New Member Possible PN post vasectomy

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New Member Possible PN post vasectomy

Postby vasregret » Thu Feb 16, 2017 6:28 pm

Hi everyone, I am a 30 year old male and had a no-scalpel vasectomy performed in October 2016. I had heard about PVPS, but thought it was super rare. I was told it was 1 in 10,000, when in fact it's actually more like 1 in 20 or 1 in 50 depending upon which studies you read.

Anyways, the vasectomy went fine, I walked out, went home, put an ice pack on and took some Aleve. No biggie right? Anyways, around 4 days out the pain kept getting worse and worse and on day 7 it was horrendous.

It's been almost 5 months now and the pain is still there. I currently take 150mg of lyrica and 30mg of nortryptline daily, along with tylenol and aleve. All these do is take the edge off and allow me to be somewhat functional.

I have been on the postvasectomypain.org board for a while now, but I am seriously thinking that the vasectomy may have just been a catalyst that started PN for me.

I'll elaborate as to why I think this.

My testicles don't really hurt much at all. Maybe a bit sore when sitting certain ways, but the pain is really quite minimal. The biggest issue I am having is horrific penis pain, burning urethra, burning/pins and needles in the scrotal skin, pelvic/groin pain, tailbone/sacrum and low back pain.

The worst pain is definitely the penis and groin pain. Before I started taking the lyrica/nortryptline combo I would get stabbing shooting electric like shocks in the tip of my penis and around the base. I would also get a pinching type pain in my perineum. Now that doesn't happen quite as often, but I do always have a chafed/burning sensation at the tip of my penis.

I have been doing stretches and relaxation techniques as outlined in the Amy Stein Heal Pelvic Pain book. It helps with the tailbone, perineum, and anal pain, but hasn't really done a lot for the penis pain.

I've seen multiple docs and uros about this, and my current uro has recommended a reversal since I didn't have these problems before the vas (makes sense right?) but there is a small chance it could get worse. And he doesn't really have any answers for the penis pain, which is why I'm exploring the idea of a possible PN diagnosis.

Sitting for long periods of time definitely makes the pain worse the following day. Any strenuous physical activity causes me penis pain (basically it feels like someone's grabbing my penis as hard as they can, along with a burning sensation, hard to describe really, almost like a toothache) and so does bending over. I still get the electric shocks, just not as often. The vibration from long car rides causes a flare in pain, usually for a couple days after.

Oddly enough, my sexual functioning is totally unaffected, but obviously my libido is down because of the constant pain. I can't tell if sex makes the pain worse or better

I should mention that pre vas I would occasionally get proctalgia fugax attacks if I was constipated. They would only last for 10 minutes or so and was a rare occurrence. Never thought much of it. I also had some low back pain and supposedly had IBS, but that was diagnosed over 10 years ago and was resolved by not eating crap junk food. These issues were minor and didn't affect my quality of life. Never stopped me from doing anything.

Now I can hardly work.

Anyways, so maybe I was pre-disposed to PN due to my proctalgia fugax and IBS and the vas was just a catalyst. I know that I was tensing my pelvic floor for about 2 weeks straight post vas. Or perhaps a branch of my pudendal nerve was damaged during the vas. How that could happen is beyond me, although the guy rushed through the procedure (less than 10 minutes).

Sorry for the super long post, but I just want to explore all angles before I jump into a reversal and possibly make myself worse.

Thanks in advance for the help.

Edit: I should mention that I've had a burning sensation in the bottom of my right foot since the vas. Weird right? And sitting on a toilet seat almost totally relieves my symptoms, albeit temporarily.
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Re: New Member Possible PN post vasectomy

Postby Andy_Pablo » Fri Feb 17, 2017 3:37 am

Hi there. I certainly recognise a lot of those symptoms so you have my sympathy. I am not a doctor & can only rely on my own experiences, but I would recommend not doing any strenuous activity while you have these symptoms. "Pushing through" & continuing lifting weights & helping friends move home are what pushed mine over the edge to become completely life changing in a negative way. I would not want that happening to anyone else. Everybodys case is different, but it would probably be an idea to speak to a doctor who specialises in PN/PNE. They will be able to talk you throughways of trying to diagnose, & then help. There are lists of docs here http://www.pudendalhope.info/node/54, depending on which country you live in. I wish you luck in your journey.

Andy.
Credula vitam spes fovet et melius cras fore semper dicit...
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Re: New Member Possible PN post vasectomy

Postby vasregret » Sat Feb 18, 2017 3:42 am

Andy, thank you for the info. I certainly find a spike in pain the following day if I push myself or do core exercises. I mean, the pain is always there, but I usually cause a flare up if I push myself.

I'm in Canada, so my options are limited to Dr. Gordon, but I've heard good things about him.

Would you recommend continuing with the pelvic floor exercises? I find that afterwards I have more nerve pain, but my pelvic muscles feel looser and I have a lot less referred pain.

My experience with PT with a neck problem I had was that it got worse and then better after a few sessions with PT.
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Re: New Member Possible PN post vasectomy

Postby Andy_Pablo » Sun Feb 19, 2017 1:36 am

I dont have any experience with pelvic floor excercises, so Im probably the wrong person to answer that question. If you feel like doing them helps, then it might be an idea to test a period of time when you do the excercises, and then the same time period where you dont do them, & measure the quality of life you have from either. That is what I would do. Failing that, a chat with a pelvic floor specialist might be able to explain the "do's & dont's"... Apologies for the fence sitting... I wouldnt want my lack of knowledge to give bad advice that makes you worse...

Andy.
Credula vitam spes fovet et melius cras fore semper dicit...
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Re: New Member Possible PN post vasectomy

Postby Violet M » Sun Feb 19, 2017 4:37 am

Vasregret,

Regarding symptoms in in your foot, I wanted to point you to the website of Dr. Vancaillie's group where it discusses pudendal neuralgia and symptoms in the feet. Even though it's a women's website the same principal would apply to men.

http://www.whria.com.au/for-patients/pe ... neuralgia/

Are the core exercises you are doing listed in Amy Stein's book? You mentioned strenuous physical activity and lower back pain. I am wondering how tailbone, sacrum, and lower back pain would have anything to do with a vasectomy. Were you already engaging in strenuous physical activity before the vasectomy?

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: New Member Possible PN post vasectomy

Postby vasregret » Sun Feb 19, 2017 6:49 pm

Violet, thank you for that info.

The core exercises aren't listed in Amy Stein's book. I used to do a 10-20 minute high intensity workout everyday before the vas, which consisted of planks, sit ups, push ups, running and weightlifting. I usually alternated some of these exercises. Post-vas, I can barely exercise as it causes a flare up in pain, particularly the planks, sit ups and push ups.

I used to be very active pre-vas, exercise, yardwork, cutting firewood, heavy lifting etc, sometimes for 12+ hours a day on the weekends. The only issue I would have is a bit of low back pain when bending over and lifting something, but it wasn't severe and I never sought medical attention because of it.

Interestingly enough, a lot of members on postvasectomypain.org have complained of low back pain, leg or thigh pain post-vas. I've come to learn that there are branches of 4 major nerves in the scrotum (iliohypogastric, ilioinguinal, genitofemoral and perineal branch of the pudendal) and damage to any of these nerves during the vas can refer pain anywhere along the nerve.

I wish I had read more about this crap before getting it done, but I thought 'how could such a simple procedure cause any issues?'
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Re: New Member Possible PN post vasectomy

Postby Violet M » Mon Feb 20, 2017 3:31 am

Well, it's really unfortunate this happened to you. I just watched a you-tube video on how the procedure is done https://www.youtube.com/watch?v=M2C1ZggmaK8 and I can see how it could be painful. It looks like they leave some little clips in. I don't know if there would be any merit in having the procedure reversed in case those little clips were irritating something but then it seems unlikely because it sounds like your primary pain isn't scrotal. There is a branch of the pudendal nerve that innervates the skin of the scrotum so I suppose there is a possibility that nerve was irritated or damaged during the procedure. Or possibly scar tissue developed around that nerve. Also I noticed they put a rubber band on the penis to hold it in place during the procedure and I wonder if that might have damaged the dorsal nerve. It seems like healing would have taken place afterward though.

I wonder if there would be any merit in having an evaluation by a PT or manual therapist who specializes in the pelvis just to rule out any pelvic instability or sacro-iliac joint dysfunction, given your history of exercise. Or to rule out tension in the pelvic floor muscles that might have developed in response to the post-procedure pain. Often with pudendal neuralgia there can be more than one thing in your background that contributes to it and sometimes a procedure or incident such as your vasectomy can be the straw that breaks the camel's back so to speak and causes you to start having symptoms. Seems like it might be important to rule out any other underlying causes.

I continued to do stretches and certain exercises after my initial PN pain and while it felt good immediately afterward it generally caused a flare-up in nerve pain and over time the nerve pain escalated. So I guess I would caution you against continuing exercises that increase your nerve pain.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: New Member Possible PN post vasectomy

Postby vasregret » Wed Oct 18, 2017 8:56 pm

Hi everyone, just wanted to post an update.

In April/May I weaned off of all meds, except for extra-strength tylenol throughout the day. To be honest, I don't think that the lyrica and nortriptyline were really doing anything.

I started taking a supplement, alpha lipoic acid 600mg 1x day (there's research showing it to be helpful for peripheral neuropathy) and it did help. I was skeptical about it.

My nerve pain improved a little bit and I'm able to work, albeit carefully.

From about May/June onwards my scrotal pain started to increase and I was getting stabbing pains up the spermatic cords into my abdomen, yet I had almost no perineal pain. The penis pain continued and sometimes it's like a chafing/sunburn sensation and other times it's like an awful squeezing feeling.

My urologist recommended a reversal, as it had a low potential for making PVPS worse and it sometimes can help guys who have scar tissue or nerve damage from the vasectomy, but he literally said it was rolling the dice.

So I took the plunge and got reversed. I'm about 5 weeks out now and although the surgery wasn't painful and I returned to baseline pain in about 10 days, I've had basically zero improvement. The right side of my scrotum hurts, I have bilateral testicular pain still, spermatic cord pain, and of course the same penis pain, perhaps slightly worse and pain in my right thigh. I feel like the reversal was pointless to be honest.

When I mentioned in my earlier post that I had tailbone pain etc. I think I was mistaking where the pain was coming from. Basically I've had rectal pain/pressure on and off since the vasectomy and I think it's more of a pelvic floor spasm/issue than anything. I know I'm fearful of causing pain and my pelvic floor tightens and I have to breathe deeply to relax it.

So... at this point, my next step is pelvic floor physio and I have an appointment booked for next month. I've also reached out to Dr. Eric Williams and he has recommended that I get some nerve blocks done here locally and if they're successful I may pursue nerve resection with him.

Can anyone tell me what I should expect at a pelvic floor PT? Is it even worthwhile?

Thanks.
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Re: New Member Possible PN post vasectomy

Postby Violet M » Sun Oct 22, 2017 5:33 am

Hi Vas,

I'm sorry the reverse procedure didn't work out for you.

I think with PT, it depends on who you are seeing, but for me it was well worth it because they were able to evaluate whether my pelvic floor was tense, whether there was pain or tenderness along the course of the pudendal nerve, specifically at the ischial spine and alcock's canal, and whether I had any musculoskeletal anomalies such as SI joint dysfunction, pelvic misalignment, piriformis pain, which pelvic floor muscles were in spasm, and whether I had any strained ligaments.

Even though surgery was part of the solution for me, I believe that PT significantly helped in my recovery. Some people have been able to avoid surgery with PT. So will it be worthwhile? I can't say for sure but since there is a possibility that it will, I think it makes sense to at least be evaluated.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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