I am a 43 year old male in good health. My left testicle has always been slightly smaller than my right. I had a scalpel vasectomy performed 10 months ago. The procedure went well on my right side, but was difficult on the left. The surgeon had to remove a fibrous tissue mass he found in the left side of my scrotum in order to get to the Vas deferens.
Since then my left testicle has shrunk considerably and is sore all the time. It is now one quarter of the size of the right. At the recommendation of my GP, I have seen three other Urologists since and have had Doppler ultrasound and nuclear medicine imaging tests performed. The conclusion is that I have decreased blood flow in the left testicle, perhaps as a result of or aggravated by the surgery, which is likely causing the testicle to shrink and be sore. Repeated examinations have ruled out other problems, including hernia, infection, hydrocele, testicular cancer, etc.
The soreness is localized to the left testicle and left side of my scrotum. It does not stop me from working, but the soreness is always there, much like a back ache or tooth ache. The soreness has killed my sex life. I am also embarrassed and upset by the ongoing demise of a part of my manhood. The most recent opinion is that the problem is likely permanent, although nobody is sure if it will continue to shrink or stabilize in size. One Urologist offered to open me up again to have a “look and see”. I am hesitant to go under the knife again with no clear action plan and no assurance that the problem won’t get even worse as a result.
Are there specialists within the Urology field or other healthcare specialties that may be able to help me with this problem? What are my options to fix this? Do you have any recommendations on what to do next?
Disparate testicular size/volume prior to a vasectomy likely represents some other type of pathology prior to the vasectomy. This can result from a varicocele, mumps orchitis, bacterial infections, trauma or an undescended testicle. Vasectomy can compromise the testicular blood supply if the artery is damaged resulting in further atrophy (shrinkage) of the testicle. If there is confirmed significant atrophy of the testicle to the point where the function of the testicle is questionable, then removing the testicle to alleviate pain might not be a bad idea. Many men are born with only one testicle or only have one testicle after suffering from an injury to the testicle, unsalvageable torsion or even cancer. It doesn’t make them any less of a man than someone who has two testicles. If having only one testicle becomes a cosmetic problem, then a testicular prosthesis can be placed at the same time as the testicle is removed. Testicular prosthesis offers an excellent cosmetic result. Most insurance carriers in the United States will cover this procedure.
Dr. Edward Karpman