Intended for healthcare professionals

Rapid response to:

Clinical Review

Investigating and managing chronic scrotal pain

BMJ 2010; 341 doi: (Published 06 December 2010) Cite this as: BMJ 2010;341:c6716

Rapid Response:

How disabling is post-vasectomy pain syndrome?

Attendees at our annual BANSV conferences have often expressed
concern regarding the true incidence of post-vasectomy pain syndrome. The
article from Keoghane and Sullivan quotes 1-15%, although severe pain
perhaps 1-6% in men followed up for 10 years. The summary highlights the
highest figure of 16% of men developing a chronic pain syndrome. Surely,
if 1 in 7 men were developing this as a complication, and it became severe
or disabling, then the procedure would rapidly disappear from practice. So
earlier this year I undertook a simple audit and identified 208 patients I
had vasectomised between 2002-2005 (ie 5-8 yrs post-op) for whom the GP
records (including attendances at walk-in centres and A/E) could be
viewed, either by myself (with permission) or by the patient's own GP. 10
of these records were incomplete in that at varying times they had left
the original GP practice.
My results showed:
I referral for a ?neuroma (probably a spermatocele)
I presented once with unilateral pain 2 yrs later, an USS confirming post-
vasectomy hypervascular changes - no further GP consultations
1 presented once with a recurrent ache 18m later (but no further
I presented once with recurrent unilateral pain 3 yrs later, with no
further consultations after reassurance
I referral for PVPS (timing not recorded)
Although a small study, this showed that only 1 person (0.5%) developed
'disabling' pain requiring onward referral, as I believe it could
reasonably be presumed that anyone with disabling pain would attend more
than once with their GP.
However, it is still important that this complication is mentioned and
included in any consent for vasectomy.

Competing interests: I am president of BANSV (British Association of Non-Scalpel Vasectomists) and have contracts for providing vasectomies in the community and having performed more than 4000 vasectomies.

24 December 2010
Tony R Feltbower