The decision to proceed with a vasectomy is a very personal one. So it is important that you have a clear understanding of what a vasectomy is and what it is not. The following will provide you with information that will assist you in deciding whether or not a vasectomy is an appropriate form of contraception for you.
What happens under normal conditions?
The testicles produce sperm and testosterone and are located in the scrotum at the base of the penis. Once produced, the sperm exit the testicle through a delicate, coiled tube called the epididymis, where they stay until they are fully matured. Each epididymis is connected to the prostate by a tube called the vas deferens. This muscular tube generally extends from the lower portion of the scrotum into the inguinal canal (site of most hernias) and then into the pelvis continuing behind the bladder. It is at this point that the vas deferens joins with the seminal vesicle and forms the ejaculatory duct. During ejaculation, seminal fluid and seminal vesicles mixes with sperm to form semen which is expelled through the urethra.
What is a vasectomy?
Vasectomy is a minor surgical procedure to cut and close off the tubes (vas deferens) that deliver sperm from the testes; it is usually performed as a means of contraception. The procedure typically takes from 15–30 minutes and usually causes few complications and no change in sexual function.
About 500,000 vasectomies are performed annually in the United States. A vasectomy is less invasive than a tubal ligation (i.e., the procedure used to prevent a woman’s eggs from reaching the uterus) and more easily reversed. An increasing number of couples choose it as a means of permanent birth control.
How is a vasectomy performed?
In general, vasectomies are performed in the urologist’s office. However, the procedure may be done at an ambulatory surgery center or in a hospital setting if the patient and urologist have determined that intravenous sedation is preferable. The decision to proceed in that type of setting may be based upon the patient’s anatomy, anxiety or the need for associated surgical procedures.
On the day of the procedure, the patient will be asked to sign a surgical consent form. Certain states have regulations regarding the type and timing of the surgical consent for permanent sterilization.
Once the patient has signed the consent form and has been brought into the procedure room, his scrotal area will be shaved. Some urologists will have the patient shave this area at home. The area will then be washed with an antiseptic solution. Local anesthesia will be injected to numb the area but the patient will be aware of touch, tension and movement during the procedure. However, the local anesthetic should eliminate any sharp pain. The patient is awake during the procedure so, if necessary, he can let the urologist know if he is experiencing pain so more local anesthesia can be given.
With a conventional vasectomy, an urologist makes one or two small cuts in the skin of the scrotum to access the vas deferens. The vas deferens is cut, and a small piece may be removed leaving a short gap between the two remaining ends. Next, the urologist may cauterize the lumen or ends of the vas, then ties the cut ends with suture material. The scrotal incisions may be closed with dissolvable stitches or allowed to close on its own. The entire procedure is then repeated on the other side either through the same initial incision or through a second scrotal incision.
During a no-scalpel vasectomy, the urologist feels for the vas under the skin of the scrotum and holds it in place with a small clamp. A special instrument is then used to make a tiny puncture in the skin and stretch the opening so the vas deferens can gently be lifted out, cut, then tied or cauterized and put back in place.
What should the patient expect after a vasectomy?
Your urologist should provide you with specific recommendations for your care after a vasectomy. It is generally wise to return home immediately after the procedure and avoid strenuous or sexual activity. Swelling and discomfort can be minimized by placing an ice pack on the scrotum and by wearing a supportive undergarment, such as a jockstrap. Most patients can expect to recover completely in less than a week and many are able to return to their job as early as a day after the procedure. Sexual activity can usually be resumed within a week following a vasectomy. However, it is important that all patients recognize that a vasectomy, even though successful, is not effective immediately. The effectiveness of the vasectomy must be proven by having the patient submit at least one semen analysis, which demonstrates that there are no sperm in the ejaculate. The time until disappearance of sperm from the ejaculate varies from patient to patient. Most urologists do not recommend checking the semen for sperm for at least three months or 20 ejaculates, whichever comes first. If sperm continue to be present in the ejaculate, that patient must continue to use contraception. After waiting for three months or 20 ejaculates, one in five men will still have sperm in their ejaculate, and will need to wait longer for the sperm to clear. The patient should not assume that his vasectomy is effective until his semen analysis demonstrates the absence of sperm.
Are there any risks associated with a vasectomy?
In the immediate postoperative period there is the risk of bleeding into the scrotum. If the patient notices a significant increase in the size of his scrotum or significant scrotal discomfort, he should contact his urologist immediately. A patient experiencing fever, scrotal redness or tenderness should also be evaluated by the surgeon as this may indicate an infection. Discomfort is usually minimal and should respond to mild analgesics. More severe pain may indicate infection or other complications. Patients will often complain of mild lower abdominal discomfort similar to what one would experience from getting hit in the genitalia. A benign lump, or granuloma, may develop because there is a leakage of sperm from the cut end of the vas into the scrotal tissues. It may occasionally be painful or sensitive to touch or pressure.
Post-vasectomy pain syndrome is a chronic pain syndrome that follows vasectomy. The cause of this syndrome and its incidence are unclear. It is generally treated with anti-inflammatory agents. Occasionally, patients will elect to undergo vasectomy reversal in an attempt to alleviate this syndrome. Unfortunately, the response to surgical intervention is unpredictable. There has been some debate in the past as to whether vasectomies predispose a man to any future health problems. However, there is no conclusive evidence that men who have undergone a vasectomy have a higher risk of cardiovascular disease, prostate cancer, testicular cancer or other health problems.
Frequently asked questions:
Can my partner tell if I have had a vasectomy?
There is no significant change in one’s ejaculate after a vasectomy since the sperm contributes a small amount to the overall ejaculate volume. Your partner may on occasion be able to feel the vasectomy site. This is particularly true if you have developed a granuloma.
Will my sense of orgasm be altered by having a vasectomy?
Ejaculation and orgasm are generally not affected by vasectomy. The only exception to this is the occasional patient who has developed post-vasectomy pain syndrome.
Can I become impotent after a vasectomy?
An uncomplicated vasectomy cannot cause impotence.
Can a vasectomy fail?
First, it is important to be certain that a vasectomy has been successful and that all sperm are absent from the ejaculate prior to stopping other forms of contraception. Even if the vasectomy has been demonstrated to be effective, there is a small chance that a vasectomy may fail. This occurs as a result of sperm leaking from one end of the cut vas deferens (the testicular end) and finding a channel to the other end (the abdominal end).
Can something happen to my testicles?
Rarely, the testicles may be injured during a vasectomy as a result of injury to the testicular artery. Other complications such as a mass of blood (hematoma) or infection may also affect the testicles.
Can I have children after my vasectomy?
Yes, but if you have not stored frozen sperm, you will require an additional procedure. The vas deferens can be micro surgically reconnected (in a procedure called a vasectomy reversal) to allow normal conception to occur. Alternatively, sperm can be extracted from the testicle or the epididymis and utilized for in vitro fertilization. These procedures are costly and may or may not be covered by insurance. Additionally, they are not successful 100 percent of the time. Therefore, one should carefully consider nonsurgical alternatives for contraception prior to deciding to proceed with a vasectomy.