Vasectomy

Explanation of Sterilization
Vasectomy is a minor surgical procedure that can be performed in the doctor’s office or hospital under a local anesthetic and involves cutting the vas deferens in the scrotum.  The surgery takes less than 30 minutes and involves making small openings on each side of the scrotum.  The sperm duct (vas deferens) is then cut and sealed, and the sealed ends are returned to the scrotum.  To reduce the possibility that the cut tubes may rejoin, a ½ to 1 inch piece of vas deferens may be removed during the surgery.   The skin incisions are so small that stitches may not be used.  If stitches are used, they will dissolve by themselves.

The no-scalpel vasectomy is the same procedure as described above, however, instead of using a scalpel to make the small incisions in the scrotal skin, a sharp scissor or other instrument is used.

The no-needle vasectomy is the same procedure as described above; however, instead of using a needle delivery system to give local anesthesia, a "jet injection" spray is used.

Both the no-scalpel vasectomy and the no-needle vasectomy are offered and routinely performed.

Description of the Discomforts and Risks:
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.  Occasionally, the skin of the scrotum and base of the penis bruise black and blue.  This is not painful, lasts only a few days, and disappears without treatment
Very 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 usually requires reopening of the scrotum and drainage.  Hospitalization and a general anesthetic may be required for drainage of the hematoma.
Pain:  Vasectomy is a surgical procedure and is accompanied with some mild scrotal discomfort.  Resting, avoiding exercise for 5 days following vasectomy, eliminating intercourse for 72 hours after vasectomy and using a scrotal support with a jock strap will help to improve postoperative discomfort and minimize complications.  A narcotic painkiller prescription will be given following the procedure to help with the discomfort.   A very small number of men experience chronic pain following a vasectomy.  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.
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.  An antibiotic prescription will be given to be taken for the days following the vasectomy to further decrease infection risk.
Success:  The surgical procedure is not always 100% effective in preventing pregnancy, because on rare occasions the cut ends of the vas deferens may rejoin.  This is estimated to occur in only 1 in every 600 vasectomies, however is even less likely than that to occur.  Sperm can survive from the point where the vas deferentia were cut for months, so another form of contraceptive must be used until sterility is assured.  For this purpose, a specimen of seminal fluid should be brought in for microscopic examination.  The specimen must contain no sperm before unprotected intercourse is allowed.  Typically, it take 2-3 months to clear all sperm from the vas deferens, although occasionally, it may take 6 months or longer to flush out all of the sperm.    

Benefits to be Expected
The vasectomy is performed in our office in approximately 30 minutes using a local anesthetic.  It is a simple, safe method to prevent unwanted pregnancy.  Recovery is quick, and the patient can usually return to work in 2 days.

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

Counseling Concerning Alternative Methods
If your objective is merely to space 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.

Other methods of birth control that may be used are:
Oral contraceptives (the pill)               Intrauterine device (IUD)
Diaphragm                                         Condom
Aerosol contraceptive Foam                Rhythm
Contraceptive cream and jellies          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 partner is an alternative method.  This is likewise a permanent method of birth control.

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, 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.

 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 may improve greatly the mutual enjoyment in your sexual relations.

Effect and Impact of Sterilization
The purpose of a vasectomy is to prevent sperm from entering the seminal fluid so that the female egg cannot be fertilized subsequent to intercourse.  Sperm cells continue to be produced in the testes but disintegrate and are reabsorbed.  However, the amount of seminal fluid discharged during intercourse does not decrease more than 5% after vasectomy.

A vasectomy is to be considered a permanent birth control procedure, even though these operations can be reversed if absolutely necessary with vasectomy reversal with a subsequent pregnancy rate of approximately 60% if reversal is performed within 5 years of the sterilization.  Although a vasectomy must be thought of as permanent sterilization, the procedure is not always 100% effective. 

Cryopreservation of Sperm Before Vasectomy
Cryopreservation (sperm banking) of semen is available as an option for those men considering permanent sterilization (vasectomy).  Although we do not necessarily recommend sperm banking for all couples, some couples may elect to pursue this.

Vasectomy and Long-Term Health Problems
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.

It is true that 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.

It should be remembered that there is no form of fertility control, except abstinence, which is free of potential complications. 

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.