VASECTOMY SPECIAL:

'My husband is in pain 24 hours a day'

It's NOT all in the mind. A vasectomy reversal specialist explains post-vasectomy pain (PVP) to Jim Pollard.

'Worst mistake of my life! I normally research everything. I can't understand why I didn't do the same before my vasectomy. My sex life disappeared. I have a constant dull ache turning into shooting pain when I get aroused.'

'Vasectomy a real nightmare. Swelling in lower abdomen and scrotum and pain is unbearable.'

'I'm constantly getting aches and pains, orgasm is terrible, sex has become the last thing on mind. I had a very healthy sex life and now its gone.'

These are just three quotes from recent reader feedback to malehealth about vasectomy - the tip of a large iceberg.

They make painful reading yet these people are talking about an everyday operation, one that is performed 90,000 times every year in the UK (including 40,000 on the NHS). Indeed, if you'd asked me when I took over as editor of malehealth, to guess the most common topics for readers' comments I would not have put vasectomy in the top ten.

Admittedly, vasectomy is not the most common - that's penis problems, of course - but it is the second biggest cause of concern among men who contact our site.

It has been estimated that one in five British men of reproductive age have had a vasectomy.

With those sorts of numbers, perhaps it is unsurprising that there are complications in a few cases. But surgery - even if it is the no scalpel version preferred for most vasectomies - is still surgery and if I were considering an operation in such a sensitive area I think I'd want to know about those few cases. At the moment very few people do.

Doctors are usually very cagey when it comes to committing themselves. They know what an imprecise combination of art and science good medicine is. However, when it comes to vasectomy, they're surprisingly blunt. 'There are no known long-term risks from a vasectomy' is how the NHS's patient website NHS Direct puts it.

Graham from Lancashire is one of the many men who disagree. He believes his vasectomy destroyed his sex life.

'It's never been the same - one minute the wife is struggling to keep up, the next minute nothing. I struggled to get an erection to produce the semen specimen after the operation and I've struggled ever since. Even my nocturnal erections are very poor.'

Chris, whose husband had his vasectomy in the USA earlier this year says the same thing. 'My husband says that about 85% of the sensation he used to feel at orgasm simply isn't there. Worse, in addition to greatly reduced pleasure, he is now in pain 24 hours a day, a dull ache in both testicles.'

With luck Chris and her husband will yet see some improvement. Surgeon Tim Black who has carried out 15,000 vasectomies says: 'I've seen just a handful of cases in my career where pain has continued beyond nine months after the operation.' He believes the sort of problems experienced by men like Graham can be put down to a previous trauma, psychological problems related to the nature of the operation or a misplaced hope on the part of some men that a vasectomy might solve their sexual problems.

So are Graham's problems all in the mind? Andrew Dawson, right, of the Hartlepool Vasectomy Reverse Clinic is not so sure. Dawson is a rarity - a surgeon who has been on the operating table - and he had post-vasectomy pain (PVP) himself. He says: 'My own problems made me realise that this was something we needed to take seriously. I've come across men whose PVP has taken over their lives. We've performed vasectomy reversals for them and this been 100% effective - although it is admittedly a small number of cases.'

Dawson believes he can explain what is happening.

'Vasectomy is pretty crude really - it just traps sperm which all end up in the epididymis.

'In some men - often highly-sexed ones, this can cause the epididymis to become swollen. Eventually it will probably rupture - Americans call this a blow-out - which will solve the problem naturally but in the meantime it can be very painful. A reverse vasectomy can reduce the pressure.'

Dawson is concerned that few men are properly prepared for their vasectomies. 'Not even 1 in 100 knows how it really works,' he says. 'They're usually just having it to please the wife.'

It is the doctor's responsibility to ensure patients are informed. Guidelines from professional bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG) are very clear that alternatives to vasectomy and risks such as PVP should be discussed.

By following this advice, doctors would be doing their patients a favour, themselves a favour (since several patients have successfully sued medics who have failed to warn of them of PVP) and malehealth.co.uk a favour. If we didn't have all those vasectomy questions, we might have more time for articles dealing with our readers' all important penis problems.

• Patients' names have been changed.

THE SNIP

Vasectomy FAQs

Scrotum Monologues: Vasectomy Diary

Post-Vasectomy Pain Explained: latest news from a reversal specialist

For and against: two radically different views

A Pain in the Balls: article on vasectomy problems from 2000

New Zealand: the world's vasectomy capital

What's the Score? A lighter-hearted take on the snip

Have Your Say: readers' views and experiences

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