Everything you need to know about your Vasectomy
Vasectomy is a dependable method of birth control for men who do not want any or any more children.
Developed as a means of contraception in the early 20th century, and popular (500,000 procedures per year) since the 1950s.
It is a simple, 15-minute procedure performed in a doctor’s office or clinic with a local anesthetic.
The objective is to prevent sperm from entering the semen, 95% of which is just support fluid made by glands called the prostate and seminal vesicles, located in the pelvis behind and beneath the bladder.
If you are less than 30 years old and you have had fewer than two children, please consider the following points before having a vasectomy:
- You may regret it. Men who have vasectomies when they are in their 20s, especially if they have had fewer than two children, may be the ones most likely to seek vasectomy reversal at a later date, often regretting their vasectomy decisions if their reversals are not successful.
- You may change. Many men who think they will never want children when they are in their early 20s are delighted with fatherhood when they are in their 30s. You may be totally convinced now that you will never want children, but people change and you may have a much different outlook 10 years from now.
- Women change. Similarly, women who have no desire for children when they are in their early 20s may have a much stronger desire when they are in their 30s and when many of their friends are having children of their own.
- Relationships end. Since more than 50% of American marriages end in divorce, so you may not be with the same partner ten years from now and a new partner may have a much stronger desire for children than your present partner does. So just because your present partner claims that she will never want children, her tune may change 10 years from now, or she may not even be your partner 10 years from now.
- Your thoughts and your partner’s with respect to abortion should be considered. If you are both not philosophically opposed to abortion, you have some back-up should other forms of contraception fail, and having a vasectomy now may not seem as critical to avoid an unintended pregnancy. But keep in mind that if she gets pregnant, the choice is hers.
- Vasectomy should be considered a permanent and a non-reversible procedure because vasectomy reversals are not always successful. So before having a vasectomy, research and consider all your other options.
- Young men should consider sperm storage. The companies who provide the service will send what you need directly to your home. You will be able to collect the semen specimens in the privacy of your own home and mail them back to the company in the storage container provided.
- Have you discussed your decision with your parents? Having a vasectomy is absolutely your decision, but if you consider talking with them, at least you will have granted them the respect of letting them render an opinion. If they succeed in discouraging you, because they know you better than any doctor does, you may one day thank them. If they don’t succeed in discouraging you, they may consider splitting with you the cost of sperm storage and feel much better about your vasectomy in doing so.
Sperm are made in the testes
From each testicle, sperm move through a long curled-up tube behind the testis (epididymis) wherein they become mature. From there, they swim up a foot-long tube (VAS) which guides them up to the channel (urethra) through which men urinate and ejaculate. Just before entering the urethra, the left and right vas tubes are enlarged, and it is here, behind the bladder, where many sperm are stored between ejaculations.
GETTING TO THE VAS
The easiest place to access the vas tubes is just above the testes where the vas tubes are just beneath the thin scrotal skin – easy to feel and very mobile.
Prior to starting your vasectomy, the surgeon administers an anesthetic solution with a pressure spray applicator (MadaJet®) to numb the scrotal skin and the vas tubes without using any needles.
During the procedure, your surgeon uses special instruments to perform the procedure through a single, tiny access-opening (about ¼ of an inch) on the front side of the scrotum. This usually seals within hours, so no stitches are needed.
EXPOSING THE VAS
Through the small incision, each vas deferens is delivered to the exterior where it can be interrupted.
BLOCKING THE VAS TUBES
Each vas (left and right) is divided about one inch above each testis, where it is just beneath the thin scrotal skin and is very easy to reach.
- Some operators remove a piece of vas, others don’t. We don’t remove a segment.
- Some operators tie off one or both vas ends using permanent or absorbable sutures or the small clips used to stop bleeding blood vessels during other types of surgical procedures. We don’t tie the ends.
- Others cauterize (burn) the ends so that they will seal by scarring. We cauterize the segment going into the abdomen.
- Still others simply place the divided ends out of alignment, by closing the vas sheath between the two ends with a suture or tiny clip so the ends won’t grow back together. We close the sheath between the two ends and secure it with an absorbable suture. The suture will be dissolved within 60 days.
We follow a very effective technique (with less than 0.5% failure rate) in which the portion of each vas that goes towards the abdomen is cauterized, buried into the surrounding tissue, and secured with an absorbable suture, while the portion that goes to the testicles is left open and free flowing (which reduces the risk of congestion post-vasectomy).
Most patients don’t want to talk with other people about their reproductive decisions. Having to discuss your personal reproductive matters could be inconvenient and uncomfortable, as it is an intimate decision. We have chosen to give direct access to those patients trying to get a vasectomy. By doing this, patients will be able to speak directly with the surgeon about this very personal decision.
Most patients don’t have to take time off from work for their recovery. So by Monday, you’re back to work without major restrictions.
Clinics on weekends reduce the need for patients to request time off from work, as the recovery from the procedure will only take a couple of days.
We understand there are some patients for whom weekends may not work on an immediate basis. We apologize for this, but you may be able to plan for a future clinic that might work. It is still a great advantage for most patients.
- Do not take ASPIRIN, ibuprofen, or naproxen within two (2) days of the procedure. If you are taking medications, please record them in the registration page.
- You may want to bring someone with you. Although your procedure will NOT limit your ability to drive, you may want to have someone there for support or to assist you in the case of unexpected events, such as a flat tire – you don’t want to be on the side of the road dealing with a vehicle just after a surgery.
- Make sure that you wear a jockstrap (it will be provided to you) , athletic supporter, or tight underwear. Wear it when you come to your surgery (instead of your underwear). During the week following the surgery, we suggest you use it for more scrotal support and comfort, particularly if physically active at work.
- Please trim the hair of your scrotum prior to the surgery, this will allow for a quicker preparation for the procedure and an easier surgical field.
- Take a shower prior to your surgery to minimize the potential of skin infections due to limited hygiene.
- Reminder: sperm needs to be released. About 98% of men are sperm-free after 20 ejaculations and 12 weeks.
- It is important to have a semen sample checked and to use other forms of birth control until it is confirmed by microscopic examination that the semen is sperm-free.
- Sperm is still made by the testes but can no longer pass through the vas, so white blood cells ingest and digest the retained sperm, recycling the proteins back into the system for use in other body functions.
- Men usually notice:
- No change in the semen
- No change in sex drive
- No change in climax sensation
- No change in the testes or scrotum
- No change in erections
Bleeding can occur during or after vasectomy, but it is less common with a non-scalpel method like SimpleVas Vasectomy.
- If this occurs within the scrotum, drainage of a scrotal hematoma (blood clot) in a hospital operating room may be necessary. Smaller hematomas do not require surgical drainage, but tender swelling can last for two to four weeks. Both large and small hematomas are very rare. If the scrotal skin bleeds at the vasectomy access site, the scrotum can become discolored (black and blue) for about a week. This discoloration is more common than swelling, but painless.
Infection is also a rare complication.Mild infections (swelling unresponsive to anti-inflammatory medications) respond to oral antibiotics. It is rare to require drainage of infected areas.
Sperm granuloma is a pea-sized (sometimes tender) lump on the vas tube at the vasectomy site, but it almost never requires treatment.
- They may increase the likelihood of success with vasectomy reversal. Periodic tenderness usually responds to an anti-inflammatory medication like Ibuprofen.
Congestion, tender buildup of sperm and white blood cells upstream from or at the vasectomy site. It can occur anytime after vasectomy, but usually goes away with use of an anti-inflammatory drug such as Aspirin or Ibuprofen.
- About one in 2000 patients will experience chronic post-vasectomy discomfort (PVPS or Post-Vasectomy Pain Syndrome) severe enough that he will seek vasectomy reversal or neurolysis (division of the sensory nerves coming from the testes). A larger percentage may have milder forms of chronic pain that can affect quality of life but not severely enough to seek vasectomy reversal.
Recanalization is the development of a channel for sperm flow between the two cut ends of the vas.
- If recanalization happens during the healing process (early), the semen never becomes sperm-free until the vasectomy is repeated.
- If recanalization happens months or years after a man’s semen has been examined and declared sperm-free (late), an unplanned pregnancy could result, but the odds of this occurring are far less after vasectomy than the odds of pregnancy with any other form of birth control, including birth control pills and tubal ligation (female sterilization).
- Failure rates of vasectomy vary with the technique used to obstruct sperm flow through the vas tubes. The early failure rate is about one in 2500 and the late failure rate is one in 3500.
- Vasectomy is NOT 100% reversible *
- Patients must use other forms of birth-control until the semen has been tested and deemed to be sperm-free
- Vasectomy does not prevent transmission of sexually transmitted diseases (STDs).
- Since reversal attempts often do not lead to pregnancy, vasectomy should be considered an irreversible and a permanent form of contraception.
Before choosing vasectomy, couples, especially couples in their 20s with fewer than three children, should consider all other forms of reversible contraception including birth control pills, shots, patches, implants, and barrier methods, such as the condom and diaphragm. Couples using barrier methods should also be aware that emergency contraception (“the morning after pill”) is readily available.
- Low one-time expense often covered by insurance companies or federal grant money through state programs for low-income men with no insurance (check your benefits).
- Vasectomy is more dependable than any other form of contraception, including female sterilization.
- It eliminates risks associated with birth control pills or shots and the IUD.
- Vasectomy reversals are less costly and more successful than tubal ligation reversals
- No need for inconvenient and less dependable methods
We follow a no-needle/no-scalpel technique, based on the most current evidence-based recommendations.
- During your procedure, each vas is exposed through a tiny opening in the front scrotal wall under local anesthesia. Since the opening is so small, it is easy to apply anesthesia without the use of needles.
- A spray applicator (MadaJet®) delivers a stream of anesthetic so fine that it penetrates the skin and diffuses to a depth of about 3/16 of an inch, enough to surround and anesthetize each vas tube in turn as it is lifted into position beneath the skin.
- Most, about 99%, of patients require no more anesthetic than this for completion of the procedure itself without pain.
- Some, about 1%, of patients do require injection of a little more anesthetic, but since the skin and vas are already partially numb, injection of more anesthetic with a fine needle rarely causes more than the slightest sensation.
- The tiny opening in the dime-sized area of numb skin is made with a pointed hemostat. One tip makes a pinpoint opening, then the two tips are used to spread and enlarge the opening to about 1/4 of an inch.
- Since blood vessels in the skin are spread apart rather than cut, there is less bleeding than when a scalpel is used, No stitches are required, and the opening is usually sealed closed (often barely visible) by the next day.
- Once each vas tube is lifted through the small skin opening, it is divided under direct vision with fine surgical scissors.
- Nothing is removed. The ends of the divided vas are placed out of alignment and kept from rejoining by applying an absorbable suture to the sheath surrounding the vas (the upper end stays inside the sheath, while the lower end stays outside).
- While extremely effective (failure rate less than 1 in 2000), the technique allows for easier reversal in men who choose to do so later in life.
* Procedure time is less than 15 minutes. Most men say it hurts less than having a blood sample drawn. Many have called it painless.
- A scrotal support (jockstrap, provided to you) is applied and should be worn overnight and reapplied, after a next-morning shower, when up and around for the next two days.
- Application of ice (keeping the area dry) might be helpful. Make sure you apply it 30 minutes on and then 30 minutes off for at least four hours.
- Men are advised to recline on the evening of the vasectomy, light activity the next day, and full activity two days after the vasectomy. May resume sex within 5-7 days from the procedure.
- After a vasectomy, about half of men will take non-prescription pain pills (Naproxen or Acetaminophen), often just to prevent expected discomfort; the other half don’t take any pain pills. About 1 in 1000 men will have enough discomfort to request a prescription pain medication.
* Remember that a vasectomy is still a surgery, so some discomfort (although very minimal) should be expected the following day.
Semen samples should be sent to the office twelve (12) weeks after the procedure to see if all stored sperm have been passed. 98% of men are sperm-free after 12 weeks and 20 ejaculations, some sooner, and a few men will not be sperm-free for 5 or 6 months.
Please be sure to mail your sample in lieu of bringing it to our office personally. A mailed sample is completely appropriate, as we follow a very strict procedure of checking at least 30 hpf (high-power fields) under the microscope to confirm complete absence of sperm in the sample.
* Initial evaluation of semen samples is included in the price.
No-scalpel vasectomy instruments, used in China since the mid-70’s and introduced into the United States in 1989, are simply a very pointy hemostat, used initially to make a tiny opening into anesthetized skin of the scrotal wall, and a ring clamp, used initially to secure each vas tube in turn beneath this opening.
Using a spray applicator (MadaJet®), a fine stream of liquid anesthetic is delivered at a pressure great enough to penetrate the skin to a depth of about 3/16″, deep enough to envelop the vas tube held snugly beneath the skin.
Each vas is positioned in turn beneath the very middle of the front of the scrotum and given 4-6 squirts, which numbs the skin and both vas tubes adequately for 99% of men. The other 1% (usually men who have thick skin or scarring due to prior surgical procedures in the area), will require additional anesthetic delivered with a fine needle, usually with no pain at all because of the partial anesthesia achieved with the MadaJet®.
After the vas is divided, the lower end is allowed to slide back down into the sheath, while the upper end is held outside the sheath. An absorbable suture is then used to close the empty portion of the sheath between the two ends.
* We choose to use absorbable sutures, out of preference, as we consider it allows for more flexibility in the case of bleeding from small blood vessels.
Some surgeons may use a tiny hemoclip (the size of a grain of rice), out of preference, instead of sutures. Interestingly, some patients have requested this instead of a suture, so please let us know if this is your choice, as by default absorbable sutures will be used.
Most hemoclips are made of titanium, a non-ferromagnetic metal used for many types of implanted medical devices such as dental implants, heart valves, and joint replacements. Surgeons have used hemoclips for many years to occlude bleeding blood vessels during many operations in the abdomen and chest, sometimes over 50 clips in a single procedure. Titanium will not interfere with MRI studies and the small amounts used in hemoclips and dental implants do not set off metal detector alarms.
* Removal of a small section of the vas is not necessary, as it does not influence the effectiveness of the technique.
Considering the minimally invasive vasectomy technique, the expected discomfort is minimal. Remember: you will have had a surgery, so some discomfort should be expected.
If present, the discomfort can be easily alleviated by using Naproxen or Acetaminophen. Most men require either no medications or only a few doses of over the counter analgesics.
Because of the evidenced-based technique we use, failure outcomes are expected to be a reflection of the most effective recommended techniques by the AUA (American Urological Association). With the use of absorbable sutures or hemoclips to divert the vas ends out of alignment, the rates of early failure (never cleared sperm after procedure) can be expected to be 1 in 3000.
Delayed failure (return of live sperm to the semen at some time after the semen has been confirmed to be sperm-free) resulting in pregnancy is possible but rare. It can be expected to be about 1 in 4000, which is a rate of failure much lower than with any other form of contraception.
The World Health Organization convened a 1991 meeting of 23 international experts to review all research regarding vasectomy and prostate cancer. They concluded that there was no plausible biologic mechanism for a relationship between vasectomy and prostate cancer. All available research data to date showed no association of vasectomy with prostate cancer, which is supported by the AUA (American Urological Association).
The question of an association between vasectomy and subsequent cardiovascular disease was raised back in 1978 and 1980 by two studies, but recent data comparing 24,773 vasectomized men with 159,480 non-vasectomized men showed evidence that vasectomy is not followed by an increased risk of coronary heart disease or stroke.
- Plan to spend a quiet evening at home, reclining in bed or a lounge chair. Minimize activity.
- You may take acetaminophen/ibuprofen as directed if you have any discomfort. Avoid aspirin for two (2) days after the vasectomy. See medication directions below.
- You may apply ice for 30 minutes and then remove for 30 minutes. Repeat for four hours. Keep the area dry to avoid infections.
- On the day after the procedure, you may walk and drive as much as you like. Avoid sports, yardwork, swimming, and heavy lifting of any kind. If your job is sedentary (office work or supervisor), you may return to work.
- You may take a daily shower beginning the morning after your procedure. Replace the scrotal support and wear it whenever you are standing for the next two days and during activities for the next seven days.
- Two days after the procedure, you may return to more strenuous work and regular activities wearing your scrotal support. Wait three days for aggressive sports, such as basketball and tennis.
- You may have sex 5-7 days after the procedure. It is common to have some blood in the semen for the first few ejaculations. Use other forms of contraception until you are told that your semen is sperm-free.
- Since no incision is made, a follow-up visit is not required; but if you have undue discomfort or any concerns, please contact us.
- It is normal to have some discoloration of the skin around the puncture site. Some men will develop considerable discoloration of the scrotum about four days after the vasectomy. Blood from the deep vasectomy site comes to the surface as a purplish-blue mark, gets darker and spreads out like an oil slick, then gradually dissipates.
- Some men (about one in 20) will develop swelling and discomfort on one or both sides, starting anytime from three days to three months following a vasectomy. This usually represents an exaggerated form of the normal inflammatory response necessary for sperm absorption and recycling. It is best managed with a 7-10 day course of Ibuprofen or Naproxen. See medication directions below.
- At least 12 weeks and 20 ejaculations after your vasectomy, send a semen sample to our office. This sample should be produced after a two day period of no ejaculation. We will call you once your sample has been checked.