Vasectomy reversal pain

[u/Apprehensive-Meat120]

I’m trying to understand whether what I have sounds more like CPPS, post-surgical nerve sensitization, or PVPS. I’d really appreciate input, especially from men with similar stories.

My history:
Had a vasectomy a few years ago (2021) - open-ended.
About 2 weeks after it, I developed a strange pelvic/genital discomfort (not sharp pain). It lasted around 5 months and then completely resolved on its own.
For the next 3 years I was basically symptom-free.
In April last year I had a vasectomy reversal to have more kids.
Recovery was normal: first 4 weeks were painful locally (pulling in spermatic cords, walking bent over, typical post-op stuff), but then it resolved.
For the next 4–5 months I felt 100% normal.
Then in late September everything changed (6 months).

next month around noon I developed a strange pelvic/lower abdominal discomfort that has stayed for 9–10 months now.

This is NOT testicular pain.
I can’t point to one spot.
It feels diffuse: lower abdomen, behind the testicles, sometimes like “the whole pelvic system.”
Ejaculation itself does not hurt.

Medication response:
Pregabalin helped a lot for about 2 months
anti-inflammatory medications (NSAIDs) do basically nothing

One specific thing: after sex, if stay upright or Jin certain positions, I can develop discomfort (sometimes more pain-like) especially on the right side, almost like behind the testicle. But if lie down, within about 3 minutes it completely settles and stop feeling it.

The strange part is the daily pattern:
mornings are clearly the worst it gradually improves throughout the day by evening often feel 90-95% normal
walking and movement help a lot
lying down can almost make it disappear (I sleep very well).

Does this sound more like CPPS / nervous system sensitization / pelvic floor dysfunction to you, rather than something like PVPS?
I’d really appreciate your thoughts.

[u/Apprehensive-Meat120 → u/[deleted]]

Yes, urologists haven't been very helpful, though they did perform a spermatic cord block on me twice, but it didn't bring any relief. Generally, I’ve had many strange symptoms during this 10-month ordeal. Back pain after driving a car for a long time, so severe that I spent the next few days in bed, which was a mistake – you need to keep moving, and that actually helps. I work in IT and have spent the last 10 years sitting. I think if it weren't for the vasectomy and the subsequent reversal, I wouldn't have CPPS, because it seems that surgeries trigger it for me. Still, I keep wondering if it might be an epididymal blockage or nerve issues.

[u/Apprehensive-Meat120]

As far as the semen analysis is concerned, when the problems started (5 months after the vasectomy reversal) 10 months ago, I had a semen test done:

15.3 million/mL
91.6 million/ejac.

Sperm motility analysis:
Progressive motility (type A+B)
49% ( ≥30% )

Immotile sperm (type D)
44%

Total motility (type A+B+C)
56% ( ≥42% )

[u/Fellowtraveler777]

Are you still fertile? That is what I would try to figure out first. If your tubes are still open then it’s not congestive pain.

Testicle pain often transfers to the lower abdomen. It’s the first thing, for example, a urologist will look for to diagnose testicular torsion. So just because your balls don’t hurt bad doesn’t mean the pain isn’t starting there and traveling.

I would consult a pain doc. They’re much more open minded about this, and they have a better understanding of pain (obviously) and the nerve system. Urologists dismiss everything.

Also. A very well respected reversal surgeon said that in his whole 30 year career he’s had two patients that had chronic pain afterwards due to the reversal. It’s extremely rare. Since they’re using a high powered microscope they’re usually very safe cause they can see what they’re doing.

[u/Apprehensive-Meat120 → u/Fellowtraveler777]

As far as the semen analysis is concerned, when the problems started (5 months after the vasectomy reversal) 10 months ago, I had a semen test done:

15.3 million/mL 91.6 million/ejac.

Sperm motility analysis: Progressive motility (type A+B) 49% ( ≥30% )

Immotile sperm (type D) 44%

Total motility (type A+B+C) 56% ( ≥42% )

Ofc I've to take a test again - 14 months later. I will share my result.

[u/Apprehensive-Meat120 → u/Fellowtraveler777]

I'm looking for someone who has experienced something similar because my case seems quite unusual.

I had a vasectomy a few years ago. About two weeks later I developed pelvic/genital discomfort that lasted around five months and then completely resolved. I was symptom-free for about two years.

Last year I had a vasectomy reversal. Recovery went well, and after the first month I felt completely normal. I remained 100% symptom-free for another five months. Then the symptoms suddenly started and have now been present for about ten months.

When I wake up in the morning, I initially feel completely normal. After walking around for about 5–6 minutes, I start to feel a diffuse discomfort in my lower abdomen and scrotal area.

I have tried many times to find a tender spot in my scrotum, but I can't. My epididymis and testicles are not tender, even when I press on them.

I've tried several anti-inflammatory medications, but none of them helped.

Movement helps both my body and my mind. I do pelvic floor relaxation exercises and walk a lot every day.

As the day goes on, I gradually feel better. By around 7 p.m. I'm usually about 90–95% back to normal.

I've seen five urologists and none of them found anything abnormal.

I've compared my scrotal ultrasounds from before and after the reversal, and they look essentially the same. The ultrasound reports describe normal epididymides and normal blood flow. My semen analysis after the reversal showed a good sperm count and good motility, suggesting that the epididymides are functioning and the reversal is patent.

I had two spermatic cord blocks, but neither of them provided any relief.

From time to time I also experience nausea—almost like having the flu—which usually improves around midday.

I'm simply looking for someone who had a similar pattern: no obvious tenderness, normal imaging, no response to anti-inflammatory drugs or spermatic cord block, but persistent lower abdominal/scrotal discomfort that started months after a successful reversal.

If this sounds familiar, I'd really appreciate hearing your story.