Vasectomy (Male Sterilization)
What is a vasectomy?
Vasectomy is a simple, safe and effective means of permanent contraception or birth control. Because of the way that male sexual organs are positioned, the procedure is very straight-forward. It is intended to provide a man permanent contraception, or make him unable to father a child in the future by dividing and closing off the ends of the vas deferens (the tubes that carry sperm) - preventing sperm from getting through. A total of about 50 million men have had a vasectomy — approximately 5% of all married men of reproductive age. More than 500,000 men elect to have vasectomies every year in the U.S.
Is a vasectomy 100% effective?
Other than totally avoiding sexual intercourse, no method of birth control is 100% effective. In rare cases after a vasectomy, roughly 1 in 10,000 cases, it is possible for sperm to cross the separated ends of the vas deferens. Overall, the failure rate of vasectomy is exceedingly low. It has been used for many years as a means of birth control and has a long track record as being safe and effective.
Semen samples are routinely checked after vasectomy to confirm a successful procedure. If dead or live sperm continue to appear in the semen samples, a repeat vasectomy may be necessary. Fortunately, this only happens approximately once in every 10,000 cases, a failure rate far less than for any other form of birth control. For instance, condoms fail about 1% of the time, or 1 out of every 100 times one is used.
How do I prepare for a vasectomy?
Your healthcare provider will go over your health history as it relates to vasectomy and will do a brief physical examination. Tell your provider if you have any of the following:
- History of excessive bleeding or blood disorders.
- Allergy or sensitivity to local anesthetics, such as the "caine" (things like benzocaine or lidocaine or novicaine) drugs or antibiotics.
- Skin disease involving the scrotum, especially infected pimples.
- Regular use of aspirin or medicines that contain aspirin or drugs that affect bleeding.
- History of injury or earlier surgery on your genitals or scrotum or groin (like hernias).
- History of recent or repeat urinary tract or genital infections.
You will be asked to sign a consent (permission slip) for the procedure. The form will state that you understand vasectomy and its risks. This includes that you understand the procedure isn’t guaranteed (as no medical procedure is or can be). Before you sign this form, make sure that you understand all of these things and that you’re comfortable with your decision. It is important that you resolve any questions or concerns before taking action. Remember that vasectomy is an elective procedure, so you should not proceed with it until you are sure it is the right choice for you.
Do not take any of these products for seven days before surgery unless you are told to do so by your healthcare provider. Taking these medications increases the risk of bleeding. They are:
- Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®)
- Warfarin (Coumadin®)
- Clopidogrel (Plavix®)
- Ticlopidine (Ticlid®)
- Non-vitamin K oral anticoagulants like dabigatran (Pradaxa®), rivaroxaban (Xarelto®), apixaban (Eliquis®) and edoxaban (Savaysa®, Lixiana®)
Shaving and washing
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 specific preoperative medications as directed.
- Bring a clean athletic supporter (jock strap) or tight pair of compression shorts.
- Eat lightly or stick to liquids before a vasectomy. Don’t eat heavily, but don’t avoid food.
How is the vasectomy procedure done?
There are two types of vasectomies. One is called an incision vasectomy, and the other is called a no-scalpel vasectomy. Both are done in doctors' offices or outpatient surgery centers. Both use local anesthesia to numb the scrotum. The anesthesia is given as a shot.
Both types of vasectomies divide and close off the ends of the vas deferens (the tubes that carry sperm), preventing sperm from getting through. This stops the sperm from mixing with the semen and being released when a man ejaculates during an orgasm.
The surgeon will make an opening in the skin and grasp the vas deferens. The vas deferens is then divided and tied, clipped or cauterized. Cauterizing closes cuts with an electrical current.
There is little discomfort with a vasectomy. The scrotum will be numb, but some men feel a slight "tugging" sensation or a feeling of things moving around. Your surgeon will decide if you need stitches, depending upon how they routinely do the procedure.
What will happen after you have a vasectomy?
- Pain/bruising: Mild discomfort, bruising, and swelling are common after vasectomy. Mild discomfort may be treated with acetaminophen (for example, Tylenol®) every four hours. Ice packs or a bag of frozen vegetables placed over the scrotal supporter and dressing may provide relief, as well. Repeated use of ice packs for the first 36 hours can help keep the swelling down. Always be sure to wrap the ice pack in a towel or put something between it and the skin.
- 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. It’s better that this fluid does not build up on the inside, so having it drain out is best.
- Bathing: You can start showering the day after the vasectomy. Avoid baths or swimming for a couple of weeks. To dry the scrotum, pat dry with a towel. Don’t rub.
- 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.
It’s common to have some of these symptoms after a vasectomy. They should go away within 72 hours of surgery. However, if you have an unusual amount of pain, extreme swelling of the scrotum, continued bleeding, or a fever (over 100 degrees Fahrenheit), call your doctor immediately.
What happens to sperm after a vasectomy?
After a vasectomy, the testicles 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.
Risks / Benefits
What are the risks of a vasectomy?
Complications such as inflammation (swelling), bleeding, or infection may occur, but they are relatively uncommon and not serious. Minor risks include:
- Pain: Any procedure can affect nerves and, rarely, there can be residual pain. The testicles are sensitive organs, so pain can occur in men whether they have had vasectomy or not. It is not clear whether vasectomy increases this risk of testicular pain. Post-vasectomy pain syndrome is complex and occurs in 1 to 2% of men after vasectomy. Exactly why these varied symptoms develop isn't well understood, but men may experience testicular pain, pain with ejaculation and psychological distress.
- 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 absorbed by the body. Scrotal support and mild pain relievers (like Acetaminophen) can help relieve symptoms.
- Congestion (in the scrotum): A sense of pressure caused by sperm in the testes, epididymis (the structure that stores sperm), and lower vas deferens may cause discomfort for 2 to 12 weeks after a vasectomy. Like a granuloma, congestion usually resolves itself over time.
The risks of vasectomy must be weighed against other options, including the chance of another pregnancy if you do not have the vasectomy.
What are the benefits of a vasectomy?
Vasectomy offers many advantages as a method of birth control. The main benefit is effectiveness. A vasectomy is over 99.99% effective in preventing pregnancies. Like female tubal ligation, vasectomy is a one-time procedure that provides permanent contraception. If you compare female contraception procedures (like tubal ligation) to vasectomy, you will see that vasectomy:
- Is simpler.
- Is more effective.
- Can be performed on an outpatient basis.
- Has fewer complications (is safer for the patient!).
- Is much less expensive.
So, if you are asking which is better, tubal ligation or vasectomy, vasectomy is better in many ways.
Will I have any unwanted "side effects" after a vasectomy?
This usually means:
- Will I produce less testosterone?
- Will I still want to have sex?
- Will I produce (and ejaculate) less semen?
- Will my semen be different?
- Will my partner be able to tell the difference after a vasectomy?
Basically, the answer to these questions is no! Vasectomy does not affect testosterone production or release. (Testosterone is the male hormone that is responsible for a man's sex drive, facial hair, deep voice and other masculine traits.)
Vasectomy does not affect sexuality in a negative way. 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 or interrupting things to apply contraception.
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. This is spelled out in the Vasectomy Guideline of the American Urological Association.
Recovery and Outlook
How long does it take to recover after a vasectomy?
Most men are able to go back to work in less than a week. You may need to be out for a full week if your work is strenuous and physical.
Everyday activities can be resumed a few days (usually 48 to 72 hours) after the procedure unless the activities are unusually vigorous. Men surveyed after vasectomy report full recovery in an average of eight to nine days.
When is it safe to have sex after a vasectomy?
Sexual activity can be resumed seven days after a vasectomy, but precautions (another form of contraception) should be taken against pregnancy until sperm counts show that the semen is free of sperm. In general, a semen analysis is completed about two to three months after a vasectomy.
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 two to three 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, usually a month later. Until then, you must continue using other birth control to prevent pregnancy.
It’s very important to go back to your doctor and do the semen test. This is the only way to make sure that there is no sperm in the semen. Frequent ejaculation, starting a week after vasectomy, can help clear the sperm and increase the chances of having a semen analysis return clear.
Can I have a vasectomy reversed later if I choose?
While vasectomy reversal is an option if you decide you want another child, it may also be expensive and is generally not covered by insurance. You should consider vasectomy if you are confident you do not want to father more children.
Some men might consider storing sperm in a sperm bank before you have a vasectomy. Most requests for reversals come from men in newer relationships who want children with their new partners.
You should consider vasectomy a permanent means of birth control. Men who are married or in a serious relationship should discuss this issue with their partners. If you're thinking about a reversal now, perhaps you should take more time to decide if a vasectomy is right for you.
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