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Vasectomy

Vasectomy performed in our clinic is a simple and safe method to prevent unwanted pregnancy. Recovery is quick, and the patient can usually return to work in 2 days. Any questions not answered below can be addressed in your counseling appointment before scheduling the procedure.

What is vasectomy?

Vasectomy is a form of male sterilization, or “permanent contraception”. In this procedure, the vas deferens (sperm duct) is either blocked or partially removed on both sides. Thus, sperm from the testes no longer reaches the ejaculate, and no longer enters the female reproductive tract to cause pregnancy.

Where is vasectomy performed? Are patients asleep?

Vasectomy is a minor surgical procedure, so in most patients it is performed in the doctor’s office with local anesthetic. In a small fraction of patients, it is done in the operating room with sedation or general anesthesia either due to patient preferences or due to the physician’s findings on physical exam.

How long does vasectomy take?

Typically, the procedure itself takes around 15-30 minutes. However, the office visit will be longer due to the time necessary to get positioned and cleaned for the procedure. If general anesthesia is administered in the operating room, this can add a few hours of recovery time as well.

How is vasectomy done?

The patient is positioned on an exam table, and the scrotal skin is cleaned. On each side of the scrotum, the site of interest is numbed with local anesthetic, and a small (3-5mm) opening is made in the skin (by incision or puncture). Here at Hopkins, we perform the “no-scalpel” puncture technique, as this heals well without stitches and may be associated with less bleeding.

The vas deferens is gently separated from surrounding tissues, then cut and sealed. A small segment of the vas deferens is often removed as well. All structures are then returned to their normal position within the scrotum. The skin incisions are so small that stitches may not be used. If used, the stitches will dissolve on their own. Some ointment and/or gauze may be placed on the wounds.

Does it hurt to get a vasectomy?

During the procedure, it is our job to keep you comfortable! The only sharp sensation should be that of the numbing medication through a small needle. After that, you should inform us if you are having discomfort, so that more numbing medication can be given if needed. Most men find the procedure less painful than what they were anticipating. Afterwards, some men experience little to no soreness, though most men experience some mild discomfort and/or swelling for a few days.

What are the recovery instructions after vasectomy?

Most men experience some mild discomfort and/or swelling for a few days, and this is almost always completely resolved by one week. We recommend taking 1-2 days off from work to minimize activity and ice the scrotum (longer for people with physically strenuous jobs). See below for specific recommendations:

  • 1-2 days of limited activity, frequently applying cold packs to the scrotum for around 20 minutes.

  • Avoid sexual activity and consider supportive underwear until discomfort is gone, and for at least one week.

  • Avoid exercise until discomfort is gone, and for at least one week.

  • Slowly return to these activities, gradually building up activity.

  • Avoid soaking in pool/hot tub/open-water for 3 weeks to ensure wound healing. (May shower and dab dry).

What are the risks or complications of vasectomy?

It should be remembered that there is no form of fertility control, except abstinence, that is free of potential complications. Complications of vasectomy (mainly blood collection and infection) occur in 1-2% and are usually easily managed.

Bleeding

A small amount of oozing blood (enough to stain the dressing), some discomfort and mild swelling in the area of incision are not unusual and should subside within 72 hours. Rarely, the skin of the scrotum and base of the penis bruise and appear black and blue. This is not painful, lasts only a few days, and disappears without treatment. Even more rarely, a small blood vessel may continue to bleed and form a clot. A small clot will be absorbed after a time, but a large one, or a hematoma, is painful and may requires reopening of the scrotum and drainage with hospitalization and general anesthesia.

Infection

There is a small risk of infection following any surgical procedure. Antiseptic technique is used for the procedure. It is important not to shave the scrotum prior to the time of surgery as this can increase the risk of infection. The risk for infection is so low that routine antibiotics are not recommended. However, if you experience fevers, or wound redness/tenderness, you should contact us for further instructions.

Pain

Chronic scrotal pain occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery. We don’t completely understand why this exceptionally small number of men experience pain, but it is thought to result from the build-up of sperm in the epididymis or stimulation of nerves in the scrotum.

Am I sterile immediately after vasectomy? What is “Post Vasectomy Semen Analysis”?

No! It takes some time for sperm to be completely clear out of the remaining vas deferens. It is extremely important to check a Post-Vasectomy Semen Analysis (PVSA) to confirm the absence of sperm. By 10 weeks, 85% of men will have no sperm in the ejaculate. Only once your physician has confirmed this finding can you consider yourself sterile. We advise patients to bring a sample in for analysis after around 10 weeks and 20 ejaculations. Until then, couples should continue to use contraception or understand the possibility of causing a pregnancy.

What are the alternatives to vasectomy?

Other methods of birth control that may be used are:

  1. Oral contraceptives (“The Pill”)

  2. Intrauterine device (IUD)

  3. Diaphragm

  4. Condoms

  5. Rhythm

  6. Contraceptive cream and jellies

  7. Sexual Abstinence

If you should decide that a vasectomy is not for you, yet you and your partner are sure you do not want to have any or more children, a tubal ligation for your wife or partner is an alternative method. This is likewise a permanent method of birth control.

However, most experts consider vasectomy to be the best available method of permanent contraception, since comparable procedures in women (e.g. tubal ligation) require entry into the abdominal cavity, where complications can have much more dire consequences.

What is the success rate of vasectomy for contraception?

It is greater than 99%. In rare instances, the sperm can reform a path between the ends of the vas deferens. This is called recanalization, and leads to pregnancy in 1 out of every 2000-3000 patients that get a vasectomy. Vasectomy is still considered among the most effective and safe forms of permanent contraception.

Will vasectomy affect my sex life?

Sexual activity, penile sensitivity, and the production of male hormones are not typically affected. In fact, the freedom from fear of producing unwanted children might greatly improve the mutual enjoyment in your sexual relations. You may find that your desire for sexual expression becomes more spontaneous and more frequent.

A vasectomy should have no adverse effects on your sex life. Any problems that develop in relation to having sexual intercourse would result from psychological rather than physical causes. After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in his ejaculate volume, since sperm make up only a tiny part of the semen. Because the sperm cannot come out after the vas deferens is cut, like other dead body cells, the sperm disintegrate and are reabsorbed by the body.

Some men, even knowing these facts, are still anxious about what a vasectomy will do to their sexual performance. These men should not have vasectomies. Worrying about sexual performance is likely to impair a man’s ability to have an erection or ejaculate, even though the production of sperm and male hormones continues.

Also, a vasectomy is not the answer to a problem of sexual maladjustment or failing libido or sex drive. Therefore, if you are getting a vasectomy in hopes of improving your partner’s attitude toward sex or to increase your libido or sex drive, you are likely to be disappointed. On the other hand, the freedom from fear of producing unwanted children could improve the mutual enjoyment in your sexual relations.

How does vasectomy prevent pregnancy?

Sperm are made in the testis, and the travel through the vas deferens to join the urethra. By interrupting the vas deferens, vasectomy prevents sperm from reaching the urethra. Thus, the seminal fluid (semen) contains no sperm and the female egg cannot be fertilized subsequent to intercourse. Sperm cells continue to be produced in the testes but disintegrate and are reabsorbed by the body. The amount of seminal fluid discharged during intercourse does not decrease by more than 5% after vasectomy.

What if I / we later want to have more children?

Patients should consider vasectomy permanent.

If your objective is merely to space out pregnancies, or if you have even the slightest reason to believe that you might want to have children in the future, then a vasectomy will not suit your purpose and should not be considered.

Cryopreservation (sperm banking or freezing) before vasectomy is available as an option for those men considering vasectomy, though they should understand that use of the sperm requires professional assistance. Although we do not recommend sperm banking for all couples, some couples may elect to pursue this. Vasectomy reversal is also an option, but should not be taken lightly, as this can be costly and is not 100% effective.

Are there Long-Term Health Problems Associated with Vasectomy?

Vasectomy began to be a popular means of permanent sterilization in the 1950s and 1960s. Isolated studies have caused concern from time to time regarding general health hazards that might be associated with elective vasectomy. One of these was published in 1979, when it was thought that atherosclerosis might be prematurely initiated after vasectomy. This concept grew out of a small study of a group of monkeys whose blood vessels seemed to contain increased amounts of atherosclerosis following their vasectomies. Further animal studies did not agree with these initial findings, and large epidemiological studies subsequently showed that premature atherosclerosis occurred no more frequently in men who had undergone vasectomies than in men who had not.

Similarly, suggestions have been made connecting vasectomy to Coronary Heart Disease (CHD), stroke, primary progressive aphasia (PPA), dementia, hypertension, and testicular cancer. Again, none of these suggestions have withstood the test of research. Because of the poor quality of facts suggesting these connections, the American Urological Association recommended in its 2012 guidelines that these conditions do not need discussion in counseling patients about vasectomy.

There have also been conflicting study findings regarding the association of vasectomy with prostate cancer, leading to a similar 2012 recommendation by the American Urological Association that prostate cancer does not need to be included in the discussion about the risks of vasectomy. However, in the summer of 2014, a large study with almost 25 years of follow-up suggested a small but real increase in aggressive prostate cancer in men who have had vasectomy (J Clin Oncol. 2014 Jul 7. pii: JCO.2013.54.8446). Notably, it showed prostate cancer deaths occurred in 16 of every 1,000 men who had not undergone vasectomy, compared to 19 of every 1,000 for those who had undergone vasectomy. This is a small increase in risk for a fairly uncommon condition. Thus, while it is important to discuss with your doctor, it usually will not affect the decision for most men to proceed with vasectomy.

After vasectomy, approximately 60%-70% of men develop antisperm antibodies in their blood and, in effect, this is a type of allergy to one’s own sperm proteins. However, it has never been shown conclusively that these antibodies have any significant effect on any other organ systems. The primary relevance of these antibodies seems to be the possibility of hurting sperm function should a patient later get a vasectomy reversal.

We believe that vasectomy still remains one of the best forms of permanent contraception and should be undertaken by the patient after a discussion of all potential risks.

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