It's in your head...
There are individual medical practitioners that accept the legitimacy of post-vasectomy pain. Indeed there are academic urologists that have provided an extensive literature of studies on the possible etiologies of post-vasectomy pain and explored various treatments. Many of these articles are referenced or linked on this website. The affected men are indebted to these physicians for their work in this area. Unfortunately, the field of Urology as a whole has not embraced the truth about this devastating vasectomy outcome. I say this, as I am contacted by about one patient a week via my websites, and they have, to a man, said, "I was not warned about this." In addition, as a group, the men seem to have consulted with an average of four urologists each in attempting to achieve relief and access the available treatments.
Since "post-vasectomy pain syndrome" was initially used as a descriptor for these symptoms in the late 1980's, (see article by clicking here) it is astounding to me that the treatment has not become codified and placed in the curriculum of Urology residency training and made available to all physicians performing vasectomies. There are known treatments. There are readily available review articles on the topic. Yet, men are still told daily, "there is nothing I can do for you", or "your symptoms cannot be related to your vasectomy, or "your symptoms have a psychological basis". None of these are true and they are a disservice to the affected men.
The best review article on post-vasectomy pain syndrome is available here: http://www.andrologyjournal.org/cgi/reprint/24/3/293
Other fine articles by Nangia et, al, and Myers et, al, are focused on vasectomy reversal to treat the pain and its cause.
As recently as this last week, a patient contacted me with the usual story. He had a vasectomy and was not warned of the possibility of chronic testicular or scrotal pain prior to the procedure. He developed classic PVPS with pain on erection, pain with and after orgasm, and was not helped by the vasectomist. He was referred to the director of Urology residency at the local teaching hospital who told him that the pain was "psychological". This is a ludicrous idea and added insult to injury. His wife contacted me and I am in the process of trying to get the couple in touch with a doctor who is willing to treat PVPS with the evidence based treatments with literature support - vasovasostomy (vasectomy reversal) or microsurgical denervation of the spermatic cord.
There are no studies that reliably point to a psychogenic cause for PVPS. The contribution of psychological factors is unclear. In a study by Schover, somatization disorder, depression, and chemical dependency were noted in men with chronic genital pain with no organic findings. The study population was not typical of vasectomized men as only half were married despite a mean age of forty-one and a third of the patients in the study were socially isolated (Schover, 1990). In a review of chronic testicular pain the authors concluded, “some of these patients are undoubtedly depressed” (Granitsiotis, 2004). The specific symptom complex of PVPS, similarity of reported symptoms, and consistency of histological specimens in affected patients argue against a psychological cause. Clinical focus on psychogenic causes for post-vasectomy pain can delay appropriate diagnosis and effective treatment. Chronic pain can cause depression in up to fifty percent of patients and the depression may require separate treatment. The presence of depression in patients with PVPS is more likely a consequence of the pain and its effects on sexual function than the cause of the syndrome. There are no studies in the literature that explore the specific sexual effects of post-vasectomy pain (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 psychiatric morbidity of chronic genital pain after vasectomy is not well represented in either the psychiatric or urological literature.