u/Apprehensive-Meat120

A question for my fellow PVPS sufferers:

Who among you has experienced positive effects from TRT, and who hasn't noticed any improvement or has actually felt worse?

For those who have tried it, what changes did you notice in your pain levels and overall symptoms?

And what advice would you give to others in the PVPS community who are considering starting TRT? Anything you wish you had known before beginning treatment?

I'd really appreciate hearing about your personal experiences, both positive and negative.

Question for people with PVPS who had a spermatic cord block before any surgery (reversal, denervation/MDSC, etc.):

I’m particularly interested in whether the block helped with deep, dull/heavy pain or discomfort, rather than obvious burning or nerve-type pain.

For those who had a cord block before any procedure:

• Did the block completely eliminate your pain/discomfort, partially reduce it, or have no effect?
• If your pain was thought to be congestion/pressure-related, for example epididymal congestion or a feeling of pressure/fullness, did the cord block eliminate that deep pain as well?
• If your pain was considered nerve-related, did the block completely switch it off?
• Did the response to the block accurately predict whether a later procedure (reversal, denervation/MDSC, etc.) helped you?

Most importantly: can a spermatic cord block actually switch off deep, internal dull pain/heaviness caused by epididymal congestion or another pressure/congestion mechanism?

I’m asking because I have very deep, diffuse dull discomfort/heaviness rather than a clearly localized testicular or epididymal pain, and my previous cord blocks did not eliminate this sensation.

Diffuse pain and heavy scrotum 5 months after vasectomy reversal — considering TRT

Hi everyone,

I had a vasectomy reversal and was completely fine for the first 5 months after the procedure. Then, quite suddenly, I developed a diffuse, dull pain/discomfort in the lower abdomen/pelvic area together with a feeling of heaviness in the scrotum.

The pain isn't really localized to one testicle or one specific spot. My testicles themselves aren't particularly tender. It feels more like a diffuse pressure/heaviness and discomfort involving the lower abdomen, pelvis and scrotal area.

I've had examinations and ultrasound, but nothing significant has been found.

My semen analysis is actually very good: 128 million sperm in 7.5 ml.

Unfortunately, the symptoms have now persisted for 12 months without resolving.

Because of the possibility that there could still be a congestive component despite the reversal, I'm considering testosterone replacement therapy (TRT) as a possible way of suppressing spermatogenesis and potentially reducing congestion.

For those of you with PVPS or post-reversal pain:

Has anyone tried TRT specifically for this type of pain/congestion? Did it help, make things worse, or have no effect?

I'd especially appreciate hearing from people who had diffuse pain/heaviness rather than pain localized directly to the epididymis or testicle.

Thanks!

Small update / question:

For those of you who have similar symptoms — does the discomfort/heaviness also occur when you're lying down or sleeping, or does it mostly go away in that position?

How do you feel during the night and when you wake up in the morning?

Update – today

I spoke with my doctor today, and he suspects passive venous congestion in the pelvis / pelvic venous congestion as a possible explanation for my symptoms.

One thing that led him in this direction is that lying down and sleeping in any position does not trigger my symptoms. In fact, my symptoms seem to ease when I'm lying down, regardless of the position.

He recommended that I have a detailed pelvic MRI with contrast to take a closer look at the pelvic veins and surrounding structures.

I'll update this post once I have the MRI results.

I’m trying to understand whether what I have sounds more like CPPS, post-surgical nerve sensitization, or PVPS. I’d really appreciate input, especially from men with similar stories.

My history:
Had a vasectomy a few years ago (2021) - open-ended.
About 2 weeks after it, I developed a strange pelvic/genital discomfort (not sharp pain). It lasted around 5 months and then completely resolved on its own.
For the next 3 years I was basically symptom-free.
In April last year I had a vasectomy reversal to have more kids.
Recovery was normal: first 4 weeks were painful locally (pulling in spermatic cords, walking bent over, typical post-op stuff), but then it resolved.
For the next 4–5 months I felt 100% normal.
Then in late September everything changed (6 months).

next month around noon I developed a strange pelvic/lower abdominal discomfort that has stayed for 9–10 months now.

This is NOT testicular pain.
I can’t point to one spot.
It feels diffuse: lower abdomen, behind the testicles, sometimes like “the whole pelvic system.”
Ejaculation itself does not hurt.

Medication response:
Pregabalin helped a lot for about 2 months
anti-inflammatory medications (NSAIDs) do basically nothing

One specific thing: after sex, if stay upright or Jin certain positions, I can develop discomfort (sometimes more pain-like) especially on the right side, almost like behind the testicle. But if lie down, within about 3 minutes it completely settles and stop feeling it.

The strange part is the daily pattern:
mornings are clearly the worst it gradually improves throughout the day by evening often feel 90-95% normal
walking and movement help a lot
lying down can almost make it disappear (I sleep very well).

Does this sound more like CPPS / nervous system sensitization / pelvic floor dysfunction to you, rather than something like PVPS?
I’d really appreciate your thoughts.