Painful Nodules After Vasectomy: What Exactly Is Going On?
November 5, 2024
The idea of getting painful nodules after vasectomy probably sounds like a horrible thought.
The term “scrotal nodules” evokes images of a scrotum that looks like a bag of oranges or, even worse, an Elephant man scrotum!
If you are unfortunate enough to get nodules after your vasectomy, you can be reassured you will not be able to see them on the outside of your scrotum but you will definitely be able to feel them on the inside.
Developing a painful scrotal nodule is a risk of vasectomy…but an uncommon risk.
Vasectomy is a safe and effective procedure. It is rare to develop a serious complication from vasectomy. Most vasectomy doctors are less concerned about painful nodules and more concerned about patients having a scrotal hematoma or developing chronic scrotal pain.
Developing a scrotal hematoma within the first 24 hours is the most common complication. Developing chronic scrotal pain is less common but can be difficult to treat. A hematoma will cause pain until it resolves. Chronic scrotal pain may cause pain for a long time and require a multitude of treatments. In some patients chronic scrotal pain may never fully resolve.
Non-painful scrotal nodules are common and can occur in 1 out of 4 vasectomy patients. The key word is ‘non-painful’ and also ‘common’.
Painful scrotal nodules can occur in approximately 1 out of 100 vasectomy patients. The key word is ‘painful’. Most of these painful nodules will resolve over time. The chance of having a painful nodule that does not resolve and needs additional treatment may be about 1 out of every 2,500 procedures.
At first almost all scrotal nodules after vasectomy are tender or uncomfortable but with time the discomfort should resolve. In some patients, the pain can linger. The diagnosis of a painful scrotal nodule can only be made if both the nodule and the pain lasts for six months or longer after a vasectomy procedure. These nodules may require additional medical treatment or surgical intervention.
What is a normal vasectomy nodule?
Nodule is the medical term for a ‘lump’ or ‘bump’. The lump can be as small as a green pea…or as large as your thumbnail.
A nodule can form as a healing response after vasectomy. Nodules can form in one of two locations:
- Vas deferens tube (one side or both sides)
- Epididymis (either one side or both sides)
You will not form nodules in the scrotal skin or shaft of the penis. You will not form a nodule in the testicle. If you form a nodule after vasectomy it will be deep inside the scrotum and it will not be visible.
Nodules in the vas deferens. Nodule formation at the site of the vasectomy is usually from a normal healing, inflammatory response. The inflammation is in response to the cautery (burning) from the vasectomy procedure and/or exposure to sperm.
Healing nodules in the vas deferens usually present within the first 3 months of a vasectomy. The vasectomy site nodules usually shrink in size with the passage of time.
Nodules in the epididymis. Nodule formation in the epididymis always occur from sperm congestion in the lower end after vasectomy. The increased pressure in the lower end can cause a dilation, or an aneurysm, of a weakened section of the epididymal tubules. Technically these nodules are considered sperm granulomas.
Nodules in the epididymis usually form 3 months or more after vasectomy. It is possible epididymal nodules can form anytime within 3 years of having a vasectomy procedure. Usually these nodules present with a gradual increase in pain that reaches it peak for several days and then begins to slowly subside.
In many cases these spermatic granuloma nodules are a ‘normal’ healing response after vasectomy. In rare cases, the nodules could be persistently painful and may require additional medical or surgical treatment.
What is a normal vasectomy nodule?
A normal nodule is a lump that forms at the vasectomy site in the first 3 months after vasectomy or in the epididymis the first 12 months after a vasectomy procedure. Typically these lumps are larger and more uncomfortable at first, but over time the size and pain slowly decreases.
In rare cases, these nodules can form 12 to 18 months after a vasectomy procedure. When these nodules form 6 months or more after vasectomy they are usually located in the epididymis.
The nodules that form at the vasectomy sites are a healing response to vasectomy. The nodules are usually a combination of healing tissue and an inflammatory response to sperm.
The nodules that form in the epididymis are caused by a back up of sperm inside the epididymal tubules. This spermatic congestion increase the pressure in the epididymis. This increased pressure can cause an aneurysm in the weakened areas of the epididymal walls. This is when you would first detect a non-painful nodule in the epididymis.
If the weakened aneurysm begins to leak sperm into the surrounding tissues then the body will mount an immune/inflammatory response to the sperm. This is when the nodule starts to become painful. This is when these nodules are first detected by patients. Usually once the body heals itself the nodules will decrease in size and pain.
What is an abnormal vasectomy nodule?
Normal nodules usually form within the first 6 months of the vasectomy. These nodules are painful at first, but the pain gradually decreases with the passage of time, ie several weeks. If over the counter anti-inflammatory medications (ibuprofen or naproxen) help decrease the pain then this supports the nodule being a normal healing response.
An abnormal vasectomy nodule is any nodule that forms in the vas deferens or the epididymis that is painful, persistent, and does not go away. These nodules typically cause pain with physical activity: lifting, sitting, running, sexual activity. Essentially, any activity that causes physical stimulation of the nodule will result in pain.
Over the counter anti-inflammatory medications will not help with pain from an abnormal vasectomy nodule.
Nodules located inside the testicle sphere are not from vasectomy and need to be evaluated for possible malignancy.
Persistently painful scrotal nodule? Most likely a neuroma
It can be common to form a nodule after vasectomy.
If you have a ‘normal’ nodule the pain should completely resolve with time. The nodule size will also decrease with time but the reality is…even with a normal nodule…it may not completely go away.
Abnormal nodules do not decrease with time…either in size or painfulness.
In fact, the pain could get worse with the passage of time. This is usually because abnormal nerve endings are forming and becoming hypersensitive.
A nodule with hypersensitive nerve endings is called a ‘neuroma’.
Neuromas are not normal. They can cause significant pain and/or dysfunction which may require additional treatment. We estimate neuromas occur in approximately 1 out of every 2,500 patients.
Scrotal nodules after vasectomy: Normal vs abnormal
Any nodule in the testicle is NOT NORMAL after vasectomy. A vasectomy procedure will never cause lumps or bumps in the testicle.
The testicle is the actual ‘ball’ or sphere located at the bottom of the scrotum (sac). Any new lump inside the testicle needs to be evaluated for cancer.
The epididymis is the soft “C” shaped, or banana shaped structure, that lies on the back of the testicle.
It is very common to form nodules in the epididymis after vasectomy from spermatic congestion and distention. Most vasectomy patients will commonly describe these nodules as being on the outside, back of, or on top of the testicle.
New onset nodules inside the testicle (the actual ‘ball’) need to be evaluated for testicular cancer. These are not vasectomy related.
Characteristics of a ‘normal’ scrotal nodule after vasectomy
- Develops within 3 months of vasectomy
- Size and pain decrease with time
- Firm fitting scrotal support and hot baths help with the pain
- Over the counter anti-inflammatory medications help with pain
The most important indicator of a ‘normal’ after vasectomy nodule is over the counter ant-inflammatory medications (800 mg of ibuprofen or 550 mg of naproxen) greatly help with pain relief. This is because these nodules are mostly caused by the inflammatory response.
Characteristics of an ‘abnormal’ scrotal nodule after vasectomy
- Pain increases over time
- Over the counter anti-inflammatory medications help with pain
- Lumps or nodules inside the testicle are always abnormal
If the pain does not respond to over the counter anti-inflammatory medications then you probably have a neuroma.
Pain from neuromas are caused by hypersensitive nerve endings. Anti-inflammatory medications treat pain caused by the inflammatory response and these medications have minimal impact on pain generated by hypersensitive nerve endings.
What is the treatment for a scrotal nodule after vasectomy?
If the nodule occurs within the first 12 months and the nodule is not in the actual testicle then we recommend expectant management. Expectant management is the medical term for ‘Let’s wait and see!’
Any nodule inside the testicle is not from vasectomy and needs to be evaluated for malignancy.
We typically recommend firm scrotal support (jock strap or compression shorts or tight underwear). We also recommend taking a hot bath at night. The warmth encourages increased blood flow to the scrotum and this may help to wash out prostaglandins which are released by the immune system and increase the sensitivity of nerve endings. We also recommend ibuprofen or naproxen anti-inflammatory medications.
If the above treatments help then we consider the nodules normal. We typically expect these nodules to get better with the passage of time.
If these treatments do not help then you could have a neuroma. Typically we do not recommend treatment within the first 12 months of having a vasectomy because most symptomatic nodules will improve with time. By waiting, we decrease unnecessary interventions which could prove more harmful than helpful.
If the pain still persists and is impacting your daily activities then we would recommend treatment with medication. If medications are not helpful then surgical removal of the painful nodule may be indicated.
His Choice Vasectomy: A modern vasectomy technique!
It is common to form nodules after vasectomy no matter what vasectomy technique is used. Nodule formation after vasectomy can be considered a normal healing response for many patients.
Approximately 1 out of 4 patients will form a nodule after a vasectomy procedure.
As long as the nodule is not extremely painful and does not cause disruption to your daily life then treatment is not necessary.
Nodules that are painful, persistent, and cause pain not relieved by commonly available pain medications may be neuromas. Neuroma formation after vasectomy is not common and may require an individualized treatment plan.
If you are a His Choice vasectomy patient and believe you are experiencing a painful nodule then we encourage you to contact us for further discussion.
