Post Vasectomy Pain Syndrome (PVP): A Personal Reflection
Context of this article
This article derives from a letter to a patient in the US I wrote in 2011 after he contacted me regarding his concerns about PVP. After a patient contacted me about a missing link on my website I decided to re-write it now 15 years later and with many more vasectomies completed
Introduction
After performing over 20,000 vasectomies over several decades, I want to share some thoughts on a concern that occasionally comes up during consultations: Post Vasectomy Pain Syndrome (PVP).
Vasectomy is one of the safest and most effective forms of long-term contraception available. That said, no procedure is entirely risk-free. One uncommon but important complication is the possibility of persistent testicular or scrotal pain after the operation. This is sometimes referred to as PVP.
To be clear, most men are completely satisfied with their decision to have a vasectomy and never experience long-term pain. A small number report ongoing discomfort beyond the usual recovery period. Most of these cases are mild and improve gradually with time. Occasionally, the symptoms can persist and require further management. In rare cases, a reversal may be considered.
What does research say?
According to the most recent audit by the Association of Surgeons in Primary Care (ASPC), the estimated risk of significant PVP is about 1 in 500. The American Urological Association (AUA) provides a slightly higher estimate of 1 to 2 percent. These figures show that while PVP is not common, it does happen and should be considered seriously.
Vasectomy in the US and Canada
It is also worth noting that the US and the UK use different methods of vasectomy. Most surgeons in the US use a method called “facial interposition (FI)”. They use a clip or a stitch to fix a piece of mesentery in between the 2 ends of the vas. If carried out competently it is a very safe method, likely significantly safer than a vasectomy without FI. It can be a little harder to learn and therefore not all surgeons can complete such a procedure competently in all patients. The US has no national audit, so it is hard to be clear about their failure rate. There are some studies published with very low failure rates, but they usually only include a few surgeons.
Vasectomy in the UK
In the UK most surgeons use a method called the “Marie Stopes Method” (I call it the Laurel Spooner method, because it was really her who brought it over). This vasectomy method only works with the bodies own tissue. No titanium clips are used. No stitches are used. This method is easier to learn than facial interposition. While having a higher failure rate than the US method I believe it creates a generally lower side effects profile (due to the absence of foreign bodies and creation of inflammation in a small number of patients), which is current research shows as true for post operative infection. I believe it also to be true for PVP. It is my explanation for the difference between the AUA and the ASPC figures and it is the reason why I have not changed to the US method despite of its higher safety profile.
However, I have developed a new method, which I call for ease the “Kittel Method”. It includes several very good steps I have “shamelessly” copied from other surgeons. Essentially, it seals the proximal (higher) vas end using radiofrequency to prevent re-entry of sperm. and leaves the distal (lower) vas open ended. My own failure rates are somewhere between 1:300 and 1:1000 since I have amended my method. The method ensures the interruption is long enough so sperm cannot jump from one end to the other and there is less chance of spontaneous re-canalisation. I have not reached statistical relevance yet, but this is signficantly better than the figures in the last ASPC national audit of an average of 1:100 failure rate in the UK.
My own practice
In my own practice, I see very few patients with PVP that lasts beyond the short-term. I am aware of one of my patients, who underwent a reversal specifically because of PVP. Most people with this issue respond well to simple treatments, reassurance and time.
I always discuss the risk of PVP during the pre-operative webinar, which typically lasts around 45 minutes. This gives every patient a chance to ask questions and raise any concerns. If you find yourself spending hours researching PVP online and feel unsure or anxious, you may want to pause and reconsider whether vasectomy is right for you at this point. It’s better to be confident in your decision.
Understanding Risk
Every type of surgery carries some degree of risk. Hernia repairs (10%), knee replacements (25%+) and even minor injuries like whiplash can occasionally lead to chronic symptoms. In whiplash for example most patients recover well, but a small percentage of 5 – 10% experience chronic long term neck pain. Yet, you are unlikely to refuse to step into a car because of the small possibility of whiplash
The same principle applies to vasectomy. It compares very favourably to other methods of contraception. Female sterilisation, for example, carries more serious risks, including internal bleeding and anaesthetic complications. Hormonal contraceptives increase the risk of blood clots and, in some cases, certain types of cancer. In contrast, vasectomy under local anaesthetic has an excellent safety profile, with very few serious complications and generally a low rate of side effects.
Professor John Guillebaud, a now retired previously leading figure in contraceptive care in the UK, reported at a conference in the early 2000s that in 40,000 vasectomies carried out at his clinic (The Elliot Smith Clinic), only two patients required a reversal because of pain. In a study of 5,000 of his patients, all of them said they would choose to have the procedure again, even if they had experienced minor longer term side effects.
A Final Thought
After many years in this field, I continue to believe vasectomy is an excellent option for the right person. We use a modern no-scalpel technique with tissue-sparing methods to reduce trauma and support a smooth recovery. Most men are back to normal activities within days, and only a small number experience longer-lasting issues.
However, this decision is personal. If you’re feeling very anxious about potential complications, it’s entirely reasonable to hold off. You can take your time, speak with your partner, and return for a consultation when you’re ready.
Whatever you choose, we’re here to help with clear, honest information and respectful care. And if you want to know who should not have a vasectomy, click here
Dr M. Kittel
A reflection on PVP from a senior vasectomy surgeon
July 2025