Vasectomy

A vasectomy is a surgical form of birth control. It prevents sperm (which can fertilize a woman’s egg and cause a pregnancy) from being ejaculated. As its name implies, this minor surgery involves the cutting of tubes called the vas deferens (or “vas”). Normally, the vas transports sperm to mix with seminal fluid. A vasectomy prevents this mixture from taking place. The testes still make sperm, but they are absorbed by the body. Semen is still ejaculated, but it has no sperm in it. A vasectomy is 99.85% effective in birth control and is chosen by more than 500,000 men in the U.S. each year.

A vasectomy will not interfere with your sex drive, your ability to have erections, the sensation of orgasm, or your ability to ejaculate.

Vasectomies are usually done in the urologist’s office, but may also be done at a surgery center or in a hospital, particularly if you are sedated. Whether or not you are fully sedated depends on your anatomy, how nervous you are, or if you might need other surgery at the same time.

You may need to stop taking any blood thinners (including some vitamin supplements, anti-inflammatory medications, or prescription drugs) several days to one week before the procedure. You may eat a light meal before your vasectomy.

Your scrotal area will be shaved and washed with an antiseptic solution. Local anesthesia will be injected to numb the area, but you’ll be aware of touch, tension, and movement. The local anesthetic should block any sharp pain, but you can tell the urologist if you feel any pain and need more anesthesia. The procedure takes about 20 minutes.

In 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 tiny hole is made in the skin and stretched open so that the vas deferens can be gently lifted out. It is then cut, tied, or cauterized, and put back in place. A no-scalpel vasectomy requires no suturing.

• Most men go home right after the procedure and will fully heal in less than a week. Many men can return to their job as early as the next day if they do desk work. Avoid activities that take a lot of strength for the first 3-7 days. Avoid lifting anything heavier than 10 pounds for a week.
• You may be uncomfortable for a few days and may need pain medication. This pain may feel as though you’ve been hit in the groin. Swelling and pain can be treated with an ice pack on the scrotum and by wearing a supportive undergarment, such as a jockstrap.
• A benign lump (called a granuloma) may form from sperm leaking from the cut end of the vas deferens into the scrotal tissues. This lump is not harmful and usually gets better over time, though sometimes surgery is needed to remove it. It is usually not painful, but if it is painful it can be treated with rest and pain medicine. Your partner may sometimes be able to feel the vasectomy site, especially if you have developed a granuloma, but should otherwise be unable to tell that you have had a vasectomy.
• Avoid sex for 3-7 days. However, you should still use other forms of birth control until your urologist has determined that your ejaculate is free of sperm. Even though new sperm cannot get into your semen, older sperm will still take time to clear. Only a semen analysis will determine when your vasectomy has become effective. Most urologists suggest waiting to check the semen for at least 3 months and/or 20 ejaculates.
• Your ejaculate will not noticeably change after a vasectomy, because sperm adds very little to semen volume. Except in the rare case of post-vasectomy pain syndrome, your orgasm and ejaculation will not change.
• There is a small chance a vasectomy may fail. This occurs when sperm leaking from one end of the cut vas deferens find a channel to the other cut end. Once your urologist clears you with a sperm test showing no sperm or less than 100,000 sperm, with none moving, the risk of pregnancy is 1 in 2000.

• Bleeding. Right after surgery, there’s a small risk of bleeding into the scrotum. Call your urologist right away if you notice that your scrotum has gotten much bigger or you are in pain.
• Infection. Have your urologist check you for infection if you have a fever, or if your scrotum is red or sore. When infection occurs it is usually at the site of the cut. Infection rarely occurs inside the scrotum.
• Pain. Up to 20 in 100 men may have ongoing pain or discomfort after a vasectomy. Most often, this is due to congestion of sperm behind the blockage. The pain is most often treated with anti-inflammatory drugs, like ibuprofen. This usually resolves with time, although 1 to 6 men in 100 may need more treatment to ease their pain. A rare form of pain, called post-vasectomy pain syndrome, occurs in 1 or 2 men out of 100 vasectomies and is also usually treated with anti-inflammatories. In many cases, the cause is unknown, but sometimes a specific cause is found that can be treated with medicine or a minor procedure.
• Injury. In rare cases, the testicular artery may be hurt during vasectomy.
• Unplanned reversal. In rare cases, the vas deferens may grow back together, which would allow the man to have children again.

Studies show that men who have had a vasectomy are not at a higher risk for any other medical conditions, such as heart disease, prostate cancer, testicular cancer, or other health problems. A vasectomy does not cause erectile dysfunction.

Yes. The vas deferens can be surgically reconnected in a procedure called vasectomy reversal. This procedure is requested by about 3 in 1,000 men. However, it does not always work. The success of vasectomy reversal depends mainly on (1) the amount of time since you had the vasectomy and (2) the technique of the surgeon. A microsurgical technique is crucial to success.