Question: What is this lump after my vasectomy?

From Vasectomy.com

I had a vasectomy a year ago and now I have a small pea size lump on my vas deferns and it feels as if the two ends have connected. Is this possible?

This is a common finding following a vasectomy. It can be nothing more than the normal healing process that would occur with any procedure as the body attempts to heal the trauma of the transected vas deferens.

A sperm granuloma again is a natural body response to the leakage of sperm that may have occurred at the vasectomy site.  These areas are sometimes tender to the touch or in certain sitting positions. Uncommonly if the pain is significant enough, a course of antibiotics or anti-inflammatories are necessary. Rarely the discomfort is often enough and bad enough that a patient will request that the can be removed surgically.

I did a vasectomy on a friend of mine who developed a sperm granuloma and it was painful to him about every six months or two years and responded to antibiotics, although there is no real scientific reason for this. The after a few years, it stopped bothering him.  He would call and say, “John, my sperm “granola” is back.” J.M.

ANSWERS FROM DOCTORS (3)


2 months ago by Steven K. Sterzer, MD

Yes, you may have had a sperm leak early on post-vasectomy that the ever magnificent body healing process took care of. The pea-sized lump is probably what is called a granuloma. This is of no clinical significance, unless you wish to get a reversal of the vasectomy. In that case, the reversal success rate will be higher than if this did not occur. Best wishes!


2 months ago by Mark J. Saslawsky, MD – Memphis Office

It’s typical for the vas ends to “approximate”, but they rarely reconnect. The knot could be scar tissue or a cyst from back pressure.


2 months ago by Randy Brett Ackerman, MD

If the semen analysis shows no sperm, then you should not be able to father a child. Small pea-sized lumps following a vasectomy can happen, but there is no indication from them that the procedure has failed.

What’s the skinny on the No Needle Vasectomy?

I have been using the Madajet Injector for many years. It works better on thin scrotal skin than that with prominent rugae. For the anxious male, of whom there are many, the urologist stating “I am not using a needle” and the patient not seeing a needle is a beneficial aspect of this device.

No-Needle Anesthesia Reduces Pain Before No-Scalpel Vasectomy

Urology – March 15, 2008 – Vol. 24 – No. 01

No-needle jet anesthesia results in reduced pain only at initiation of vasectomy compared with traditional needle administered anesthesia.

Article Reviewed: Comparative Analysis of Effectiveness of Two Local Anesthetic Techniques in Men Undergoing No-Scalpel Vasectomy. White MA, Maatman TJ: Urology; 2007; 70 (December): 1187-1189.

Comparative Analysis of Effectiveness of Two Local Anesthetic Techniques in Men Undergoing No-Scalpel Vasectomy.

White MA, Maatman TJ:
Urology; 2007; 70 (December): 1187-1189

Background: Improvement in vasectomy technique occurred with the introduction of the no-scalpel vasectomy. This still requires anesthesia of the skin, which traditionally requires use of local anesthesia via a hypodermic needle and associated pain. Introduction of the no-needle jet injection of aerosolized local anesthesia has claimed to reduce pain from vasectomy further. Objective: To compare the visual analogue pain scores after using no-needle jet anesthesia versus needle delivery anesthesia at the time of no-scalpel vasectomy. Design: Prospective, single blinded, nonrandomized study. Participants: 50 men (age range, 26 to 45 years) undergoing no-scalpel vasectomy. Methods: With each patient, 1 vas deferens was anesthetized with the MadaJet XL no-needle jet injector utilizing 0.3 mL of 2% lidocaine with epinephrine and the other side was anesthetized with mepivacaine through a 27-gauge needle. The patient was blinded to which method was used on each side. Visual analogue score questionnaires were given to each patient to assess pain at time of anesthesia and for the procedure to follow.

Results: The average visual pain score for the jet injection side was 1.56 of 10 and the needle injection side was 2.12 of 10 (P <0.029). There was no significant difference in the visual pain score for the vasectomy procedure itself after the 2 anesthetic methods.

Conclusions: No-needle jet infiltration of local anesthesia results in less pain at the time of the injection, but does not change the pain score for the vasectomy itself.

Reviewer’s Comments: This is the first study to compare a different anesthetic delivery system, the jet infiltration, versus traditional injection therapy. The study was powered appropriately to ensure a potential difference could be seen although only 50 patients were included in the study. The study was unique because both techniques were performed in each patient, and therefore eliminating any immediate differences between patient populations. It was also a single surgeon experience. As new technology develops to make vasectomy as “pain free” as possible and thereby more acceptable to men, more attempts at evidence-based practices like this should be performed. (Reviewer–Ajay K. Nangia, MBBS).

Epididymitis after Vasectomy-How common?

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From Vasectomy.com

Epididymitis and Vasectomy

Epididymitis is an inflammation or infection of the epididymis—a long coiled tube that is attached to the upper part of the testicle and is used to store sperm. It’s a rare complication that, if it occurs, usually hits during the first year following a vasectomy. Occasionally, however, it can manifest years after the procedure.

Common symptoms of epididymitis include:

  • swelling of the testicles
  • mild to severe pain in the scrotum
  • low-grade fever
  • pain when ejaculating
  • pain in the groin when lifting
  • pain during intercourse

Epididymitis Treatment

Consequently, since epididymitis can be caused by bacteria (and may or may not be a direct complication of vasectomy), treatment often starts with a course of antibiotics to get rid of the infection, combined with conservative therapies of reduced activity and pain management (including non-steroidal anti-inflammatories such as ibuprofen, scrotal support, and applying heat or cold).

If you still experiencing significant discomfort after a few months of conservative pain management, additional treatments for chronic pain may be necessary. These include the use of local steroids, tricyclic antidepressants, or transcutaneous electrical nerve stimulation analgesia.

For the few whose pain is not relieved by non-surgical approaches, surgery can offer relief.

Surgical options include:

Reducing the Risks of Epididymitis

These days, urologists have made some modifications to the vasectomy technique to decrease a man’s risk of developing post-vasectomy epididymitis.

Because one potential cause of inflammation is pressure from sperm building up in the epididymis, an open-ended vasectomy procedure—in which one end of the vas deferens is left uncauterized, thereby relieving pressure and decreasing the likelihood of sperm granulomas, or masses that develop in an immune reaction to sperm that have leaked from the cut vas.

Another technique is preemptive analgesia, in which the urologist floods the vas deferens with a local anesthetic before it is cut. Early evidence suggests that both these procedures can reduce the chances of epididymitis post-vasectomy, but further study is needed for conclusive results.

There is still much researchers and physicians don’t yet understand about epididymitis as a post-vasectomy complication, including what causes it and how to further prevent it. Controlled studies focusing on newer vasectomy techniques, the role of sperm granuloma in the condition and the role of the immune system post-vasectomy will help build a more comprehensive understanding of epididymitus and how best to treat it.

Updated on June 27, 2016

Most common question from the male having a vasectomy? Hint: it is not “when can I have sex?”

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The answer: “Does a vasectomy cause prostate cancer?”

Vasectomy Not Associated With Prostate Cancer

Urology – February 28, 2009 – Vol. 25 – No. 04

There is no association between prostate cancer and age at vasectomy or years since vasectomy.

Article Reviewed: Vasectomy and the Risk of Prostate Cancer. Holt SK, Salinas CA, Stanford JL: J Urol; 2008;180 (December): 2565-2568.

Background: The majority of the literature now has shown no association between vasectomy and prostate cancer. The effect of vasectomy on men with a family history of prostate cancer or on those who underwent a vasectomy at a young age or had an extended period of time since the procedure has been poorly studied due to small sample sizes and short study follow-up.

Objective: To assess the risk of prostate cancer in men by age and length of time to exposure from vasectomy to disease.

Design: Population-based, prostate cancer case-controlled study.

Participants: 1327 men aged 35 to 74 years residing in King County, Washington, with a diagnosis of prostate cancer.

Methods: Cases of prostate cancer were identified from the SEER database for this population. Structured in-person interviews were conducted. Eligible controls were identified by random digit telephone dialing. Analysis based on prostate cancer Gleason score and stage was performed. Analysis was also performed based on demographics, age, prostate cancer screening history (within the last 5 years), family history of prostate cancer, and vasectomy parameters.

Results: 1327 men were eligible for study from the SEER database; 1001 completed the personal questionnaire. In total, 1340 controls were identified, of which 942 were interviewed. The control population showed that men who had undergone vasectomy were older, white, married, non-smokers with higher income and education, and had undergone PSA screening. Of men with prostate cancer and controls, 36% had undergone a vasectomy. Mean number of years since vasectomy in cases and controls was 21.1 years. No significant association was seen between prostate cancer and vasectomy status, age at vasectomy, years since vasectomy, or year of vasectomy. There was no evidence of risk estimates across vasectomy parameters. Risk did not change if men with prostate cancer within 2 years of vasectomy and controls with no PSA screening within 5 years (n=136) were excluded.

Conclusions:

No association was found between prostate cancer and vasectomy, even in men who had a vasectomy performed at a young age or had an extended period of time since vasectomy.

Reviewer’s Comments: This paper is a well-conducted, large case-control study that answers the concern about possible limitations of previous work that reported the lack of association between prostate cancer and vasectomy. This criticism often indicated inadequate follow-up since vasectomy to make this claim. In this study, average time since vasectomy in cases of prostate cancer and controls was 21 years. Multiple variables were looked at including vasectomy in the face of prostate cancer family history and screening. This large study should end the criticism on previous work that did not answer the question of prostate cancer and time from vasectomy. (Reviewer–Ajay K. Nangia, MBBS).

Having a vasectomy improves sex life? Couldn’t hurt.

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Vasectomy May Lead to Increased Sexual Intercourse Frequency

Urology – April 30, 2016 – Vol. 34 – No. 1

Vasectomy is not associated with decreased frequency of sexual intercourse.

Article Reviewed: Relationship Between Vasectomy and Sexual Frequency. Guo DP, Lamberts RW, Eisenberg ML: J Sex Med; 2015;12 (September): 1905-1910.

Background: Men often report the concern that having a vasectomy will impair their future sexual function.

Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.

Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.

Methods: Data were extracted from 2 cycles of the NSFG (2002 and 2006-2008) and analyzed. Men were included if they were previously sexually active and were aged >25 years. Female partners were also surveyed in the NSFG and were included if they were between 25 and 45 years of age. Sexual frequency was compared between men (or male partners of female respondents) who had a vasectomy and those who did not. The database captured sexual intercourse frequency over the preceding 4 weeks.

Results: A total of 5838 men met inclusion criteria, with 353 of these having a previous vasectomy. Men who had a vasectomy engaged in intercourse at a mean rate of 5.9 times per month compared to 4.9 times in men who had not had a vasectomy (P =0.0004). Additionally, men who had a vasectomy were less likely to have not engaged in any sexual intercourse in the preceding month. In the survey of female partners, 5211 women responded regarding their male partners, and 670 partners had a previous vasectomy. Again, men with a previous vasectomy had a higher frequency of sexual intercourse during the previous month (6.3 vs 6.0), although this difference was not statistically different (P =0.1341).

Conclusions: Vasectomy does not appear to negatively influence sexual frequency.

Reviewer’s Comments: The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy. Previous reports have investigated if vasectomy has any effect on sexual function and satisfaction, with most finding minimal to no effect on sexual function. In fact, some reports have demonstrated improved sexual function with improved sexual satisfaction, likely due to the loss of anxiety about unwanted pregnancy. The authors of this article demonstrate through objective survey results that sexual frequency does not decrease and may increase with vasectomy. While no explanation can be extracted from these data, the results are encouraging and can certainly be mentioned while counseling men before vasectomy.(Reviewer–Charles Welliver, MD).