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Treatments & Procedures

Vasectomy

Percutaneous No Scalpel Vasectomy

What is a vasectomy?

Vasectomy is a simple, safe operation that involves blocking the tubes through which sperm pass into the semen. The procedure is designed to make a man permanently sterile, or unable to father a child. A total of about 50 million men have had a vasectomy—approximately 5 percent of all married couples of reproductive age.

The percutaneous no-scalpel vasectomy is an improvement on a traditional vasectomy. An advanced technique to anesthetize (numb) the scrotum is used, and patients have less discomfort, fewer complications, and a quicker recovery. What's more, no skin stitches or sutures are needed.

What are the benefits of a vasectomy?

Vasectomy offers many advantages as a method of birth control. Like female sterilization, it is a highly effective, one-time procedure that provides permanent contraception. Compared to female sterilization, vasectomy:

  • is simpler;
  • is more effective;
  • can be performed on an outpatient basis;
  • has fewer complications; and,
  • is much less expensive.

How is the percutaneous no-scalpel vasectomy procedure done?

The percutaneous no-scalpel vasectomy is performed under local anesthesia in an outpatient surgery center or doctor's office. The surgeon feels for the vas deferens (the tube that carries sperm) under the skin of the scrotum and holds it in place. Then a special instrument is used to make a tiny puncture (hole) in the skin and stretch the opening so the vas deferens can be cut and tied. There is little discomfort, though some men feel a slight "tugging" sensation. This approach causes very little bleeding, and no stitches are needed to close the incision. The procedure usually takes less than 20 minutes.

What happens to sperm after a vasectomy?

After a vasectomy, the testes continue to make sperm. When the sperm cells die, they disintegrate and are absorbed by the body. This is the same way the body handles other types of cells that die and are replaced every day.

After a vasectomy, can I stop using other birth control methods right away?

No. Sperm can remain in the vas deferens above the area of the procedure for weeks or even months after a vasectomy. A semen test is done three to four months after the procedure. If the result meets American Urological Association guidelines, you are considered sterile. If sperm is seen, the semen test is repeated. Until then, you must continue to use other birth control to prevent pregnancy.

What are the risks of a percutaneous no-scalpel vasectomy?

Complications such as inflammation (swelling), bleeding, or infection may occur, but they are relatively uncommon and not serious. A major benefit to the percutaneous no-scalpel vasectomy is that the opening in the scrotum is so small that the blood vessels are less likely to be affected and less likely to bleed.

Minor risks include:

  • Sperm granuloma. A hard, sometimes painful lump about the size of a pea may form as a result of sperm leaking from the cut vas deferens. The lump is not dangerous and is almost always taken care of by the body. Scrotal support and mild pain relievers can help relieve symptoms.
  • Congestion. A sense of pressure caused by sperm in the testes, epididymis (the structure that stores sperm), and lower vas deferens may cause discomfort for two to 12 weeks after a vasectomy. Like granuloma, congestion usually resolves itself over time.

The risks of vasectomy must be weighed against other options, including the chance of another pregnancy if sterilization is not achieved.

Will I have any unwanted "side effects" after a vasectomy?

Vasectomy does not affect the production or release of testosterone, the male hormone that is responsible for a man's sex drive, facial hair, deep voice, and other masculine traits. The operation also has no effect on sexuality. Erections, climaxes, and the amount of ejaculate remain the same; the only difference is that your semen will no longer contain sperm. Often, men who have had the procedure find that sex with their partners is more spontaneous and enjoyable because they no longer have to worry about pregnancy.

Is a vasectomy 100 percent effective?

Other than total abstinence, no method of birth control is 100 percent effective. In rare cases after a vasectomy, it is possible for sperm to find its way across the void between the two blocked ends of the vas deferens. This generally occurs within the first few months after a vasectomy. However, the failure rate of vasectomy is very low. It has been used for many years as a means of sterilization and has a long track record as a safe and effective method of contraception.

If dead or live sperm continue to appear in the semen samples, or if sperm are discovered after a period of sterility, a repeat vasectomy will be necessary. Fortunately, this only happens approximately once in every 1,000 cases, a failure rate far less than for any other form of birth control.

Can I have a vasectomy reversed later if I choose?

While vasectomy reversal is an option after vasectomy if fertility restoration is desired, vasectomy should be considered a permanent means of birth control. Men who are married or in a serious relationship also should discuss this issue with their partners. If you're thinking about a reversal now, perhaps you should take more time to decide whether a vasectomy is right for you.

Does vasectomy pose long-term health risks?

Many studies have looked at the long-term health effects of vasectomy. The evidence suggests that no significant risks exist. Men who have had a vasectomy are no more likely than other men to develop cancer, heart disease, or other health problems.

In 1993, a panel assembled by the National Institutes of Health, the Association for Voluntary Surgical Contraception, and the National Cancer Institute confirmed the conclusion of most medical experts that vasectomy is a safe and effective means of permanent birth control. The panel advised that doctors continue to offer vasectomy, and that all men, whether they have had a vasectomy or not, receive the same regular screenings for prostate cancer and other illnesses.

How do I prepare for a percutaneous no-scalpel vasectomy?

We will discuss the procedure with you to determine if you are a good candidate for a percutaneous no-scalpel vasectomy. Among other things, we will go over your health history as it relates to vasectomy, and you will receive a brief physical examination. Please be sure to advise us if you have any of the following:

  • History of excessive bleeding or blood disorders
  • Allergy or sensitivity to local anesthetics, such as the "caine" drugs or antibiotics
  • Skin disease involving the scrotum, especially infected pimples
  • Regular use of aspirin or medicines that contain aspirin for a week before vasectomy
  • History of injury or earlier surgery on the genital organs
  • History of recent or repeat urinary tract or genitalia infections

What should I do before vasectomy surgery?

  • It is important that you settle any lingering questions or concerns you may have. Remember that vasectomy is a completely elective procedure, so you should not request to have the procedure until you are convinced it is the right choice for you.
  • Do not take aspirin, coumadin, Plavix®, Ticlid®, or NSAIDs (ibuprofen, such as Advil® or Motrin®) for seven days before surgery without prior medical approval. Taking these medications increases the risk of bleeding.
  • The night before or the morning of the vasectomy, shave away the hair from the entire scrotum. Remove the hair all the way to the top of the penis, including any pubic hair that seems to fall onto the scrotum. Do not use an electric razor on the scrotum. A single blade disposable razor is the best choice.
  • To reduce the risk of infection, thoroughly wash the scrotum and groin the day before and the morning of the surgery.
  • Several hours before surgery, take any preoperative medications as directed.
  • Bring a clean athletic supporter or tight pair of jockey shorts.
  • A light snack or liquid is preferable to any heavy food before a vasectomy.
  • Plan to have someone drive you home.

What will happen after vasectomy surgery?

Pain/bruising

Mild discomfort, bruising and swelling are common after surgery. Mild discomfort may be treated with acetaminophen (e.g., Tylenol®) every four hours. Ice packs or a bag of frozen vegetables placed over the scrotal supporter and dressing may provide relief, as well. Aggressive use of ice packs for the first 36 hours helps keep the swelling down.

Dressing

The dressing should be changed when it is stained or soiled. Small sterile gauze squares are available at any drugstore. The dressing can be removed when it is dry or stain-free, usually within a day or so. A small amount of oozing is to be expected, as it is preferable that this fluid not build up on the inside.

Bathing

You can start bathing or showering the day after the vasectomy. To dry the scrotum, use a patting motion rather than rubbing with a towel.

Skin separation

Sometimes the skin will separate due to tissue fluid, oozing blood, or body fluids. The edges can be pinched together with sterile gauze and your fingers. This will bring the skin together and allow it to heal.

Return to activity

Most men recover completely in less than a week. Everyday activities can be resumed the day after surgery unless the activities are unusually vigorous. Men surveyed after percutaneous vasectomy report full recovery in an average of 8 to 9 days.

Sexual activity can be resumed within a few days after a vasectomy, but precautions should be taken against pregnancy until sperm counts show that the semen is free of sperm. Generally, the semen is checked for sperm two months after the vasectomy, and again a month later.

Symptoms after a vasectomy are not unusual and should go away within 72 hours of surgery. However, if you have an unusual amount of pain, large swelling of the scrotum, continued bleeding or fever, call your doctor immediately.

To make an appointment:

Telephone: 216.444.5600 or toll-free 800.223.2273, extension 45600

For more information about the Glickman Urological Institute or services offered, please write or email us at:

Cleveland Clinic
Glickman Urological Institute
9500 Euclid Avenue / W14
Cleveland, Ohio 44195
www.clevelandclinic.org/contact

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/21/2016...#4423

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