Vasectomy

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What is a Vasectomy?

A vasectomy is one of the most common surgical birth control procedures intended to provide a permanent form of sterilization. However, other permanent and non-permanent alternatives to vasectomy are available. In the US, approximately half a million vasectomy procedures are performed annually. Vasectomy can be reversed or sperm can be aspirated for fertilization later on but these options are not always successful and can be expensive.

Normally, sperm are produced in the testes. They then travel through a very small tube called the epididymis. The epididymis is connected to the prostate by a larger tube called the vas deferens (or “vas” for short). At the prostate, the vas joins the seminal vesicle to form the ejaculatory duct. During ejaculation, sperm are mixed with the seminal vesicle fluid to form semen, which are propelled out of the urethra. Most of the fluid of the semen comes from the seminal vesicles. Sperm contribute only a small volume of the semen. Therefore, there is no significant change in your ejaculate after having a vasectomy. Your testes will continue to make sperm, which will be absorbed by your body.

Bleeding (hematoma) and infection: these occur in about 1-2% of men and vary with the surgeon’s experience and criteria used to diagnose this condition.
Chronic scrotal pain syndrome: this can be associated with a negative impact on the quality of life. The cause of this is unclear and occurs in about 1-2% of men. Few of these men require additional surgery.
A small lump or sperm granuloma may develop from the cut end of the vas. It can be sensitive to touch or pressure and may cause pain.
Currently, there is no conclusive evidence that vasectomy increases the risk of cardiovascular disease, prostate cancer, testicular cancer or other illnesses.
Generally, an uncomplicated vasectomy does not change your orgasm, ejaculation, or erectile function.

Your healthcare provider may ask you to do the following:

Sign a consent form. In some states in the US, a consent form must be signed at least 3 days prior to the vasectomy. This form gives your healthcare provider permission to perform the procedure.
Do not take any blood thinning medications, including over the counter medications such as aspirin, ibuprofen, or naproxen for at least 1 week prior to the procedure.
Take a bath or shower on the day of the vasectomy. Some healthcare providers may ask you to shave the front part of your scrotum.
Eat light before the vasectomy procedure if it is done under local anesthesia. In rare cases, when it is done under intravenous sedation or general anesthesia, do not eat or drink 8 hours before the procedure.
Bring a jock strap or athletic supporter or snug briefs.
Arrange for someone to give you a ride home. This is optional.

*You have the option to donate sperm for sperm banking. You may need to arrange this well ahead of the vasectomy procedure.

The procedure usually takes about 30 minutes under local anesthesia in your doctor’s office. But if you request, or for special circumstances, it can be done under sedation or general anesthesia in a surgery center
Your scrotal area will be prepared with an antiseptic solution
You will be given a local anesthetic injection into your scrotum to numb the area
One or 2 incisions are made (Figure 2) (or a puncture with a pointed clamp in the case of a no scalpel vasectomy as shown in Figure 3)

The vas are lifted through the opening and cut. The ends of the vas are sealed off by one of several methods preferred by your healthcare provider, such as mucosal cauterization or clips (Figure 4)
If necessary, the incision is closed with small stitches that dissolve themselves (Figure 5)

Go home and rest. Avoid strenuous or sexual activity for about 1 week.
You may have some purplish or bruised scrotal skin and some small amount of bleeding from the incision for several days to a week.
Wear scrotal support or a jock strap for about 3 days or longer for your comfort.
You may apply an icepack or a pack of frozen peas to the area (for 1-2 days as needed).
You may take acetaminophen (Tylenol) or pain medication prescribed by your health care provider. Avoid taking medication that may increase bleeding such as aspirin, ibuprofen, or naproxen.
Check with you healthcare provider when you can take a shower (usually in 24-48 hours).

After a vasectomy, you will still need to use one of the birth control methods until vas occlusion is confirmed by a post vasectomy semen analysis (PVSA). A vasectomy procedure does not produce immediate sterilization
Vasectomy is not 100% reliable in preventing pregnancy even after vas occlusion is confirmed by PVSA. The risk of pregnancy after vasectomy is approximately 1 in 2000 men with PVSA testing that showed no sperm or rare non-motile sperm.
A repeat vasectomy procedure is necessary in less than ~1% of cases, provided that a technique for vas occlusion known to have a low failure rate has been used.
A report stated that a vasectomy could possibly increase the risk of high grade prostate cancer
The choice of time to do the 1st PVSA is left to the judgment of the surgeon. It is usually about 2-3 months after the vasectomy. Some surgeon may ask you to repeat 1 more PVSA after the first to verify.