A sperm granuloma is an infection caused by sperm leaking into the scrotum during a vasectomy or vasectomy reversal. Successful reversal is more likely when there has been a granuloma following vasectomy. Those who have had a granuloma following a vasectomy reversal frequently have sperm antibodies, but these have not been shown to affect fertility.
The granuloma is formed when sperm leaks out of the damaged vas defrans, which is the cord that carries sperm from the testicles. An immune response happens, and the sperm is surrounded by a protective mass. Many cases cause no symptoms, but of those that do, the most common is radiating pain in the groin. Cases of sperm granuloma usually resolve without treatment, although pain can last for up to a year.
This type of infection occurs in approximately 35% to 42% of vasectomies, and troubling symptoms occur in approximately 3% to 5% of these cases. Symptoms typically occur two to three weeks after surgery. Although granulomas are common following vasectomy and reversal, any palpable lump should be checked by a healthcare professional to rule out testicular cancer.
When treatment is necessary, steroids injected into the mass usually resolve the problem. If the steroids do not work, the mass may need to be surgically removed, although this is usually viewed as a last resort.
Vasectomies are usually performed in a doctor's office or in a surgery center as an outpatient procedure. Local anesthetic is used, and the procedure lasts 20 to 30 minutes. A hole or incision is first made in the scrotum, then part of the vas defrans is pulled through and either clipped or cauterized. The incision is then stitched, but if a hole was used it, will not need stitches.
A vasectomy reversal is done either in a surgery center or a hospital. General anesthesia may be used, although a local anesthesia or an epidural are sometimes given instead. The most common method is to reattach the cut end of the vas defrans. Occasionally, the vas defrans is attached to the epididymis, a coiled cord that connects the testicles to the vas defrans, instead.
Rarely, a sperm granuloma may occur following rupture of the epididymis. Rupture is usually associated with injury, and is a medical emergency. Testicular torsion can cause the epididymis to swell and eventually burst. This usually occurs following injury, and causes extreme pain and swelling of the testicle.
Traditional Vasectomy vs. No-Scalpel Vasectomy (NSV)
There are two mainstream surgical techniques for vasectomies. Both of these methods reach the same goal. They cut and seal the vas deferens so that the sperm traveling through it cannot reach the semen. The main difference between these two methods is whether or not an incision is made.
The first method of vasectomy is a traditional vasectomy or incision vasectomy. In this method, a scalpel opens one or two incisions in the scrotum before an operation on the vas deferens occurs.
The second method of vasectomy is a no-scalpel vasectomy (NSV). In an NSV, sharp forceps pierce the skin instead of the traditional scalpel. The World Health Organization (WHO) recommends the NSV method over the traditional vasectomy.
NSV has much fewer risks of complications than traditional vasectomy. For example, there are fewer risks of clinical complications such as hematoma, hemorrhage, and infections.
Additionally, the operation takes less time, and the patient can resume sexual activity more quickly after an NSV than a traditional vasectomy.
Is Sperm Granuloma Dangerous?
Despite cases where it may cause pain, sperm granuloma is not typically dangerous. It can, however, cause complications in the long-term success of the vasectomy operation.
A sperm granuloma can prevent obstruction of the epididymis, and it can also help to connect the two vas deferens stumps. The sperm granuloma connects these stumps and creates a new channel through which sperm travel. Thus, in this case, a sperm granuloma can cause a failed vasectomy.
Sperm granulomas can often be mistaken for testicular tumors. If a patient finds a lump in the scrotum region, the best action is to consult a doctor. Sperm granulomas are generally harmless, but tumors can signify cancer.
The best way to prevent a sperm granuloma from forming is to refrain from ejaculation for at least one week after surgery. Doing this does not guarantee that a patient will not form a sperm granuloma, but it greatly reduces the risk of one forming.
Where Do Sperm Granulomas Form?
Sperm granulomas typically form at the end of the vas deferens or the epididymis. Sperm travels through the epididymis before making its way through the vas deferens. Since these are two passages through which sperm goes, it makes sense that sperm granulomas would form in these regions.
What Are Sperm Antibodies?
Also known as anti-sperm antibodies, sperm antibodies often appear after a vasectomy. Studies show that 50% of vasectomized men have sperm antibodies following vasectomy. Antibodies are blood proteins, and the body’s immune system produces them as a response to foreign substances called antigens.
The vasectomy procedure may expose sperm antigens to the immune system. As a result, the body will stimulate a sperm antibody reaction, which reduces fertility. Of course, as eliminating fertility is the goal of a vasectomy, this isn’t problematic. Unlike other antibody reactions, a sperm antibody reaction shouldn’t cause side effects like fever, shortness of breath, or rash.
What Are Other Potential Vasectomy Complications?
Other potential side effects of a vasectomy include hematoma, infections, epididymitis, and Post-Vasectomy Pain Syndrome (PVPS).
Hematoma
A hematoma is essentially a severe bruise. This condition can occur anywhere in the body when an injury or surgery causes blood to collect and pool beneath the skin.
A hematoma is not the same as a blood clot. Small hematomas can resolve themselves. If a hematoma increases or appears concerning, a patient should consult a medical professional. One complication is the risk of infection.
Epididymitis
Epididymitis is the inflammation of the epididymis. Males of any age can get epididymitis, regardless of whether they had a vasectomy procedure. A bacterial infection or a sexually transmitted infection causes epididymitis.
Symptoms of epididymitis include swelling, pain, and discharge. Epididymitis occurs due to inflammation following the procedure for men who have recently undergone a vasectomy.
Post-Vasectomy Pain Syndrome (PVPS)
Post-Vasectomy Pain Syndrome (PVPS) is one of the vasectomy's most common side effects. PVPS occurs when a patient experiences chronic pain in one or both testicles for three or more months following the procedure.
If PVPS causes swelling or discharge or disrupts everyday life, a patient should seek professional medical help. Doctors can use anti-inflammatory drugs and minor surgical interventions to resolve the issue.