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Vasectomy

Vasectomy is a common surgical procedure for men looking for permanent birth control.  With this procedure, a portion of the duct that carries sperm is removed.  Every year more than one-half million men in the United States have this minor surgery.  Vasectomy is safe, highly effective, and has no impact on erections or sexual performance.

 
Normal Male Anatomy 

The Male Reproductive System

Sperm are produced in the testicles.  Sperm then travel through long ducts (the vas deferens or vas) to mix with fluids from the seminal vesicles and the prostate to form semen.  The semen passes through the urethra and is ejaculated during sexual intercourse.

A vasectomy prevents sperm from mixing with semen by blocking both sperm ducts (vas deferens).  Sperm continue to be produced in the testicles.  The sperm, however, make it only as far as the new point of the blockage in the sperm duct (vas).  At this point, the sperm is reabsorbed by the body.  As a result, there are NO SPERM IN THE SEMEN that is ejaculated at the time of intercourse. 

How Will a Vasectomy Affect Me?

The prostate and seminal vesicles continue to produce fluids that are ejaculated.  In fact, the amount of fluid ejaculated decreases only about 5% after a vasectomy.  In terms of sexual performance, vasectomy has no negative effects -- erections and male hormone levels remain the same.

What are the Benefits of a Vasectomy?

Vasectomy is a permanent means of birth control.  You may find that the freedom from fear of producing an unintended pregnancy improves the enjoyment of sex for both you and your partner. If you or your partner has a sexually transmitted disease (STD), such as gonorrhea or HIV, a vasectomy will NOT PREVENT you from being infected.

 
The Vas Deferens is brought to the
surface through a small opening in the skin

Are There Any Complications?

There are no known long-term complications of the vasectomy itself.  About 60-70% of men develop antisperm antibodies in their blood, which is a harmless reaction to one's own sperm.  There is no evidence that these antibodies have any major effects on other organs in your system.

How Should I Prepare for a Vasectomy?

A vasectomy is usually performed in your doctor's office or in a hospital on an outpatient basis.  Since you will receive a local anesthetic and most likely some medication to help you relax, you should arrange to have someone drive you home afterward.  The morning of the vasectomy, you will shave your scrotum with an ordinary safety razor, and then take a shower.  You do NOT have to shave all of your pubic hair, only the scrotal sac.  (Allow plenty of time; it is not as easy as it sounds!)  An athletic supporter or "jockey" type shorts will give more support and possibly be more comfortable.  Again, you will need to have someone come with you to drive you home.

How Long Does it Take?

A vasectomy takes 15 to 20 minutes.  Most men are prescribed a mild sedative to be taken prior to the procedure to help them relax.  First, a local anesthetic will be used to numb the scrotal area.  A small puncture is made in the middle of the scrotum, through which the vasectomy is performed.  The doctor will cut the sperm ducts (vas deferens), removing about one half inch to one inch of each duct.  The ends of the ducts are blocked with small clips.  This is done to reduce the possibility of the sperm ducts rejoining together.  The same opening in the middle of the scrotum is used to perform both sides.  The opening in the scrotum is so small that stitches may not even be needed.  If stitches are used, they will dissolve by themselves in about a week.

What is a "Scalpel-Free" Vasectomy?

This procedure is not very different from a regular vasectomy.  In a scalpel-free vasectomy, the skin is opened using a razor sharp clamp rather than a surgical blade.  This creates the small hole in the scrotum, through which the vasectomy is performed.  The overall result is a smaller incision and less time for healing.

How Will I Feel After the Procedure?

 
 
A section of the Vas is removed
and clips are placed on each end
The most common side effects of vasectomy are minor bleeding (enough to stain the bandage), some discomfort, and mild swelling in the area of the incision.  These are not unusual and should stop within 72 hours.  Occasionally, the skin of the scrotum and the base of the penis turn black and blue.  This lasts only a few days, and will disappear without treatment.

The most commonly reported complication from the procedure is mild discomfort in the testicles that usually improves with medication, warm soaks and by elevating the scrotum.  Infrequently, a patient may experience pain around the testicles that shows up 20 years after the vasectomy.  This is a harmless reaction and usually responds to medical treatment.

Very rarely, a small blood vessel may open in the scrotum and form a clot.  A small clot will dissolve after time, but a large one can be painful and usually requires reopening of the scrotum for drainage. Surgical drainage requires hospitalization and usually a general anesthetic.

Will I Miss Any Days at Work?

Most men return to work after 2 days. Some men choose to recuperate over a weekend so they don't miss any work.  Your doctor will tell you to avoid strenuous exercise or heavy lifting for the first 3 days after your vasectomy.

Is the Procedure Always Successful?

Semen is sperm-free in almost all men following a vasectomy.  Of every 1000 men who have a vasectomy, less than 2 continue to have sperm in their semen.  It is very rare for the sperm ducts not to seal completely.  In the event that they do not, you may need a second vasectomy.

 
The small clips remain on
the ends of the vas deferens
When Will I Be Able to Resume Normal Sexual Activity?

You should postpone sexual activity for 72 hours.  Because sperm can survive for 6 months or more, you will be asked to bring one or more specimens of ejaculate for examination under a microscope to your follow-up visit.  Unprotected intercourse should not take place until sterility is assured, so continue to use some form of birth control.  The first semen analysis will be done 90 days after the vasectomy.  Continue to use some form of birth control until the analysis indicates the absence of sperm. 

Will My Masculinity Be Affected?

No.  Vasectomy is not the same thing as castration, and sterility does not mean impotence.  The hormones that affect masculinity (eg, growth of facial hair, having a deep voice and sex drive) are still made in the testicles after a vasectomy.  These hormones will continue to flow throughout the body in the bloodstream.

What If I Have a Vasectomy and Then Change My Mind?

Vasectomy should be considered to be a permanent procedure.  It is not for men who plan to have children in the future.  However, with the death of child or spouse, or in the case of divorce, it may be possible to reverse this procedure.  However, the reversal may fail due to persistent blockages in the sperm ducts.  Therefore, you should approach a vasectomy as if you are making an irreversible decision.

Some men choose to place one or several sperm samples in a sperm bank prior to their vasectomies.  They view this as a type of insurance in case they change their minds.  Sperm banking, however, only saves a limited supply of sperm and does not guarantee fertility.  Lastly, there are alternatives to vasectomy reversals, but they pose even more of a challenge in terms of cost and efficacy. 

Are There Alternatives to Vasectomy?

It is important to remember that vasectomy is meant to be a permanent means of birth control.  If you are unsure about your plans to have a child or additional children, there are several nonsurgical alternatives for you and your partner to consider.  Many are highly effective when used correctly.

Contraceptive Method Failure Rate During 1st Year of Use (%)
Oral Contraceptives ("the pill")
Intrauterine Device (IUD)
Condom Alone
Diaphragm with Spermicides
Spermicides Alone
Vaginal Sponge
Periodic abstinence ("rhythm method")
No method
1-3
3
12
18
21
18-28
20
85

You should also remember that there is no form of birth control that is free from potential complications, except abstinence.  If you decide against having a vasectomy, but are certain you and your partner do not want to have children or any more children, a tubal ligation for your partner is an alternative procedure.  This is also a permanent method of birth control.