Everything You Need to Know About a Vasectomy

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi, everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, we're very pleased to have Dr. Sarah Vij, who's an Assistant Professor of Urology and the Center Director for Male Fertility, who specializes in men's health and urology here at the Department of Urology at the Cleveland Clinic. And we're going to talk a little bit about today everything you want to know about a vasectomy. Sarah, thanks so much for joining us on Butts and Guts.

Dr. Sarah Vij: Thanks for having me.

Dr. Scott Steele: So, tell us a little bit about yourself. Where are you from, where'd you train, and how did you come to the point that you're here at the Cleveland Clinic?

Dr. Sarah Vij: Sure. I'm from the East Coast. I grew up in Connecticut. I ended up at medical school at Northwestern in Chicago and ultimately matched at the Cleveland Clinic for my residency and stayed on for a fellowship here in infertility and andrology, and I've been on staff now about five years.

Dr. Scott Steele: So, we're going to talk a little bit about a vasectomy, and I know a lot of people, that term may make you cringe or it may not, or you may be looking forward to it. But at a very high level, what is a vasectomy?

Dr. Sarah Vij: Sure. So, a vasectomy is the only FDA-approved form of male contraception or option to prevent a pregnancy for men. There are many options for women. During a vasectomy, what we're doing is we're essentially blocking sperm flow through the vas deferens, which is the tube that carries sperm from your testicles, your sperm-producing structures, into the ejaculate. So, it's a form of preventing pregnancy essentially by mechanical blockage.

Dr. Scott Steele: So, who qualifies for the surgery, how long does this surgery typically last, and how often is it successful?

Dr. Sarah Vij: Any patient with male genitalia qualifies. You have to be over the age of 18; that's really the only other factor. And the procedure, itself, is very quick, under 10 minutes. Sometimes it can be under five minutes. It's very quick; it's typically done in the office. We do probably over 90 percent of them here in the office just under local anesthetic, and in occasional situations, we will put patients under a twilight-type or a general anesthesia in the operating room.

Dr. Scott Steele: So, how is a vasectomy actually performed?

Dr. Sarah Vij: There's several different ways to do it, but essentially the vas deferens is very easily accessible in the scrotum, or the sac. We can bring it essentially right underneath the skin just with a grip, a specialized grip. And then, assuming the patient's awake, which is again how we do most of these, we will give some numbing medicine in the skin and in the tissue surrounding the vas deferens so the patient doesn't feel any severe pain during the procedure. And then, we use various tools to basically bring about a centimeter or two of the vas out through a very small incision. We don't typically even use a scalpel for the incision; we use just a sharp instrument to spread the skin. And then, there are several different techniques. The most common would be clips or ties around the vas deferens, then we remove a small segment of it, and some people will put a little fascia or tissue layer in between the ends. So, you really can do it however you've been trained, as long as your procedure is effective and you use generally more than one form of mechanical blockage. And then, that's really it. We drop the structures back in, and some people put a stitch in the skin, other people don't, and that's it. The patient goes home.

Dr. Scott Steele: So, what are the benefits of a vasectomy?

Dr. Sarah Vij: Certainly, vasectomy, like I mentioned earlier, it's the only FDA-approved option for contraception for men. So, it really gives, I think, men some control over their reproductive outcomes. And the other benefit for men who are in a relationship with a woman is it takes the burden of contraception off the female partner, and that really does tend to be the norm in our society; women tend to bear the burden of birth control or contraception. And so, if your partner is on birth control pills or has an intrauterine device, that can all be stopped. And it's a one-and-done procedure, so you don't have to deal with side effects of medications and things like that.

Dr. Scott Steele: So, truth or myth: more than 500,000 men elect to have a vasectomy every year in the US?

Dr. Sarah Vij: That is accurate. Truth.

Dr. Scott Steele: Truth or myth: vasectomy is over 99.99 percent effective in preventing pregnancies.

Dr. Sarah Vij: That is also true. It is the most effective form of contraception. Another way to look at that number is to say that between one and two women out of 1,000 will end up with a pregnancy if their partner's had a vasectomy. So, it's pretty much as good as it gets. There's no such form of contraception that's 100.

Dr. Scott Steele: Okay, so I have to ask, I just have to ask, what happens if you've had a vasectomy and somebody gets pregnant? Did it recanalize, or did the tie fall off? What's going on here?

Dr. Sarah Vij: That's a good question. The most common is when we say a vasectomy has been done and it worked, that means that that patient had his vasectomy and anywhere from eight to 12 weeks later got a semen test that showed the procedure was a success. Unfortunately, the compliance with getting that post-procedure semen test is only about 50 percent. So, half of men are just saying, all right, I've seen those stats, I'm going to just run with it, and they don't actually get the confirmatory test to ensure that they did not have a failure, because failures are rare.

So, most of the pregnancies that occur after vasectomies are in men that never got their follow-up testing and actually never had a successful procedure to begin with. In those who did and showed, say, no sperm, and then two years later they have a pregnant partner, the thought is that it essentially, yes, recanalizes, in other words, the two ends find each other, fistulize, is the way we think about it. So, the sperm find a pathway through. Fortunately, that's really, really rare, but I just make that point to emphasize that getting that post-procedure semen test is really the final step in the process, and until you have done that, you really are not considered clear.

Dr. Scott Steele: Are there certain foods or medications to avoid prior to this surgery?

Dr. Sarah Vij: Different surgeons have different preferences on this. Foods, no, there's really nothing you need to avoid. We do recommend patients do have breakfast before the procedure because we don't want people getting lightheaded. So, we do encourage people to eat, of course, if they're not having anesthesia. Medications, we don't want patients on blood thinners, medications like Coumadin, Eliquis, Plavix. Mostly in this patient population, that's a little bit less common. And then many urologists will ask that patients stop anti-inflammatories like NSAID class of medications.

Dr. Scott Steele: So, is your ability to urinate affected right after a vasectomy?

Dr. Sarah Vij: Not at all. It has no overlap with your ability to empty the bladder.

Dr. Scott Steele: And how does a vasectomy alter your libido?

Dr. Sarah Vij: There's no evidence that vasectomy changes sex drive. There are always going to be reports out there of patients who do have this side effect, and we don't really have a great physiologic explanation, meaning the blockage of sperm flow should not have any impact on sex drive. It's thought to maybe be a psychogenic or psychologic factor, where they're no longer fertile and that may change how they view their sex lives. It's hard to say. So, there are a very, very small percentage of patients who report sexual side effects after this procedure, but there's not a great anatomic or physiologic explanation for that.

Dr. Scott Steele: And so, is it possible to reverse a vasectomy? You talked a little about the recanalization, so can you undergo a vasectomy reversal?

Dr. Sarah Vij: Absolutely. We do a lot of these here. It's another thing that I'm trained to do. It is not always successful, so there's no guarantees with the reversal. When patients say to me, "I want a vasectomy, and I'll just have it reversed in five years," we really don't encourage that because we can't guarantee a success, and there are other forms of temporary birth control. And, it's not typically covered by insurance, and the cost is relatively high. So, the success rates are pretty good if the vasectomy has been performed recently, but again, you have to think about the cost for patients.

Dr. Scott Steele: And finally, are there any advancements on the horizon in terms of vasectomies?

Dr. Sarah Vij: There are. Everyone is trying to find a form of vasectomy or male birth control in general that's easily reversible. So, is there some way to inject, say, like fibrin glue that's dissolvable into the lumen or the inside of the vas, so that you can say, okay, I'm going to have this procedure done, and then in two years I'm going to be fertile again. There's a lot of scientific research being done for procedures like that. And, then there's a lot of interest in hormonal birth control for men, so the equivalent of birth control pills, so to speak, for women. What this typically requires is taking testosterone, because testosterone actually makes you sterile. The problem is it requires very frequent dosing and it's a little bit unreliable, and when you're talking about contraception, being a little bit unreliable is not acceptable. So, as of now, the standard vasectomy is what we have to offer for men, and for those who are certainly done having children, it's a very good option. But hopefully, there'll be more flexibility for men in the future.

Dr. Scott Steele: Now it's time for our quick hitters to get to know you a little bit better. First, what's your favorite food?

Dr. Sarah Vij: Pizza.

Dr. Scott Steele: What is your favorite sport?

Dr. Sarah Vij: Soccer.

Dr. Scott Steele: Flying right along. What is your favorite place that you've been to that you tell other people, you got to go there?

Dr. Sarah Vij: I would say Costa Rica. We go every year and it's become just one of my favorite places in the world to visit.

Dr. Scott Steele: Behind the scenes for all the listeners here, we tape a couple of these a day, and that's the second Costa Rica of the day.

Dr. Sarah Vij: Oh, wow.

Dr. Scott Steele: So, it must be a good spot. And so finally, what is it that you enjoy about Northeast Ohio, living here?

Dr. Sarah Vij: I love Northeast Ohio. The people are kind. I think we really take advantage of what we have around here, despite maybe not having the best weather. It's an easy place to live, not a lot of traffic. I love it here. Can't complain.

Dr. Scott Steele: And so, what's a final take-home message for our listeners about vasectomy?

Dr. Sarah Vij: I would just say, I like to just make sure that people know about it as an option, and that men who really see their child-rearing days have come to an end, it's a really, really good option for them, and that women don't need to always be the bearers of contraception. Please come in and talk to us and you can learn more about the procedure, and we have virtual visits to help make this easier for our young professional working population.

Dr. Scott Steele: That's fantastic. And so, to learn more about vasectomies at the Cleveland Clinic, visit our website at clevelandclinic.org/vasectomy. That's clevelandclinic.org/vasectomy. V-A-S-E-C-T-O-M-Y. You can also call us at (216) 445-6246. Again, that's (216) 445-6246. Sarah, thanks so much for joining us on Butts and Guts.

Dr. Sarah Vij: Thank you so much for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. And until next time, thanks for listening to Butts and Guts.