From the Guidelines
Sperm granuloma is a benign condition that typically requires only symptomatic treatment, with mild cases managed with over-the-counter pain relievers like ibuprofen or acetaminophen 1. When a sperm granuloma occurs, it is essential to understand that it is an inflammatory reaction to sperm leaking into surrounding tissues, often after a vasectomy. The body's immune response to the sperm as foreign material leads to the formation of a small lump of inflammatory cells.
Symptoms and Treatment
- Mild cases of sperm granuloma can be managed with over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) for discomfort 1.
- For more painful granulomas, a doctor may prescribe stronger anti-inflammatory medications or consider a local steroid injection to reduce inflammation.
- In severe cases that cause persistent pain, surgical removal of the granuloma may be necessary.
Importance of Medical Attention
Patients should seek medical attention if they experience severe pain, rapid growth of the lump, or signs of infection such as redness, warmth, or fever. While most common after vasectomy, sperm granulomas can occasionally occur with other conditions that damage the epididymis or vas deferens, as seen in cases of obstructive azoospermia where there is a blockage in the reproductive tract 1.
Underlying Conditions
It is crucial to identify any underlying conditions that may have led to the sperm granuloma, such as congenital bilateral absence of the vas deferens (CBAVD) or ejaculatory duct obstruction (EDO), which can be indicated by a low volume, acidic pH, azoospermic ejaculate 1. Clinicians should recommend karyotype testing for males with primary infertility and azoospermia or sperm concentration <5 million sperm/mL when accompanied by elevated FSH, testicular atrophy, or a diagnosis of impaired sperm production 1.
From the Research
Sperm Granuloma Overview
- A sperm granuloma is a complication that can occur after vasectomy, a surgical procedure for male sterilization 2
- It is characterized by the formation of a granuloma, a type of inflammatory tissue, at the site of the vasectomy
Effects of Sperm Granuloma
- The presence of a sperm granuloma at the vasectomy site can prevent epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma 2
- It can also enhance the reversibility of the vasectomy and lessen the likelihood of epididymal discomfort
- However, it can create a greater risk of spontaneous recanalization, which can be solved by more careful sealing of the upper end of the vas 2
Relationship with Postvasectomy Orchialgia
- Postvasectomy orchialgia, or chronic pain in the testicles after vasectomy, can be related to the presence or absence of a sperm granuloma 2
- In some cases, the absence of a sperm granuloma at the vasectomy site can lead to increased epididymal pressure and pain 2
- Vasovasotomy, a surgical procedure to reverse the vasectomy, can relieve pain in these cases 2
Ibuprofen and Sperm Granuloma
- There is no direct evidence on the effect of ibuprofen on sperm granuloma 3, 4, 5
- However, ibuprofen has been studied for its potential effects on semen quality and fertility, with some studies suggesting adverse effects on sperm parameters such as motility and viability 3
- Other studies have found no significant adverse impact of ibuprofen on semen parameters, including sperm concentration, motility, and forward progression 5