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Post-Vasectomy Pain Syndrome, and risk evaluation in contraceptive choices.

There was a recent post in which a man complained that his wife had a morbid fear of getting pregnant, so she was insisting on using condoms and was pressuring him to get a vasectomy. She also ruled out the pill because she didn't trust herself to remember to take it, and refused to consider any alternatives.
Many of the replies were, roughly, "Dude, it's just a snip! And IUDs and the pill are horrible! She's right to demand that you have surgery and you're being unreasonable in asking her to even discuss alternatives."
This struck me as cavalier and unbalanced advice, in part because I was aware of a case where vasectomy had gone badly wrong, so I mentioned in my comments that vasectomies have a fairly high long-term complication rate.
One of the mods challenged my response and asked me to back up my claim:
Where is the data for the risk of long term complications for vasectomy being higher than other methods?
I thought this was an important question, so I asked for more information on the case I had heard about and then did some research in the medical journals. Unfortunately, I was unable to answer this question before the entire thread got locked, so this post is to answer that question and summarize what I found.
To begin with, the high long-term complication rate is no secret. As the Mayo Clinic says:
Delayed complications can include:
  • Chronic pain, which can happen for 1 to 2 percent of those who have surgery
  • Fluid buildup in the testicle, which can cause a dull ache that gets worse with ejaculation
  • Inflammation caused by leaking sperm (granuloma)
  • An abnormal cyst (spermatocele) that develops in the small, coiled tube located on the upper testicle that collects and transports sperm (epididymis)
  • A fluid-filled sac (hydrocele) surrounding a testicle that causes swelling in the scrotum
All told, about 14% of vasectomies result in some degree of chronic pain extending more than a year after the procedure. About 1-2% of cases are serious enough to interfere with sex and quality of life. Many of those require substantially higher-risk corrective surgeries, and a significant percentage of them are never resolved with additional treatment. If the treatments don't work, the patient suffers the effects for life.
The case I had heard about involved the father of one of my employees. He had a vasectomy 6 years ago and is living with lifelong pain, with no cure available. It ended his sex life and his marriage, and has led to severe depression that may well be fatal.
He has had four unsuccessful surgeries, and has been told his only remaining form of relief would be an "orchiectomy" (i.e., castration). So he has a choice between endless pain and getting his balls cut off, and needless to say he is despondent about it.
This "PVPS Treatment Flowchart" from a recent journal article shows what men like him with PVPS are facing. Different kinds of surgery resolve some cases, but it's all guesswork, and if you go to the bottom you can see that when all the surgical options fail, the chart ends with the choice of either castration (lower right) or a lifetime of chronic pain (lower left).
Here are some quotes I pulled from the journal articles and other medical sources I reviewed:
Post-Vasectomy Pain Syndrome (PVPS)
When scrotal pain becomes persistent lasting more than a few months it is considered to be post vasectomy pain syndrome (PVPS). This condition interferes with daily activities and negatively impacts quality of life.
Pain can be experienced as dull or sharp, localized or general. The skin can become so sensitive that wearing clothing of any kind over the area is very painful. Pain can radiate to the inner thigh and become worse during physical activity such as cycling. It is usually more severe during or following sexual activity.
PVPS naturally causes reluctance to engage in intercourse or other activities that will cause more pain. Life is greatly impacted by post vasectomy pain syndrome not only for the man but for his partner and others that he interacts with.
The 2012 American Urological Association (AUA) guideline for vasectomy which was updated in 2015 states that 1–2% of men who undergo a vasectomy will develop chronic scrotal pain that is severe enough to interfere with their quality of life and require medical attention.
Chronic scrotal pain after vasectomy is more common than previously described, affecting almost one in seven patients. All patients undergoing vasectomy must receive appropriate preoperative counseling about this.2
... Surveys in recent years have found that almost 15% of men suffer from PVPS, with 2% of men experiencing pain intense enough to impact their quality of life.
Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them.
I'm happy for the many men on SO30 who have had vasectomies with little or no long-term issues. But it seems irresponsible for people to be saying "I was fine, so you'll be fine too!" Each person needs to make his own decision, based on his own tolerance for risk. But to do that, you need to have accurate information about what those risks really are.
One final quote that does not involve PVPS:
"Vasectomy is associated with a statistically significant increased long-term risk of prostate cancer. The absolute increased risk following vasectomy is nevertheless small, but our finding supports a relationship between reproductive factors and prostate cancer risk."
The 39-year longitudinal study involved a massive sample, consisting of "2,150,162 Danish men during 53.4 million person-years of follow-up."
It's a small risk, and it would not be a reason by itself for not getting a vasectomy. But it's a controversial topic that showed up repeatedly in my searches and the new Danish study is high quality. So I'm including it for completeness, and because similar small cancer risks are sometimes used to argue against hormonal birth control.
 
Putting Vasectomy Risk in Context with Other Methods of Birth Control
As this chart from the Center for Disease Control makes clear, the five most effective forms of contraception are the implant, a vasectomy, the hormonal IUD, getting your tubes tied, and the copper IUD, in that order, and they are MUCH more effective than the rest:
The CDC effectiveness rates are based on large data sets dealing with long-term real world usage, not lab data that assumes perfect use. They are the best available numbers on the real -- as opposed to theoretical -- risks of pregnancy with each type of contraception.
As indicated, the Nexplanon implant is THE most effective form of contraception. The pregnancy rate for vasectomies is three times higher than it is for the implant. The pregnancy rate for the hormonal IUD is four times higher. The pregnancy rate for tubal ligation is 10 times higher. The pregnancy rate for the copper IUD is 16 times higher. The pregnancy rate for the pill, patch, or ring is 180 times higher. And the pregnancy rate for the condom is 360 times higher!
Clearly a woman who is morbidly afraid of pregnancy should not be relying on either condoms OR the pill, patch, or ring!
Many people are surprised to find out that the implant is more effective than a vasectomy. It is also safer than a vasectomy in a second sense, because it is so easily reversed. If you have side-effects you don't like, it takes five minutes to get your implant removed and about a day or two to flush the hormones out of your system. End of problem!
About 10% of users do just that at some point during the first year. So the risk of side effects with the implant essentially amounts to a 10% chance of having a few months of discomfort or excess spotting or flow that does not resolve even with treatment. (The most common side-effect is actually the opposite, the gradual reduction or complete elimination of menstrual bleeding, which most people think is a major advantage.)
In any event, the possible side-effects are nothing like the comparatively high risk of long-term pain from the vasectomy, and a 10% chance of removal seems like a reasonable price to pay for a 90% chance of finding a simple, painless, and extremely reliable way to prevent pregnancy.
Yes, it would be wonderful if the implant worked for everyone, but unfortunately NO form of hormonal birth control (HBC) works well for everyone. However, in the particular case that started this discussion, the OP's wife is morbidly afraid of pregnancy, so what she needs to know is what form of contraception is the most effective at preventing pregnancy. That's why I advised OP to share the CDC chart with her.
The implant is not just the most effective form of birth control. It is also one of the safest forms of contraception overall. Long-term complications (i.e., effects that persist after removal of the implant) tend to be relatively minor, and occur roughly on the order of one per 100,000, or somewhere around 0.001%, which is less than one ten-thousandth of the risk from a vasectomy and substantially lower than the complication rate for the IUD.
The overall mortality rate with the implant is unknown because it is too small and indirect to be measured. As far as I have been able to tell, there has never been a death directly attributed to Nexplanon. Whatever the risk may be, it is tiny, far less than the mortality risk from getting pregnant.
In any discussion of contraception, it's important to keep in mind that the morbidity and mortality rates associated with pregnancy are FAR higher than the risks with any form of hormonal BC. In the U.S., roughly one pregnancy in 7,000 results in death and roughly 1% of all pregnancies result in severe health problems:
Severe maternal morbidity (SMM) includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health. Using the most recent list of indicators, SMM has been steadily increasing in recent years and affected more than 50,000 women in the United States in 2014. [out of ~5 million pregnancies]
Now add complications that can occur before labor and delivery, like diabetes, pre-eclampsia, ectopic pregnancy, blood clots, stroke, and more, and the total risk of serious health effects exceeds 1%.
Because that risk is so high compared to the risks from contraceptives, the most effective form of birth control is also generally the safest in terms of a woman's total health. The implant's 1 in 100,000 chance of some long-term consequence, even a relatively minor one, needs to be balanced against its dramatic reduction in the risk of exposing the woman to the far higher chance of death or serious harm from getting pregnant. This means that a sexually active woman who is relying on an implant or IUD for contraception will have a higher life expectancy and a lower overall health risk than a woman relying on condoms or the pill, simply because she is so much less likely to get pregnant.
 
The Other Form of Surgical Sterilization
In researching the vasectomy risks, I came across this, and wanted to add it to the discussion to put the risks of the two forms of surgery in context:
a 1999 American study showed that, if compared with vasectomy, tubal ligation has 20 times the risk of major complications, and a death rate 12 times higher.
As far as I can tell, it's the only form of contraception that is more dangerous than a vasectomy.
Here's a link to the original study:
Sterilization and its consequences., Obstetrical & Gynecological Survey [01 Dec 1999]: 10.1097/00006254-199912000-00005
I fault the medical community for pushing the false idea that surgical sterilization is the most effective way to prevent pregnancy. It's not, but it IS the most lucrative for doctors, by a very wide margin, so they have a big financial incentive to mislead patients and the general public.
 
Thinking about Risk
It's easy for people on the internet to form their impressions of riskiness based on the frequency of negative reports. This can have the perverse effect of making people think that the most popular alternatives have the highest risk. If something has been used by a billion people and it has a 0.1% dissatisfaction rate, that's still one million unhappy people yelling about it. If something has been tried by a million people and has a 1% dissatisfaction rate, there will only be one one-hundredth as many people complaining about it, even though it is riskier. Since we hear 100 times as many complaints for the first one, we assume it is riskier, when in fact it is ten times safer.
There is also a tendency to blur minor and major issues, and in the case of contraceptives a well-documented tendency to blame the contraceptive for problems that would have occurred anyway. A shining example of this is that loss of libido is listed as a side-effect for all forms of HBC, even though the reported rate of libido loss is LOWER for people using HBC than it is for matched populations of women the same ages who are NOT using HBC.
The fact is, humans are very bad at informal risk assessment. We all tend to underestimate familiar risks and overestimate the riskiness of unfamiliar activities. (E.g., reckless drivers who are afraid to fly.) We get confused between absolute risk and relative risk. We also tend to be overinfluenced by anecdotes and shocking stories. Intuition simply doesn't work well for risk analysis, so there's no substitute for digging into the data.
That means that we should be careful about dispensing advice based on hunches or conventional wisdom. When people on SO30 confidently dispense inaccurate advice, it has potentially serious harmful consequences.
Here are some samples from that thread that started me looking into the data:
The potential implications from use of the BCP are much greater than a simple vasectomy, which is typically outpatient and done in less than an hour, with minimal expected complications.
False choice (the BCP was not the alternative to vasectomy in this case), the risk of complications is NOT minimal for vasectomies, as I've indicated above, and even in the case of the BCP, the serious long-term complication rate is much lower -- NOT "much greater" -- than it is for vasectomies.
So, since you don't want to take it easy for a week it makes sense your wife gets on the pill indefinetely.
Another false choice. OPs wife is in her 40s. The choice is actually a few years on the implant or IUD for her (easily reversible if there are problems) vs. moderately risky surgery and the possibility of a lifetime of problems for him.
She gave the pill a shot already and didn't like it. Do some research on how bad the pill can fuck a woman up. Then do some research on the minimal pain and quick recovery of a vasectomy.
Again, that's a false choice (the pill is not an alternative here), and it completely dismisses the serious risks of a vasectomy.
Overall, the overwhelming consensus was that vasectomies are easy and risk free, and that the alternatives are somehow much more dangerous for her, both of which are simply untrue.
Just so you know I'm not cherry picking, here are more responses:
  • Man do yourself a favor and get snipped. Its easy, relatively painless and your back in the game in a few days.
  • BTW, being snipped isn't a big deal. Been there, done that, just FYI.
  • Get snipped.
  • My husband decided to have a vasectomy and couldn’t be happier.
  • It would be significantly safer for you to get a vasectomy.
  • She could have a significantly more dangerous procedure done by getting an IUD, or by taking hormones that could literally kill her.
No, vasectomy is not "significantly safer." No, IUDs and implants are not "significantly more dangerous."
So what is the harm done by an outpouring of false medical information, especially when it is accompanied by a ton of social pressure and ill-disguised contempt toward the OP and anyone else who disagrees?
 
tl;dr:
  • The risk of long-term pain from a vasectomy (PVPS) is significant. 14% of men who have had vasectomies still experience chronic scrotal pain a year or more later.
  • The American Urological Association states that 1–2% of men who undergo a vasectomy will develop chronic scrotal pain that is so severe that it interferes with their quality of life and requires further medical intervention.
  • PVPS can be extremely difficult to diagnose and treat. If corrective surgeries fail, the man will face a choice between castration, a lifetime of severe pain, or suicide. Even castration is not guaranteed to end the severe chronic pain.
  • Vasectomy may also somewhat increase the risk of prostate cancer.
  • The risk of serious long-term consequences from a vasectomy are far greater (like, well over 100 times greater) than the risk of comparably serious long-term consequences from the contraceptive implant or IUD.
  • The safest and most effective form of contraception is not the vasectomy, tubal ligation, IUD, or pill, but the implant. Insertion is painless, the serious complication rate is extremely low, side effects are well-tolerated by 90% of women, and it is quick and easy to remove if it has side effects that are not acceptable.
  • The morbidity and mortality rates associated with pregnancy are FAR higher than the risks from any form of hormonal BC. That means that the most effective form of contraception is also generally the best for overall health simply because it greatly reduces the much higher health risks from getting pregnant.
Sorry for the monster wall of text. Some things can't be reduced to soundbites or bumper stickers.
 
Edit 1: I don't know how I missed it, but there's -- of course! -- a subreddit devoted to this subject, called postvasectomypain. There are many personal stories and the stickied post is an excellent, very even-handed review of what is known at this point about "How common is chronic pain after vasectomy?" Recommended!
 
Edit 2: Here's something else to check out if you've had a vasectomy and you're having chronic pain:
A better resource for men in pain is www.postvasectomypain.org -- lots of regular contributors there to commiserate.
 
Edit 3: I've been reading those two sites and there are some successes and many tragic stories. I wanted to share this exchange because the problems these guys are facing sound so much like my employee's father's situation. Sadly, they are not alone:
Some of you know that I’ve underwent a lot of surgeries, tried a shit load of medication and visited at least 12 urologist and that none of that helped. The last months I got hot flashes and fatigue and after another test I found out my testosterone level dropped 63% in one year to the lowest you can get on the average scale (8.9 nmol/l in US measurements, 258 ng/dl in European). And the pain and liver damage are going the opposite direction so I’m also turning to the last resort [castration] to prevent this from killing me. Tomorrow I have an appointment with the hormone specialist to discuss my options (I prefer a shot every week based on what I have read), got a psychiatric report (otherwise no urologist wants to do the operation) and found a urologist who is willing to perform the operation. Only thing I want to decide next is do I go for a bilateral in one shot and do or do I not get prosthetics.
This is from one of the replies:
I know after my epididmectomy it was a sure decision to remove my left [testicle] as pain was so bad…it was terrible and imo was never going to be right.
The immediate recovery from the incision in groin was very rough for me and was nearly 3 weeks before I could walk again without being in a lot of pain and hunched over. So me personally I wouldnt like to have to do it again after recovering from one.
Its a tough decision as we know its not guaranteed to work so going in both at once has its risks in case it made things worse.
(Emphasis added.)
 
Edit 4: Reference material.
I wrote this post offline and for some reason a lot of the links didn't transfer when I copied and pasted it in here. I'm going to try to backtrack along my trail and recover the missing ones and provide some others that may be useful. Unfortunately, some of them are behind paywalls, but you should be able to read them if you have access to a university library. Alternatively, many authors will send you a copy of a paper if you ask, or you can look for bootleg copies online.
I've also added some information in this section that is relevant to questions that have been raised in the comments, about things like the side-effects of other kinds of birth control.
 
PSVP
This is the easy part, since PVPS is so common. Medical associations collect statistics and doctors publish research guidelines. I'm going to start with the stickied post on the PVPS subreddit, which is excellent, and then borrow many of the links it includes:
How common is chronic pain after vasectomy?
  • Canadian Urology Association give the chronic pain outcomes for vasectomy at between 1-14% (Link)
  • American Urological Association says chronic pain serious enough to impact quality of life occurs after 1-2% of vasectomies. (Link)
  • British Association of Urological Surgeons, patient advice reports troublesome chronic testicular pain which can be severe enough to affect day-to-day activities in 5-14% of vasectomy patients. (Link)
  • UK National Health Service says long-term testicular pain affects around 10% of men after vasectomy. (Link)
  • 11th edition of Campbell Walsh Urology (2015) cites 10% incidence of chronic scrotal pain caused by vasectomy. (Link)
  • European Association of Urology (2012) cites 1-14% incidence of chronic scrotal pain caused by vasectomy, usually mild but sometimes requiring pain management or surgery (Link)
  • Royal College of Surgeons of England says significant chronic orchalgia may occur in up to 15% of men after vasectomy, and may require epididymectomy or vasectomy reversal. (Link)
  • Journal of Andrology cites large studies that find Post Vasectomy Pain Syndrome 2-6% of the time (Link)
 
Treating PSVP
Post-vasectomy pain syndrome: diagnosis, management and treatment options 2017 May -- 10.21037/tau.2017.05.33
An overview of the management of post-vasectomy pain syndrome 2016 Mar 4 -- 10.4103/1008-682X.175090
 
Pregnancy Risk for Different Contraceptive Methods
This information is also easy to find, since the CDC collects massive amounts of data on real-world effectiveness:
Effectiveness of Contraceptive Methods - CDC
 
Long-Acting Removable Contraceptives (Implants and IUDs, aka "LARCs")
Non-technical summary: Carafem Implant FAQ
Non-technical summary: Carafem IUD FAQ
LARCs last longer than advertised: Use of the Etonogestrel Implant and Levonorgestrel Intrauterine Device Beyond the U.S. Food and Drug Administration–Approved Duration March 2015 -- 10.1097/AOG.0000000000000690
Planned Parenthood is even more aggressive about extending the time line:
Nexplanon works for 5 years. ... A nurse or doctor will take your implant out of your arm after 5 years or whenever you want to stop using it.
Weight gain: Gaining weight: Is it the birth control? (informal, but has links to research)
From young adulthood into middle age, Americans gain an average of 1 to 2 pounds per year. Women with LARCs do not gain weight on the average any faster than women of the same age, health, education level, starting weight, etc., who are not using any form of hormonal BC. However, women who were told that the implant or IUD might cause weight gain were more likely to think they had gained weight. In some cases, this caused them to stop using the implant or IUD.
Blood clots are not a risk with LARCs: Association of Venous Thromboembolism With Hormonal Contraception and Thrombophilic Genotypes
No known cancer risk: It is well-known that contraceptives that contain estrogen reduce the risk for some kinds of cancer and increase the risk of others. However, LARCs do not contain estrogen, and I have not been able to find a single study linking etonogestrel or levonorgestrel (the progestin compounds in the Nexplanon implant and the Mirena and Skyla IUDs, respectively) with any increased cancer risk.
As Bedsider put it: "Levonorgestrel is one of the longest-studied types of progestin, and all the scientific evidence to date shows it is super safe." Etonogestrel (Nexplanon) is a "third generation" progestin. It has has been studied for more than 30 years and is also believed to be extremely safe.
A Google Scholar search on "levonorgestrel etonogestrel cancer risk" produces only negative results. This is a typical negative report: Use of the Levonorgestrel-Releasing Intrauterine System and Breast Cancer:
CONCLUSION: The results suggest that the use of the levonorgestrel-releasing intrauterine system is not associated with an increased risk of breast cancer.
The fact there are a number of studies with negative results, and no studies linking LARCs with cancer, doesn't prove that LARCs don't increase the risk for any kind of cancer. But, at the very least, we can say that if it does happen the effect is extremely rare or subtle.
Other Effects: The copper IUD can create long-term heavier flow, which some women can't tolerate. The best known side-effects of the other LARCs are irregular menstrual bleeding or the complete cessation of menstrual bleeding. However, some women have heavy or non-stop bleeding initially after getting an implant or hormonal IUD. This usually subsides with time, or with a brief treatment of estrogen or combination birth control pills. If it does not, those women usually decide to switch to a different method of BC, which solves the problem. There are no known long-term consequences from any of these changes in menstrual patterns.
Cramps after insertion of the IUD rarely last more than 1-3 weeks and can generally be treated with NSAIDs. Mild bruising after insertion of the implant usually clears up in about a week.
Implant Insertion Risk: This was a significant issue in the past, especially in cases where the Implanon implant was being inserted in crowded clinics with poorly trained staff. Since Nexplanon was introduced, the rate of insertion problems has dropped. In a very recently published study of 7,364 Nexplanon insertions in Germany, 1.26% had initial insertion problems, including such minor issues as difficulty removing a stuck applicator cap. The most common issue for patients was pins and needles and numbness in the arm/hand/fingers, from the rod being placed too close to a nerve. Of 5,159 removals, all but one were successful without further intervention. (The problem case involved, a rod that was inserted too deep and became embedded in the muscle, requiring surgery.) In no case had the rod migrated out of the arm. No significant long-term injuries occurred.
Minimizing Implant Insertion Risk: Get it done by someone both trained and experienced. Make sure it is done in a quiet place with no distractions. Don't allow the rod to be inserted in the sulcus, the groove between the bicep and the tricep. When the needle goes in, watch to see that it is just barely under the skin for its whole length.
Immediately after the procedure, feel the rod under the skin. If you can't feel the whole rod, it's not where it should be and should be removed immediately, using xrays or CT scan to precisely locate it. Check the rod once a week, but DO NOT get in the habit of playing with it! (Some women use it as a fidget toy and have flexed it enough to break it. That won't stop it from working, but it will make removal harder, so don't do it!)
Finally, don't get it replaced after 3 years. It has been shown to effectively prevent pregnancy for up to five years, so wait until at least 4-4.5 years before getting it replaced:
Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant Oct 2016 -- 10.1093/humrep/dew222:
The extended use of the one-rod ENG-releasing subdermal contraceptive implant showed 100% efficacy in years 4 and 5.
This has been known for a long time. For example, the original trial for Implanon back in the 1990s had over 4000 women using it for four years with zero pregnancies. Back in 2010 my GYN told me I could safely leave mine in for four years. The USDA approval for only 3 years had more to do with the cost of certification and the desire of Merck, the big pharma company, to have the higher profits from more frequent replacements.
IUD Insertion Risk: There are three main risks. The device can be expelled, possibly without the woman noticing it. The woman's cervix or uterus can become infected (typically during the first 20 days) because of non-sterile conditions during insertion. And the IUD can perforate or become embedded in the wall of the uterus.
Expulsion of the IUD happens about 3-5% of the time for adults and more often for adolescents. (This is one of the reasons many doctors and public health workers recommend the implant over the IUD for teens.)
The other two problems were so serious back in the 70s that they killed the entire IUD market for years. They are now extremely rare.
Beneficial Side-Effects: Aside from preventing pregnancy, hormonal LARCs are prescribed for other beneficial reasons:
A considerable literature now exists to demonstrate the multiple and substantial noncontraceptive health benefits of long-acting progestogen-releasing systems... These benefits mainly relate to disturbances of menstruation and related symptoms, such as heavy menstrual bleeding (due to many causes); iron deficiency; pelvic pain, especially around endometriosis; and endometrial hyperplasia.
And, of course, the big benefit for a lot of users is that implants and hormonal IUDs can result in lighter periods or none at all.
 
Long-Term Risks from the Nexplanon Implant
This is the hard one, because there is so little information. To be conservative, I'm including several cases where thoracic surgery was needed to remove the implant. That's a very serious risk for the patient, even though none (that I know of) have resulted in permanent injury.
I am also including cases of peripheral nerve damage that couldn't be corrected by surgery. These have been cases where patients have had permanent numbness or weakness in a finger, hand, or wrist as the result of an implant being improperly placed through or against a nerve, or having been removed improperly. For example:
Peripheral nerve injury with Nexplanon removal: case report and review of the literature 22 October 2018
In this case the patient lost the use of the two outermost fingers, treatment was delayed, and the surgeon was only able to restore partial function. Compare that with the effect of immediate action in reversing the nerve injury:
Contraceptive Implant–Related Acute Ulnar Neuropathy: Prompt Diagnosis, Early Referral, and Management Are Key (The patient was treated one day after a botched insertion. "A review 3 months after removal of the implant showed near-complete resolution of her symptoms.")
The incidence of permanent loss of function (as happened in the first case) is still so low that we're seeing individual reports, not numerical tallies, so it's hard to be sure how many have happened. All told, it looks like about a dozen, but it may have been as many as a hundred (out of millions of patients). That would mean that the risk of a serious long-term injury, one that persists after the device is removed and can't be fixed in a reasonable amount of time, is very roughly somewhere between 1 per million and 1 per 100,000.
This makes it hard to compare risks precisely, but the overall comparison between the Nexplanon implant and a vasectomy is clear. There far more implants inserted per year than vasectomies performed, yet the number of serious long-term injuries from vasectomies is reported to be in the thousands while serious long-term injuries from implants are so rare that they are still being reported individually.
 
Edit 5: I added a section above in the main post about tubal ligation surgery. The risks of injury and death from this kind of surgery are even higher than the risks from vasectomy.
Everything I said in this post about vasectomies should be multiplied many times over for the risks of getting your tubes tied or cut. Surgical sterilization is not the most effective form of birth control and it is by far the riskiest in terms of your health!
(The two forms of surgery are also the most expensive alternatives and the most profitable ones for doctors, which is why doctors push them and play down the risks.)
I also added a section in the reference material under "Edit 4" on "Minimizing Implant Insertion Risk."
 
Gold and Platinum! Thank you, kind strangers!
submitted by TantraGirl to sexover30

vault app messed up all my files, i need them back urgently

DISCLAIMER: Please read all for full story and check out all the links for screenshots if that'll help, I am not a tech expert so I'm not sure which detail is important and which isn't, so I added everything, Also, English is my third language so please forgive me if you notice any mistakes, I am more than willing to clarify any part you dont get.
I downloaded a calculator app by FishNet on Google play, it was an app where you can store media files in an app disguised as a calculator and can only be accessed by typing a passcode into the app. They hide the files using AES encryption. Here's an example of a picture (original form) once its uploaded onto the app (encrypted form).
I put 937 files on the app; 744 images and 204 videos. All together they was 2GB in total. After some time I released all of them back into normal gallery, then back on the app. After a while, my files were missing, and I asked the developers for help. They showed me a section on the app that said manual retrieval or automatic retrieval. I tried automatic but it said no encrypted files found.
I tried manual and they put all my lost files into a folder called LostFileRestore, but they all had strange names all starting with e-randomnumbersandletters.fileformat (This is the exact same name of a file in encrypted form only without the .fileformat at the end, which were mostly .mp4 or .jpg). When I tried opening the video file it fails, and its the same case with the image files too. I provided what they look like if i tried to open them in form of hyperlinks linking to screenshots I took.
I told them this, and they told me to make all the image files into JPG (some were originally PNG while some were JPEG, but majority were already JPG) and make all the video files MP4 (some were originally Webm) and then try manual retrieval again, and I complied. But the situation didn't change.
They then told me to try automatic retrieval, but when I did the app said no encrypted files found. I told them this and they haven't responded to me in over a month. Is it over Have I lost everything? I really need some of those files before September.
They all have their encrypted names but are in jpg and mp4 formats and are all unviewable. Is there a way to fully decrypt them and recover them?
submitted by MasterCMB to techsupport

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