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Treatments & Procedures

Vasectomy

What is a vasectomy?

Percutaneous No Scalpel 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—a number that corresponds to roughly 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 the scrotum is used, and patients experience 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, more effective, can be performed on an outpatient basis, has fewer complications and is much less expensive.

What does the procedure involve?

The procedure is performed under local anesthesia in an outpatient surgery center or doctor’s office. The surgeon feels for the sperm-carrying tubes, or vas deferens, under the skin of the scrotum and holds it in place. Then a special instrument is used to make a tiny puncture 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 produces very little bleeding, and no stitches are needed to close the incision. Generally, the procedure takes less than 20 minutes.

What happens to sperm after a vasectomy?

After 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 on a daily basis.

Can I discontinue other birth control methods right away?

No. Sperm can remain in the vas deferens above the operative site for weeks or even months after vasectomy. You will not be considered sterile until two post-surgical semen tests, usually performed between eight to 12 weeks post-vasectomy, show that no sperm remain. Until then, you must continue to use other birth control to prevent pregnancy.

What are the risks?

Although complications such as inflammation, bleeding or infection may occur, 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 the blood vessels responsible for bleeding are less likely to be affected. 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 resolved by the body. Typically, scrotal support and mild pain relievers help relieve symptoms.
  • Congestion. A sense of pressure caused by sperm in the testes, epididymis, and lower vas deferens, may cause discomfort for two to 12 weeks after vasectomy. Like granuloma, congestion usually resolves itself over time.

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

Will I experience any unwanted “side effects?”

Vasectomy does not affect production or release of testosterone, the male hormone 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 undergone the procedure find that sex with their partners is more spontaneous and enjoyable once they are freed from concerns about contraception.

Is a vasectomy 100 percent effective?

Other than total abstinence, no method of birth control is 100 percent effective. In rare cases, it is possible for sperm to find its way across the void between the two blocked ends of the vas deferens. Called recanalization, it generally occurs within the first few months following 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, the medical literature shows that 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 it reversed later if I choose?

Vasectomy should be considered a permanent means of birth control. Reversing a vasectomy is difficult, expensive and many times unsuccessful. The decision should be considered along with other contraceptive options and discussed with a professional counselor. 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 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 reaffirmed the conclusion of most medical experts that vasectomy is a safe and effective means of permanent birth control. The panel advised that physicians continue to offer vasectomy, and that all men, vasectomized or not, receive the same regular screenings for prostate cancer and other illnesses.

Preparation

We will discuss the procedure in person to determine the suitability of percutaneous no-scalpel vasectomy for you. 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 aspirin-containing medicines for a week before vasectomy
  • History of injury or prior surgery on the male genital organs
  • History of recent or repeat urinary tract or male genitalia infections
Before surgery
  • It is important that you resolve any lingering questions or concerns you may have. Remember that vasectomy is a completely elective procedure, so you should not request to proceed with 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 7 days prior to surgery without prior medical approval. Taking these increases the risk of bleeding.
  • The night before or the morning of 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 groins the day before and the morning of the surgery.
  • Several hours before surgery, take any preoperative medications as directed.
  • Bring with you a clean athletic supporter or tight pair of jockey shorts.
  • A light snack or liquid is preferable to any heavy food before vasectomy.
  • It is advisable to have someone drive you home.

Post-Vasectomy management

Pain/bruising

Mild discomfort, bruising and swelling are common after surgery. Mild discomfort may be treated with acetaminophen (e.g., Tylenol® or Datril®) 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 minimize swelling.

Dressing

Dressing should be changed when 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

Bathing or showering can start the day after 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 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.

Post-vasectomy symptoms are not unusual and should subside within 72 hours of surgery. However, if you experience an unusual amount of pain, large swelling of the scrotum, continued bleeding or fever, call your physician immediately.

To make an appointment:

Tel: 216.444.5600 or toll-free
800.223.2273 extension 4-5600

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

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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. For additional written health information, please contact the Health Information Center at the Cleveland Clinic 216.444.3771 or toll-free 800.223.2273 extension 4-3771 or visit www.clevelandclinic.org.  This document was last reviewed on: 1/29/2007...#4423

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