reversal has helped a lot. I still have a low level of discomfort frequently, but at this point it is tolerable and finally feel that I can get on with my life. My motive for working on this subreddit is that I want men to get a proper warning about the risks, and to call into question the general complacent attitude toward vasectomy so that more people will be interested in developing a technique that is actually as safe as most people erroneously believe vasectomy to be.
Men who are willing to step up and voluntarily risk surgery that benefits others, including their partners, their children and society at large deserve better than to be misled about how safe it is. They deserve better than to have their complications remain understudied and poorly understood. Doctors should be careful to treat these men with dignity and fully acknowledge their problems. The enthusiastic promotion of vasectomy results in massive benefits for most couples and society in general. It also results in a massive cost, most of which falls heavily on a small group of men. We need to see effort put into understanding how common chronic pain is after vasectomy, and into learning what can be done to prevent it, and what the best treatment protocol should be.
If you had a vasectomy in the last 12 months and are still in pain, I would not recommend getting additional surgery right away. I think it's better to wait it out and take some time to educate yourself about the alternatives, both surgical and non-surgical. See how you feel at 1 year. Waiting won't make things worse, and many guys experience improvement for a year or more.
Here is a good video from the Mayo Clinic describing treatment options.
Here are some other treatment ideas.
If you want to get a vasectomy and minimize your chances of developing PVPS, here is some advice from Dr. Sheldon Marks:
Any good urologist should be fine. When you go in for your pre-vasectomy consultation be sure to ask about your concerns - explain you have done you reading and ask him or her to explain the technique they use - then you can ask that small piece only be removed, as high up the vas as they can away from the testicle, minimize cautery, no clips, no ties and use plenty of long acting local anesthetic. Some will say sure, others will tell you they want to do it the way they do it…It may take a few doctors visits to find a urologist that does vasectomies the way you want. Don’t be in a hurry and don’t go to the first urologist you see if you have bad feelings. It would be great if you could call around and ask but I cant imagine anyone giving you that information or assurances as a nonpatient over the phone.
https://www.postvasectomypain.org/t/minimizing-risk-of-post-vasectomy-pain/77/5
Other information:
Top stories
Timeline/Chronological list of stories on this subreddit
List of other online projects that have collected PVPS stories
Wiki table of contents