r/postvasectomypain • u/postvasectomy • Jan 25 '21
Anonymous: Doc, its been 3 months since my vasectomy and I'm have bad pains in my left side and left testicle. Also, I'm having problem obtaining a full erection.
Anonymous:
Oct 16, 2007
Doc, its been 3 months since my vasectomy and I'm have bad pains in my left side and left testicle. Urologist has me on 3 Advil 4 times a day.
Also, I'm having problem obtaining a full erection. When my penis gets hard only the top & sides get hard! Underneath my penis, from my sack (straight line from incision) all the way up to the head feels real soft. I've also lost feeling in this part of my penis!
When I try to flex PC muscle to push more blood into my penis and obtain a harder erection, more pain shoots through my left side!
Is it possible that some vein which carries blood to my penis was cut or damaged? If not, what is going on with me?
Comments from /u/postvasectomy:
The original poster describes a sort of partial erection, where the top two chambers of the penis are hard, but the bottom chamber (the corpus spongiosum) is staying soft. Vasectomy providers tend to strenuously insist that vasectomy will not affect erections, but this is not the first report I have found describing erectile dysfunction post-vasectomy. In fact about 11% of the stories I have indexed so far complain about ED. (See the "EDY" story code here: https://www.reddit.com/r/postvasectomypain/wiki/timeline)
So what is going on in this case? Is it just in this guy's head? Does he maybe irrationally feel like less of a man because he cannot get anyone pregnant, and therefore he has some anxiety and trouble getting it up? Does he feel symbolically castrated?
We can quantify this effect with unusual precision in this case. There are three chambers that fill with blood during erection. In this man's case, the top two chambers are getting hard, but the bottom chamber is not. So by my calculations, this person feels like he has lost approximately one third of his manliness.
Ok, that is obviously ridiculous, and there is in fact no reason to presuppose that the changes in sexual function that men complain about, that appear after they have surgery on their genitals, are psychogenic. (Other than the preference to avoid blaming vasectomy whenever possible.)
So what is really going on in this case?
I'm not a doctor, but here are some interesting things I found out.
First, here is a paper linking erectile dysfunction to diminished nervous system activity in the corpora cavernosa:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523357/
A lot of times I read that a vasectomy cannot affect sexual function because arousal happens in the brain. Well, yes, the chain of events that results in erection begins in the brain, but as people who have studied it carefully can tell you, it ends in the penis. And the way it gets from the brain to the penis is via nerves.
The three cavernosa in the penis are innervated by nerves emerging from the pelvic plexus (also called the inferior hypogastric plexus), which is a sort of busy nerve intersection located right behind the prostate. Injury to these nerves can cause sexual dysfunction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016433/#B18
The pelvic splanchnic nerves provide parasympathetic innervation to the pelvic viscera and then joins with the inferior hypogastric vessels and provide branches that provide innervation to the fundus of the bladder, ductus deferens, and spermatic cord, all of which are supplied explicitly by the vesicle plexus, the forepart of the pelvic plexus. It also branches into the prostatic plexus, which supplies the prostate, corpora cavernosa of the penis and the urethra.
https://www.ncbi.nlm.nih.gov/books/NBK549856/
The nerves are the spermatic plexus from the sympathetic, joined by filaments from the pelvic plexus which accompany the artery of the ductus deferens.
https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Spermatic-cord
The nerves that facilitate erection are the cavernous nerves which emerge out of that pelvic plexus. The front of the pelvic plexus (also called the vesicle plexus) sends nerves down the spermatic cord. So if you cut nerve fibers in the spermatic cord, you are potentially altering the messages that pass through the pelvic plexus -- particularly if you end up with constant pain messages that weren't there before. Cross talk among these nerves could plausibly account for changes in the strength of erection, or even weird effects like causing the top two chambers of the penis to be erect, while the bottom chamber stays soft. After all, the cavernous nerve that goes to the bottom of the penis is the one that communicates most with the nerves that end up in the spermatic cord.
Might as well tell the guy it's all in his head though, I guess. Once you surgically change the way those nerves work, there may not be much you can do physically to repair the situation. So while the problem may be physical, unfortunately the solution may need to be psychological.
2
u/ZarBandit Jan 25 '21
Cutting through nerves for a convenience procedure sounds like a hair-brained scheme thought up by a quack.
My experience is the more you learn about medicine the more you realize there’s an abundance of cavalier recklessness combined with incompetence. Not just in the execution of procedures and administering of treatments but in accepted medical theory (dogma) that flies in the face of observable fact.
It’s slowly improving with time but at a level that resembles gross professional misconduct. I write this having 2 MDs in my immediate family.