VASECTOMY
Vasectomy refers to a minor surgical procedure performed on a male which provides a permanent means of contraception (birth control). Nearly 600,000 men undergo this procedure per year in the United States. Although no procedure or medication can provide 100% effectiveness, vasectomy has one of the lowest failure rates at less than 0.2%.
Patients always have some degree of anxiety prior to a vasectomy. We encourage patients to seek answers to their questions before proceeding with this procedure. Careful consideration of the risks and benefits of this permanent method of contraception is critical to reducing patient discomfort and anxiety. The Urology Center of the Rockies (UCR) can provide a sedative and pain killers, upon request, which should be taken several hours before this procedure.
Here are answers to some of our most commonly asked questions:
What exactly is a vasectomy?
It is a minor surgical procedure usually performed in the office which takes between 15-25 minutes. During this procedure, the operating physician numbs the scrotal skin, makes either one or two ¼ inch opening(s) and delivers both vasa through this incision. Both vasa are then carefully divided and returned to their normal place in the scrotum. Division of both vasa disrupts the flow of sperm during ejaculation which is responsible for reproduction.
What is meant by a No-Scalpel Vasectomy (NSV)?
No-scalpel vasectomy refers to a vasectomy which is performed by creating one or two small punctures to deliver the vas rather than using a scalpel to create an opening. The no-scalpel method is the most commonly used technique in the United States largely due to less discomfort, bleeding and scarring after the procedure. All of the urologists at UCR employ this method when performing a vasectomy.
What should I expect DURING the procedure?
Most patients tolerate this procedure very well. The first step to performing a vasectomy is numbing the scrotal skin and both vasa. Most patients describe this numbing process as a “bee sting” like feeling; some patients experience groin discomfort. This entire process typically lasts 15-20 seconds. After the scrotal skin and vas are anesthetized, the remainder of the procedure is performed with very little discomfort. Again, the entire procedure takes between 15-25 minutes.
What should I expect AFTER the procedure?
Local anesthetic used during the procedure typically lasts several hours once administered. As the medication wears off, most patients experience dull achy pain; some describe sharper pain. Ice should be applied to the scrotal area as soon as possible to address both swelling and pain. Prescription pain medication can be provided upon patient request.
When can I return to normal activities?
Most patients are able to return to work in 3 days assuming that work is not physically strenuous. Most patients can resume light to moderate exercise and sexual activity within 5-7 days after the procedure. Bike riding, heavy lifting (>50lbs) and strenuous activities should be avoided for at least 7-10 days.
Am I sterile following the procedure?
No. Although the vasa are divided, there is residual sperm in the reproductive system. Typically, it will take 20 ejaculations and/or 2 months to fully clear all of the sperm from the ejaculate. For this reason, protected sexual intercourse until 2 negative semen specimens are submitted is mandatory . Amazingly, only 25% of males return to submit the recommended 2 negative specimens! Of course, we strongly encourage our patients to follow this recommendation.
What happens to the sperm after a vasectomy?
The testicles continue to produce sperm despite a vasectomy. The sperm is simply absorbed by the body and has no ill effect. In fact, this absorption process is entirely normal and typically occurs if a male has not ejaculated for a while.
Will a vasectomy affect my manhood or my sexual performance?
No. The testicles are responsible for the production of sperm as well as a hormone called testosterone. Testosterone production is not affected by a vasectomy. This hormone is made by the testicles and is delivered through the bloodstream and not the vasa. Additionally, sperm contributes very little fluid when a male ejaculates; therefore, ejaculation is essentially unaffected. Libido, erectile function and sexual pleasure during ejaculation are not in any way affected by a vasectomy.
I’ve heard of pregnancies after a vasectomy. How does this happen?
There are generally two causes of a “failed” vasectomy. Either both vasa were not completely divided at the time of surgery or the two ends of the vas grew back together; this later event, called re-cannulization, can occur very early (during the recovery period) or even decades later. If one or both vasa are not divided, a man can remain fertile. It is for this reason that we strongly encourage our patients to initially submit two semen specimens to confirm the absence of sperm. As well, to minimize anxiety, patients are invited to re-submit semen specimens even years after the procedure to confirm the absence of sperm. If sperm persists, this procedure will need to be repeated to achieve sterilization.
Are there any risks or complications of a vasectomy?
Yes. All surgical procedures have risks. However, vasectomies are one of the safest procedures especially compared to other permanent methods of sterilization such as a tubal ligation. Immediately following a vasectomy, common risks include: infection, bleeding, bruising, testicular injury, swelling and pain or persisting sterility. Long term common risks include: chronic pain, fluid accumulation around the testicle, loss of testicular volume and re-cannulization; all of which occur with very low frequency.
Can a vasectomy be reversed?
Yes, however, a vasectomy should be viewed as a permanent method of contraception. Although a complex microsurgical procedure to re-connect the two ends of the vasa can be performed, fertility rates tend to be lower following this type of procedure. We encourage our patients to very seriously consider temporary methods of contraception if there is any question about the desire to have any more children in the future.
Does it matter whether an urologist or my primary care provider performs this procedure?
Although a vasectomy is a relatively minor surgical procedure, complications can occur. Experience is critical to minimizing the risks of both complications and failures. An urologist has between 5-8 years of formal surgical training, which includes vasectomies, prior to entering into private practice. All of the urologists at UCR have extensive formal training and experience with this procedure.