Other Vasectomy Side Effects

Vasectomy is advertised as a safe procedure with no effects on sexual function. While this may be true for many men, the Internet has allowed vasectomized men an anonymous forum with which to post their complaints. Any sexual side effects from vasectomy are generally kept secret. Vasectomy side effects are rarely mentioned, even in private. Many men do not even feel comfortable talking to their physician about them.  Men are very shy about talking to anyone about their sexual function due to the “macho” culture we live in. Can you imagine talking to a friend about how your vasectomy went bad?  Soon, others might know how your “vasectomy went bad” bringing up connotations that you are a sexual invalid or not an able bodied man in the sexual arena. You would never mention it again, and there’s the rub, the men with bad outcomes do not talk about them. About fifty percent of men keep their vasectomy a secret and up to a third of men do not go back to have the required semen analyses after their vasectomy.

Changes in sexual function that have been reported to me either in my on-line support group or reported in the medical literature include:

  • Decreased ejaculate volume or expulsive force (which would seem to reduce sexual pleasure) as well as decreased ejaculate consistency. The decrease in ejaculate volume has been linked to changes in the secretory function of the prostate after vasectomy.
  • Rarely, men notice a decrease in orgasm sensation. This may be due to anatomical variants amongst men as to the innervation or nerve pathway of this function with damage to these nerves from the vasectomy or from scar tissue. Of course, pain related changes in enjoyment of sex could reduce orgasmic "sensation".
  • Decrease in libido are reported due to changes in orgasmic function or from a drop in testosterone levels over time from testicular damage/fibrosis. There are at least five medical studies documenting testicular fibrosis and scarring after vasectomy.
  • Decrease in erectile potency (usually not frank impotence) or an increase in erectile latency (taking longer to get an erection)
  • Pain during ejaculation due to back pressure in the post-vasectomy closed system and congestion of sperm in the epididymides) or after ejaculation (from the same mechanism).
  • Testicular pain that can be a chronic dull ache (can be congestion related or due to an auto-immune reaction to sperm that causes testicular inflammation/scarring) Sharp pains in the testes have also been reported, usually with or after orgasm.
There are no studies in the literature that explore the specific sexual effects of post-vasectomy pain (pain associated decrease in libido, changes in orgasmic response or ejaculation, decrease in sexual enjoyment, or pain related erectile potency issues). It seems likely that any significant genital pain associated with sex could affect sexual response, potency, or sexual enjoyment, and in this way affect libido and mood. The psychological morbidity of chronic genital pain after vasectomy is not well represented in either the psychiatric or urological literature. This association between pain and intercourse or orgasm must have effects on libido, arousal, sexual enjoyment, and potency, but no studies exist that specifically address this outcome for vasectomized men.

Other complaints included: epididymal pain or swelling, pain on ejaculation, pain after sex that could last hours or days, pain under the scrotum in the tail of the epididymides bilaterally that stopped them from riding bicycles or pain on erection. Some men reported difficulty with pain after any physical activity, pain that made them “guard” their laps such that they could not allow their children onto them, or pain that interfered with their ability to work around the house or in their vocation. Others reported changes in the way the testes were situated in the scrotum due to scar tissue, and they generally found this distressing.

Known side effects of vasectomy that are usually included on the consent form include:

  • Hematoma - Post-operative bleeding in the scrotum from the surgery itself can cause nasty bruising, pain, and large blood collections that can take up to six weeks to get “reabsorbed” or sometimes need a second procedure to drain the blood.
  • Infection – As with any surgery, you can get an infection that would require antibiotics, but a few men develop abscesses that require surgical drainage and may have a rubber drain inserted in the scrotum for days.
  • Sperm granuloma – This is a local immunologic reaction to sperm leakage that causes scar tissue that can become attached to nearby nerves and may require surgical removal. These can be up to a few centimeters in size and can be quite painful, although they resolve on their own in some men.
  • Congestive epididymitis - If the re-absorption of backed up sperm fails or is inadequate, the epididymides become enlarged, inflamed and can be quite painful in some men. The incidence of this complication is reported to be around 5% of vasectomized men.  This known side effect can sometimes lead to chronic post-vasectomy pain and can affect ability to participate in sports or pysical activities on a long-term basis. Some men with congestive pain respond to conservative treatment, but about 1% of vasectomized men seek a vasectomy reversal to relieve this condition. The corrective surgery (vasectomy reversal) is not covered by insurance and can cost from $6000 to $10,000.
Qualifiers such as, “transient” or “minor” almost always follow the side effect descriptions, and there seems to be an inordinate focus on alleviating fear and anxiety over “vasectomy myths”. The affected men do not find these changes and symptoms mythical.

I think the sites that feature the standard,

  • No change in the semen
  • No change in sex drive
  • No change in climax sensation
  • No change in the testes or scrotum
  • No change in erections

are to be distrusted. It would be more honest to say that vasectomy CAN affect all of these in some men and can also cause chronic pain that can markedly affect quality of life in a small percentage of men. I think it is unconscionable to state that vasectomy changes nothing when some men complain of changes.

The connection between testicular damage and vasectomy is usually NOT covered on the consent. Testicular damage is well documented in all mammalian vasectomy models studied to date, including rodents (rabbits, rats, mice, hamsters, and guinea pigs), canines, non-human primates, and other mammals (sheep, horses, and others). There are studies in humans showing testicular damage (testicular fibrosis) after vasectomy that date back to 1985. See this reference from The New England Journal of Medicine.

“To determine whether there are any deleterious changes in the human testis after vasectomy, we obtained testicular biopsy specimens from 31 healthy men undergoing vasectomy reversal and from 21 healthy, fertile volunteers. Morphometric analyses of these specimens revealed a 100 per cent increase in the thickness of the seminiferous tubular walls (P less than 0.001), a 50 per cent increase in the mean cross-sectional tubular area (P less than 0.001), and a significant reduction in the mean number of Sertoli cells (P less than 0.01) and spermatids (P less than 0.01) per tubular cross section in the post-vasectomy group, as compared with the control group. Focal interstitial fibrosis was observed in 23 per cent of the specimens from the post-vasectomy group and in none from the control group.We conclude that significant morphologic changes occur in the human testis after vasectomy. The presence of focal interstitial fibrosis was associated with a high incidence of infertility in this series. There was a significant correlation (P less than 0.01) between interstitial fibrosis and infertility in patients who underwent a surgically successful vasectomy reversal (sperm in the ejaculate). None of the other measured characteristics correlated with infertility after vasectomy reversal."

Focal interstitial fibrosis is essentially scar tissue. The pressure-induced effects of closing off the sperm delivery system could cause this scarring by interrupting the flow of sperm through the vas deferens (the “tubes” that are cut during vasectomy). An alternate hypothesis supported by animal studies suggest that the fibrosis is caused by inflammation due to an auto-immune reaction to sperm or sperm components after disruption of the blood/testes barrier that is induced by vasectomy. The studies of testosterone levels after vasectomy have led to conflicting data. This is partly due to reliance on “normal ranges” that are very wide (300 to 1200 ng/dl) and lack of pre-vasectomy levels for comparison purposes, as well as lack of testing for free (bioavailable) testosterone levels or changes in the ratio of testosterone to dihidrotestosterone (DHT) after vasectomy. In addition, the studies that show transient increases in testosterone levels reflect damage as opposed to health, and declines in levels may follow. It is likely a reflection of damage and after the inflammation subsides you are left with inadequate testicular function in some men.

I believe the testicular damage is related to back-pressure form closing off the system with vasectomy and also auto-immune in some patients more than others, as the immune response is individual.

This is person specific based on:

  1. The degree of epididymal obstruction which may depend on the vigor of the auto-immune response
  2. The length of the testicular segment of vas left after vasectomy for sperm reabsorption and the effect of this on sperm granuloma formation.
  3. Individual variation in pre-vasectomy sperm count and thus post-vasectomy immune response which is genetically pre-determined
  4. The continuing presence of soluble antigen presented to the immune system in sperm granulomas (the bodies response to immune cell contact with sperm and sperm components.)

It is easy to make a case for the back pressure effects on the testes based on the human studies and other mammalian studies I have read. The auto-immune component is much more difficult to prove. Nonetheless, the issues presented here are cause for caution.