I had a vasectomy in April 1999 and had an epididymitis in Feb 2000. Also developed a thrush type rash on the glands of my penis. Nothing was found after ultrasound cystoscopy etc. Shortly after that I developed cognitive problems (can’t remember or spell words as I used to) along with a neuralgia type sensation to the right hand side of my face. This is very problematic and something I have lived with for seven years. I had an MRI brain scan in 2002 but all was apparently normal. I had a vasectomy reversal in 2006 to see if this would help with testicular pain but to no avail. To date I have ongoing penile rash, and the neuralgia and constant cognitive problems and don’t have any ideas where to go with this. Have you any ideas what mechanisms could be involved here.
Up until a very recent press report there has never been any implication of vasectomy with any type of neurologic disease or forms of dementia. A recent observational study with a very small group of patients has suggested a slightly higher risk of primary progressive aphasia (PPA), a type of dementia, in patients who have had a vasectomy. Unfortunately, the authors of the study could not really provide a good mechanistic explanation of how this relationship could exist and stated that further research should be conducted prior to saying that any such association exists between vasectomy and PPA. The media, however, has done a fantastic job at sensationalizing this small study because it catches the attention of many of the 600,000 men and their partners who undergo a vasectomy procedure annually and encourages people to buy their newspapers/journals/media. The fact that this study was published without the input from any urologist at the authors institution or elsewhere I think speaks volumes as to the intentions of this study to cause paranoia and not truly understand what relationship, if any, exists between vasectomy and PPA.
PPA occurs at an average age of 62 and all of the men in the above mentioned study were between the ages of 55 and 80. Obviously, many men without vasectomy develop this condition and there was only a slightly higher incidence in men who had a vasectomy. The average age of men undergoing a vasectomy is somewhere in their mid-thirties. Why and, more importantly, how can something like a vasectomy performed 20 to 50 years earlier cause PPA is unknown to me. I think we have to be careful in attributing every neurologic symptoms that a patient might have after a vasectomy to PPA, especially so shortly after the procedure, as in the case in question here.
As a physician who closely follows the medical literature, I have to say that there are hundreds of these types of observational studies published annually in our medical literature. Some of these studies turn out to have credible data. Many of these studies are refuted by better studies that control for variables that confound the results. Unfortunately, in my experience, I have never seen the media print a retraction or follow-up story when newer information disputing the previous information is reported. I think the best example of this is the recent scare we had with Viagra causing men to go blind. Subsequent, better controlled studies, showed that the risk of that particular form of blindness attributed to Viagra was no greater in men taking Viagra as compared to their counterparts who were not taking the medicine. I’m sure most people never heard the follow-up studies printed in our media.
Penile rashes are not related to vasectomy. A rash on the penis that persists for several years likely represents some type of dermatitis, lesion or infectious disease. These have never been reported in association with a vasectomy. You can only diagnosis these skin conditions by visual examination and possible biopsy if the rash/lesion looks suspicious. Otherwise, it is difficult to say what might be causing the problem.
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