Scalpel / No - Dr Jonathan Follows

6 What You Need To Know About Your VasectomyThe Possible ComplicationsRight Away:Syncope: That’s the medical termfor fainting. One particular subtype,vaso-vagal syncope, happens tocertain prone individuals when theyexperience a noxious stimulus, like thesight of blood, the smell of cautery,the idea of vasectomy, to cite buta few examples. It’s like a suddenpanic attack, then the nervous systemover-reacts to it’s own adrenaline andpumps out a bunch of vasodilators;chemicals that relax blood vessels,particularly in the abdomen andextremities. As blood pools to theseareas the blood pressure drops andthe person feels faint, dizzy andclammy or may even pass out briefly.In the First 10 Days:Hematoma: This results from bleedinginto the scrotum. It can get large andpainful, and turn the scrotum blackand blue. Incidence with conventionalvasectomy is around 3%. The NSVliterature puts it at 0.3%, but I’ve onlyseen 3 “big ones” in 16,000 (0.03%).Infection: Minor infections occur inabout 1 to 2% of patients. Seriousinfections, requiring intravenousantibiotics or drainage of an abscessoccur in about 0.2% of cases. Eventhese rare and serious infections usuallyresolve completely in a few weeks.Vasitis or Epididymitis: Inflammationand swelling of the tissue surroundingthe vas or extending down around theepididymis (the part just below thevas that joins it to the testicle) occursabout 10% of the time. It’s usuallymild and transient, no bigger thana grape, but rarely the swelling canget to the size of “a third testicle”.Needless to say, it can be painful, butthis too will settle with religious use ofindustrial strength non-steroidal antiinflammatorydrugs (NSAIDs). It cansometimes take a few weeks to settledown. Given that swelling is what themale genitalia like to do best, all thisis not surprising. In fact, inflammationand erection both produce swellingthrough almost identical biochemicalpathways. That is why I encouragethe liberal use of ibuprofen or otherNSAIDs for a full week post-op, evenif you’re not having pain. Tylenol isusually not as effective for this.Later:Sperm Granuloma: This as a smallinflammatory lump which can occurnear the cut end of the vas or in theepididymis weeks or even months aftersurgery. It can be painful, but it’s notserious and usually resolves with a shortcourse of an NSAID like ibuprofen.Chronic Post-vasectomy Pain: Thisis rare. Most pain settles within 1 to 2weeks with NSAIDs, if you take them. Ifthis doesn’t work then a longer, strongerNSAID is required. In about 1 per 1000pain will persist beyond this and anumber of other approaches may betried, including anti-depressant medsor other “pain modulating” drugs. Anexact cause of the ongoing pain isusually not apparent, but this conditionappears to be similar to other chronicpain syndromes, in that pain pathwaysin the spinal cord and brain appear toremain activated in the absence of anyapparent ongoing stimulus. Surgery to