I beg your forgiveness in advance, dear reader – as you might’ve guessed by the title, this isn’t exactly holiday fare, and it’s a bit long – but for anyone thinking about permanent birth control, or living with ongoing pain, this is my gift to you.

I had my vasectomy on a Friday afternoon six years ago – Friday the 13^th, actually.

A few things I remember about that half hour in the doctor’s office: the female nurse shaving my testicles without water or shaving cream; the deep bite marks I left on the colored block of wood I brought along with me (borrowed from my son’s toy block set); the doctor adding extra cc’s of lidocaine to my left testicle because, as he put it, it was “tougher” than the right side; and the long puddle of sweat I left on the examination table.

I was able to drive myself to and from the appointment – it was only local anesthetic.  I got home and lay down on the couch with a frozen bag of peas on my jock strap – part of the protocol.

Once in a while I would lift the bag of peas to look at the blood stained jock.

It was painful from the beginning, but I expected this.  This was minor surgery, but surgery just the same. Two to three weeks of soreness wasn’t unusual.  What was a bit unusual was that my pain wasn’t a dull ache, but rather, something I can only describe as tiny jolts of electricity that ran on top of and through my left testicle, and, when I walked, even the softest of underwear felt like 40 grit sandpaper.

But again, it had only been a few days…..

Six years, four urologists, three prescriptions and one surgery later, I’m here to plead with any couples out there considering a vasectomy to just say no.

My journey began seven years ago, when my wife and I first started talking about permanent birth control.  She had been on the pill early in our relationship, but it had played ping pong with her moods and so we switched to condoms, which was fine, except that it was a bit of a buzzkill to stop and put it on.

What about spontaneity, right?  We’re not the types to do it in a mall elevator, but what if we wanted to, dammit!!?

We wanted the freedom to get a little kinky, or at least a little more spontaneous, so we decided to go permanent, and a vasectomy sounded like a no-brainer – just 30 minutes in a doctor’s office.

I went to my first consult, and the doctor had me sign a consent form which was valid for six months.  He mentioned verbally, and it was also there somewhere in the fine print, that a very, very small number of men suffer from chronic pain afterward.   He put the odds at 1 in 1000.

Now being a worrier by nature, that 1 in 1000, that .001 %, actually bothered me.  I let the consent form lapse without scheduling the procedure.

Here’s another window into my worrier nature: the second reason I was considering a vasectomy, just as important as the prospect of adding spontaneity to our sex life, was the fear that the rubber would break and I would get my wife pregnant again.  We had two kids, and we were done.  Linda had told me before that she would not get an abortion if she got pregnant.  So my overactive and overworried and overcautious imagination pictured the condom breaking and us having an unwanted child who would cause us so much stress that it would wreck the marriage and suck the joy out of our children’s lives.

But it wasn’t my umpteenth visualization of this scenario that got me back into the urologist’s office.  It was a chance encounter with my old college roommate Martin at a coffee shop.  Martin and I somehow got on the topic of birth control and he urged me to reconsider the vasectomy.  Why?  Because his wife, while on the pill, got pregnant.  They had an abortion, and it was a miserable experience for both of them.  Like us, Martin and his wife had two kids, and were done.  He said the vasectomy was a breeze and recommended his doctor, Dr. Laney.

I had my consult with Dr. Laney, and he, too, mentioned the 1 in 1000 statistic.  This time I was resolved, though.  I had my reassuring anecdote: Martin.  My insurance was set to expire in three months, so I figured I had better make the appointment as soon as possible, so that any follow up visits would be covered.

At home I joked with my wife: “what if I hit the anti-lotto and have pain all the time?”  It was a passive-aggressive joke.  Deep down I was hoping she would say, “Well, if there’s any chance at all of you being in life long pain, let’s not do this.”  But she didn’t.  It’s strange.  I didn’t have the guts to say “no” by myself.  The rational Virgo in me who appreciates statistics, plus the vision of that third surprise baby, prevented me from putting on the brakes.

Whether it makes sense or not, I have to say I felt from the beginning that this was our decision to make.  And because of that, the fallout over the next few years would put a strain not just on me, but on her, and on us.

Ten weeks after the procedure, the pain had not abated.  I tried to keep positive and tell myself that the average of a two week recovery is just that – an average – and that there must be plenty of guys like me who take a little longer to heal.

I scheduled a follow up visit with Dr. Laney, and he informed me that not only was I the first patient of his ever to suffer from something called PVPS (Post Vasectomy Pain Syndrome; something I’ve since become more familiar with than I ever wanted to be), but that there was nothing he could do about it.

Nothing.

I drove home in a daze.  I couldn’t believe this would be the new normal.   Do you know how a toothache or really bad sore throat can color your day?  You’re grouchier, moodier, shorter with people, unable to be fully in the moment?   PVPS is like that 24 hours a day, only there is no dentist who can help, and the sore throat never goes away.

I remember telling my wife the news in the kitchen, and both of us crying.

She had been through the ringer on this, too.  Fair or not, I couldn’t hide the resentment I felt: why hadn’t she stopped me when I told her there could be chronic pain?  Why wasn’t she being more sympathetic now?  Why did she seem irritated when I lay on the couch, pillow between my legs, watching TV, turning away from her?

This is one of the cruel lessons I’ve learned about pain: it’s completely isolating.

Your friends and loved ones want to help you – they do – but if they can’t, it just drives them away.  You’re a drag to be around.  You darken the room. Both of my grandparents passed away before I had the surgery, but I remember thinking, “god, I wish they were still alive, because next time grandma complains about the pain in her knees, I won’t just nod blankly, I will ask her how she feels, I will tell her that even though I can’t really imagine what it is like, I am very sorry for her, and I will ask her if there’s anything I can do for her, even if it’s just running to the store to buy some cookies.

I can not ride a bicycle anymore.  When my family took a trip to Oregon, I couldn’t go horseback riding with them.  If I run around too much, playing soccer or basketball with my kids, say, or doing anything which causes too much jostling, I have to stop – the pain flares.

Boo hoo, you’re saying, Alfredo can’t ride a horse for the rest of his life.  How tragic!!

And I agree.  Believe me, I am no stranger to self loathing.  Feeling sorry for yourself is ugly.  It’s weak.  And how dare I complain about a bit of pain and not being able to ride a bike when I can still walk and talk and think?  What about a war vet who has his arm blown off, or someone who loses an eye in a car accident?

In fact, I often wished that it had been a car accident, that a shard of glass had cut my testicle and led to this pain.

Why?

Because one of the worst things about all this is the fact that I brought it on myself.  No one put a gun to my head.  I chose to go under the knife.  I didn’t have to do this.

Hope.  I needed hope.

I’ve learned over the last few years that if I could just convince myself there was one more thing out there I hadn’t tried, one more option, well, then I could grin and bear it until I gave the new treatment a shot.

I remember driving with my wife to get a second opinion while talking on the phone with one of our fellow offenders about a cancer comedy we were working on (and, no, writing a cancer movie didn’t occur to me after the surgery; it occurred before – another little window into me, I guess).  But I remember feeling buoyant and hopeful and being in a good mood because a new doctor brought the promise of a new treatment.

That doctor had me take an ultrasound, found a few small benign lumps, and offered to surgically remove them.  But he also said he was not at all sure that the lumps were causing my pain.  That was the end of that – I had gone under the knife needlessly once.  I wasn’t going to do it again.

He was actually the third urologist I saw.  The second suggested hot soaks and prescription anti-inflammatories.  They didn’t help.

Another urologist referred me to a colleague in San Francisco, Dr. Paul Turek, the head of the urology department at UCSF.  That sounded promising, and of course I cursed myself for not going to the expert in the first place.

Dr. Turek first tried two injections of a strong, long lasting anesthetic into the testicle.  The pain of the injection set me back about a month, but I still had faith in the man – probably more for his patient, sympathetic manner than the impressive degrees on his wall.

He next tried a low level dosage of Celexa, an anti-depressant, in combination with EMLA, a topical cream so strong that if you don’t wash it off after ten minutes, it starts burning.   At the level of Celexa he prescribed  – cutting a normal pill into quarters, essentially – it would have no effect on my mood – but it had been shown to dampen the nervous system’s response to pain.

This regimen helped – a bit.  It had been three years, and by now I was buying pants two sizes too big for me for the extra room in the crotch – I already have a flat butt, so this made me look like I somehow had no ass at all, yet still wore a droopy diaper.

Queue up ladies, it only gets hotter: I could no longer wear boxers, and could only tolerate certain brands and fabrics of tightie whities.  Good lord, my poor wife: if the vasectomy was supposed to improve our sex life, you can imagine what an aesthetic and emotional backfire this was!

Actually, our sex life wasn’t too badly affected, except that we had to move very gingerly or I would end up in an hour of pain that would almost make the orgasm not worth it.  Almost.

On good days – that is, on days when I wasn’t feeling resentful or sorry for myself, and she was feeling particularly sympathetic – it actually brought us closer together and made for more tender sex.  I never felt closer to her than the times when she asked me, with a soft and caring tone in her voice, how I was feeling down there.

That alone took the edge off the pain.

Other times were more challenging.  I remember a family trip to Disneyland one year, where, after a day in the amusement park, we met my cousin Nick and his family for dinner at a Marie Callendar’s.   He and his wife have three kids, and I remember him telling me, as we walked backed to our cars, that he was considering a vasectomy.  I stopped in my tracks and told him not to even consider it.  I told him my story, and I could see my wife Linda watching me.

Later that night, at the hotel, after the kids went to bed, Linda and I fought.  She was mad that I had been so negative and had semi-publicly aired our dirty laundry.  And I was furious with her because it seemed to me she cared more about a moment’s embarrassment than a lifetime of pain.  But again, that’s the isolation.  Linda couldn’t feel the pain herself – how could she be expected to feel as impassioned about the whole thing as I did?

Naturally she just wanted it to go away and for us to be normal again.

We made up, of course, but that’s the collateral damage of pain – the guilt, the anger, the shame, the resentment.

There was one more thing to try, but it required going back under the knife: a vasectomy reversal.  This time I did my homework, and I consulted with two separate urologists who had a lot of experience with the procedure.  They both showed me tables of their patients’ histories, and the bottom line was this: 30% showed improvement, but none showed a worsening.

That was key for me.  Nobody got worse.  Not even 1 in 1000 got worse.

So at 5 am one morning last year, I drove to UCSF Hospital and a nice looking young man, Dr. James Smith, who replaced Dr. Turek (Dr. Turek had gone into private practice), sliced open my left testicle, cut off the sautered ends of the vas deferens, and stitched them back together.

This surgery required general anesthetic.  I woke up an hour later, and Linda drove me home.

So: did it help?

I hate to give you an unsatisfying answer, but I’m just not sure.  I think it may have helped – a little – I feel the pain has abated by something like an extra 15%.  But what I don’t know is how much of that 15% is due to the procedure, how much is due to the healing power of time, and how much is due to my body, brain and heart finally accepting “the new normal.”

It still hurts – not nearly as bad as it did the first year or two – but I don’t think of it all the time anymore, and that’s huge.

It no longer defines me.  And more importantly, it no longer defines us.  I’m no iron man, but I am proud to say that it is just one part of who I am, and now, today, six years on, a very small part at that.

In fact, I’m almost beginning to daydream about having sex with my wife in a mall elevator again.