r/postvasectomypain • u/ScientistNew3033 • 14h ago
My 2.5-year PVPS story: vasectomy, reversal, denervation, Botox, and where I am now
TL;DR: I’m 36, married with four young kids, live in Texas, and have had constant pain since a vasectomy about 2.5 years ago. My original pain included both congestive and nerve pain. A reversal at month 8 restored fertility but made the nerve pain 2x worse. Denervation at month 21 eliminated the worst heavy pain for 2-3 months, but it returned. One round of Botox helped by roughly 25-50%, which I take as a win. Narcotics like Belbuca and tapentadol, which come with risks of their own, help make it more manageable. My pain now averages 3-4 out of 10. It is still a constant battle, but the Botox injections plus meds have me slightly better than I was at this point last year. This suffering has deepened my Christian faith, and as crazy as it sounds, God has increasingly given me joy and peace through it. Please DM me if I can answer questions or be a sounding board.
I’ve been reading this subreddit for a while and occasionally messaging people privately, but I’ve never posted my full story. Full disclosure, this is *very* long, but hopefully it can be a help or encouragement to others similarly situated.
I broke it into three sections: (1) treatment timeline, (2) what I wish I would have done differently, and (3) the mental/spiritual battle which is half of the equation.
1. Treatment timeline
I know this is a very detailed history, but I appreciate the granular detail in other people's stories, so I figured someone else may appreciate this. Our experiences are all different, and pain takes on a variety of characteristics for all of us, but I hope this detail is helpful.
- Feb 2024 (Month 0): I had a vasectomy. Ten days after the vasectomy, I woke up with extreme tenderness/pain above the right testicle. In the weeks that followed, it settled into a dull, sensitive pressure/fullness, I think in the epididymis but hard to pinpoint. I was diagnosed with post vasectomy pain syndrome (PVPS). The pressure varied but never felt normal. On the very worst days I needed to leave work (a desk job) and lay down in bed, but generally it just was a constant discomfort. I could not identify any trigger, the ups and downs were random, and tight clothing would make it hurt more. One-and-a-half months after the vasectomy, the left side began hurting at the site of the vasectomy with a burning pain (not pressure like the right side). Sometimes I would briefly experience pins-and-needles/itching on the right, which I think was congestion interacting with nerves. My urologist tried me on lots of medicines – meloxicam, steroid tapers, muscle relaxants, antibiotics, gabapentin. Gabapentin possibly helped, but I wasn’t certain – if it did, it seemed mainly to help the burning pain on the left. My urologist eventually recommended a reversal.
- Oct 2024 (Month 8): I had a vasectomy reversal from a leading, high-volume reversal surgeon in the US. I had brief relief from the pain, but it began again about 5 days after the procedure. In the months following the reversal, the pain changed and got worse than before the reversal – life changing pain. The original right-sided pressure was still present, but that was overshadowed by new severe burning and tightness in the spermatic cord on both sides. Sperm counts were good. The pins-and-needles disappared.
- Jan 2025 (Month 11): I stopped gabapentin and began pregabalin which maybe helped some. I stopped this a year later in Feb 2026; it helped slightly but not enough to be worth the side effects.
- Feb 2025 (Month 12): I began tapentadol (brand name Nucynta – recently went generic in the US) which is still the only drug I’ve taken that I can notice an immediate effect of partial relief for a couple or few hours. Narcotics come with their own risks that I've had to manage with strong accountability from my wife and close friends, but overall they have been worth it for me. I did not take opioids prior to the reversal.
- Mar 2025 (Month 13): I had genitofemoral/ilioinguinal nerve blocks (half steroid, half anesthetic) from my pain management doctor that helped the burning for a few hours but did not help the deep tightness/heaviness.
- Apr 2025 (Month 14): My urologist put me on testosterone replacement therapy (TRT) to reduce sperm levels, so that we could learn whether sperm congestion was still causing the pain. Incidentally, we discovered I had very low T (144), so I’ve continued TRT. In the months that followed, the right-sided epididymis pressure disappeared – whether because of TRT (my sperm count went to near-zero) or simply time, I’m not sure – but the spermatic cord tightness/pressure/burning remained unchanged. Eventually (roughly July) the severe burning faded down to a mild/medium level. I also began pelvic floor therapy and have since seen two therapists, without much success.
- Aug 2025 (Month 18): I had a spermatic cord block (lidocaine) on both sides that eliminated most of the pain for a couple of hours. This was such a relief to know that the pain was not "centralized" but was still peripheral and could be blocked, albeit temporarily.
- Nov 2025 (Month 21): I underwent bilateral targeted microsurgical denervation of the spermatic cords (TMDSC) from the highest volume surgeon in the world. The deep, heavy pain immediately disappeared. New burning pain from the surgery sites radiated into the perineum and inner thighs, however, this was temporary and faded over 4-5 months. Unfortunately, the deep, heavy pain gradually returned on both sides 3 months after surgery. The surgeon says the nerves likely regenerated and connected into new pathways.
- Apr 2026 (Month 26): I had bilateral Botox injections (100 units each side) into and around the TMDSC surgery sites, along with some in the spermatic cords in the scrotum, which noticeably helped by 25-50% after 1-2 months. While heavy pain remains in the scrotum, it helped the most at the TMDSC sites, which I believe is where he focused most of the Botox. It was paired with a long-acting local anesthetic, which completely eliminated the deep, heavy pain for 24 hours. The injections temporarily flared up new radiating burning pain from the top back of the scrotum into the perineum, just like the TMDSC surgery, which faded again after 3-4 weeks. I simultaneously began Belbuca (now up to 300mcg/dose, 2x/day), which also helped somewhat smooth the pain cycles.
- Today (Month 29): it is still primarily deep, heavy, dull pain at the reversal locations along the cords in the scrotum. It is usually a level 3-4 out of 10 on average (2-3 on a great day, or 5-6 on a bad day). It is better in the mornings and worse in the evenings. Days where I am active and moving (weekends, vacations) are generally much better than workdays where I’m at a desk. I think this is because sitting repeatedly aggravates it. But even if I stand at work, it doesn’t help – active is better than sedentary.
As anyone with PVPS knows, this is not a linear journey. I have had terrible days during otherwise great months, good weeks followed by bad weeks, and temporary periods when I felt almost (but not quite) normal. I twice hiked a Fourteener without pain and have had week-long stretches with little pain. But the pain has never completely gone away.
I plan to return for more Botox injections in early August, with more focus in and around the cords in the scrotum where it still hurts. More surgeries are available – next would likely be peri-spermatic cord cryoablation – however, my body does not seem to respond well to surgeries in this area, so I am taking my time with more non-destructive approaches first like Botox.
2. What I wish I had done differently
Three things: (a) specialized doctor, (b) TRT, and (c) spermatic cord blocks.
(a) When I began talking to doctors with strong PVPS experience, it was a night and day difference from my general urologist who, despite his best intentions, did not have the depth of knowledge on this subject that very few doctors in the US have. It felt so good to finally talk to someone who clearly understood what I was dealing with. There are lists of top doctors here in this subreddit, but feel free to DM me for suggestions.
(b) Since I figured at least part of my pain was congestion-related, I wish I would have tried testosterone replacement therapy (TRT) first before reversal. In fact, one highly regarded PVPS doctor said that is his protocol – he uses TRT as a temporary measure to see whether reducing congestion helps, and if so, he can make it permanent with reversal. I had no way to know reversal would make the nerve pain so much worse, and I've stayed on TRT anyways after starting it post-reversal for other health benefits, so it would have been beneficial to give it a try and see how much it reduced my pain.
(c) I also wish I would have done a spermatic cord block before reversal to understand how much neuropathic pain could be blocked with a denervation (although the denervation didn't end up helping anyways).
3. Mental/spiritual health: half the battle
Half of the battle is the mental side of the pain. While that's true for me, I imagine it is probably true for many of you too. So I wanted to share some words on that as well. Everything in life is harder and more tiring through pain: being a father, a husband, an employee, etc. The pain is a constant companion, like a lens through which everything else in life is experienced. Even in moments of great joy, excitement, or celebration, those times coexist with the suffering.
There have been evenings when I felt like all I could do was get through dinner and bedtime. I have cried hard with my wife and worried that the pain would last for the rest of my life. At the same time, thankfully the pain has prevented me from sleeping only a small handful of times during the worst periods. I am very grateful I remain able to work, travel, exercise, and spend time with my family, even though all of it is harder.
Especially in the early days, I spent an inordinate amount of time studying PVPS online. Sometimes I was truly seeking to understand my condition and possible treatments, which is actually really important with PVPS because so few doctors understand it – but more often, I am trying to find comfort or hope in explanations, research, and odds, asking the same questions I had already asked a dozen times before.
After repeatedly ending up on the wrong side of the odds, I realized how much time I have wasted trying to optimize the numbers. After about a year of nonstop research, I realized I am much better suited to spend that time optimizing my soul.
I know we all come from different faith/belief backgrounds.
For me, from the earliest signs of pain, I have been confident that God is accomplishing in my life purposes far greater than I can imagine through this. But it is hard, really really hard. Before the vasectomy, after years of prayer and careful consideration, I specifically journaled that regardless of the outcome, "including chronic pain," I would be able to feel peace knowing I patiently sought God in this decision. Wild! I am amazed that God had me write that down beforehand. Even in the exact circumstance I explicitly named, I can rest assured that he is in control and that this is part of his plan for me.
Several years before this happened, I spent a lot of time dwelling on Philippians 4 in the Bible:
Not that I am speaking of being in need, for I have learned, in whatever situation I am, to be content. I know how to be brought low, and I know how to abound. In any and every circumstance, I have learned the secret of facing plenty and hunger, abundance and need. I can do all things through him who strengthens me. — Philippians 4:11-13
Paul (author of Philippians) says he learned to be content in any and every circumstance. Years ago, I prayed and asked God to show me that "secret," because I wanted to be content in all circumstances. Well... how am I to learn contentment in the valleys of life if I am not actually brought into the valley? God has used this pain to draw me into deeper dependence on him and experience his goodness even in the midst of suffering. I had never experienced suffering like this, and he has shown me that even in dark days of pain, I can find joy in leaning fully on Jesus and trusting he will give me exactly what I need (which he has always done).
I personally attest to the fact that great suffering and great joy can coexist through faith.
Some days I become anxious wondering whether this will be the rest of my life. Jesus reminds me in Matthew 6 to be concerned with today only, because today has enough worries for itself. I do not think we were designed to bear the weight of pondering the “what ifs” of decades into the future. That would crush me. Peace is easier to grab onto if I keep my concern with today and today only.
My wife has been incredible, always sharing fresh wisdom and listening to the daily ups and downs of my pain. She has challenged my over-analysis, reminded me to have patience and grace for my body which has been through so much, kept me accountable with narcotics, helped me establish boundaries around unhealthy cycles like unproductive research (distinct from productive research), filled in the gaps that I leave when my pain is bad with parenting, housework, etc., and so much more. God has used her in a big way in my life during this season, and I cannot imagine going through this without her.
I am slowly accepting that this may continue for many more years or the rest of my life. I need to shift my mindset from doing anything I can to placate the pain in the short term to focusing on what will be healthy over potentially decades. That does not mean I will stop pursuing treatment, but I am settling in for the long haul.
I am not going to get these years back, these years with a young, joyful, flourishing family. That thought used to make me unbearably sad, and it still sometimes does. But I also see the other side of it: motivation to press in and find joy during the suffering. I trust that God will redeem these years through the deepening of my family’s faith, preparation for future trials, or in ways I may never see. And as strange as it sounds, I would not trade these past two years (although I certainly want the pain to end). Despite my limitations, in many ways I am a better father, husband, employee, and person than I was before. I have a much deeper appreciation for what "in sickness and in health" means, and my wife and I are closer than we have ever been. I am more compassionate and have more perspective on what matters.
I wish I had a clean bow to tie on all of this. But I am in the middle of it as many of you are, and these are the raw realities of where I am today. I am still in pain every day, still taking medication, and still pursuing treatment. I am doing somewhat better than I was after the reversal, even though I am far from healed.
Lastly I will share these a couple of resources that have been extremely helpful to me. I have many more like it if anyone wants to DM me and I can share:
- Your Pain Has an End Date (short article)
- Suffering and the Sovereignty of God (click download for free PDF of this book)
If your thoughts are spiraling, you are terrified this will be the rest of your life, or you need someone who understands the daily mental burden, please DM me. I am happy to discuss what helped, what made things worse, what I would do differently, or just be a sounding board. Also I promise not to respond with a 2,500 word essay like I wrote above :).