Vasectomy is a minor surgical procedure that we can perform in the doctor’s office or hospital using local anesthetic. The procedure involves interrupting the communication of sperm into the ejaculate by transecting or cutting the vas deferens.
Vasectomy: Expert Care in Maryland
Dr. Karen Boyle regularly performs vasectomy procedures, using a standard no-scalpel approach. She is a board-certified surgeon and has performed thousands of vasectomies during her career. Learn more about Dr. Karen Boyle.
Dr. Boyle performs a no-scalpel vasectomy and uses a topical numbing cream applied to the scrotal skin. She then administers an additional local anesthetic. After the small sting from the numbing medication, minimal pain and some pressure should be felt throughout the procedure. A feeling of tugging or feeling warm is common.
Vasectomy Procedure: What to Expect
The surgery takes approximately 30 minutes. During the procedure, Dr. Boyle:
- Makes small openings (one to two millimeters in length) on each side of the scrotum using a no-scalpel technique.
- Delivers the vas deferens through these small openings.
- Cuts the vas deferens and removes at least 1 cm of length, and seals the vas deferens with electrocautery, and uses fascial interposition.
- Returns the sealed ends into the scrotum.
- Places a dissolvable skin stitch to reduce oozing
Often, the skin incisions are so small that stitches may not be used. If stitches are used, they will dissolve by themselves.
The no-scalpel vasectomy is the same as the above procedure. However, instead of using a scalpel to make the small incisions in the scrotal skin, a sharp scissor or other instrument is used.
Vasectomy: Risks and Discomfort
Vasectomy information and American Urologic Associate guidelines can be found on the American Urologic Associate website. In summary:
- Vasectomy is intended to be a permanent form of contraception.
- Vasectomy does not produce immediate sterility.
- Following vasectomy, another form of contraception is required until vas occlusion is confirmed by post- vasectomy semen analysis (PVSA).
- Even after vas occlusion is confirmed, vasectomy is not 100% reliable in preventing pregnancy.
- The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have post-vasectomy azoospermia or PVSA showing rare non-motile sperm (RNMS).
- Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a technique for vas occlusion known to have a low occlusive failure rate has been used.
- Patients should refrain from ejaculation for approximately one week after vasectomy.
- Options for fertility after vasectomy include vasectomy reversal and sperm retrieval with in vitro fertilization. These options are not always successful, and they may be expensive.
- The rates of surgical complications such as symptomatic hematoma and infection are 1-2%. These rates vary with the surgeon’s experience and the criteria used to diagnose these conditions.
- Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.
- Other permanent and non-permanent alternatives to vasectomy are available.
Patients who undergo a vasectomy may experience:
- Bleeding: A small amount of oozing blood (enough to stain the dressing), some discomfort and mild swelling in the area of incision are not unusual and should subside within 72 hours. Occasionally, the skin of the scrotum and base of the penis bruise black and blue. This is not painful, lasts only a few days and disappears without treatment. Very rarely, a small blood vessel may continue to bleed and form a clot. A small clot will be absorbed after a time, but a large one, or a hematoma, is painful and usually requires reopening of the scrotum and drainage. Hospitalization and a general anesthetic may be required for drainage of the hematoma.
- Pain: Vasectomy is a surgical procedure and is accompanied with some mild scrotal discomfort. A narcotic painkiller prescription will be given following the procedure to help with the discomfort. Rarely (less than 0.5 percent of the time), a prolonged pain or chronic pain may occur. To improve postoperative discomfort and minimize complications, you should:
- Avoiding exercise for five days following vasectomy
- Eliminate intercourse for 72 hours after vasectomy
- Use a scrotal support with a jock strap for one week
- Infection: There is a small risk of infection following any surgical procedure. Antiseptic technique is used for the procedure. It is important not to shave the scrotum prior to the time of surgery as this can increase the risk of infection. An antibiotic prescription will be given to be taken for the days following the vasectomy to further decrease infection risk.
Vasectomy Procedure: Preventing Pregnancy
The surgical procedure is not always 100 percent effective in preventing pregnancy, because on rare occasions the cut ends of the vas deferens may rejoin. This occurs in only one in every 1000-1500 vasectomies. Sperm can survive from the point where the vas deferentia were cut for months, so another form of contraceptive must be used until sterility is assured. For this purpose, a specimen of seminal fluid should be brought in for microscopic examination. The specimen must contain no sperm before unprotected intercourse is allowed. Occasionally, it may take six months or longer to flush out all of the sperm.
The vasectomy is performed in Dr. Boyle’s office in approximately 30 minutes using a local anesthetic. It is a simple, safe method to prevent unwanted pregnancy. Recovery is quick, and the patient can usually return to work in two days. Sexual activity, penile sensitivity, and the production of male hormones are not adversely affected. In fact, the freedom from fear of producing unwanted children may greatly improve the mutual enjoyment in your sexual relations. You may find that your desire for sexual expression becomes more spontaneous and more frequent.
Birth Control: Alternatives to a Vasectomy
If your objective is merely to space pregnancies, or if you have even the slightest reason to believe that you might want to have children in the future, then a vasectomy will not suit your purpose and should not be considered.
Other methods of birth control that may be used are:
- Oral contraceptives (the pill)
- Intrauterine device (IUD)
- Aerosol contraceptive foam
- Contraceptive cream and jellies
- Contraceptive patch
- Rhythm method
If you should decide that a vasectomy is not for you, yet you and your partner are sure you do not want to have any or more children, a tubal ligation for your partner is an alternative method. This is likewise a permanent method of birth control.
Vasectomy and Sexual Pleasure
A vasectomy should have no adverse effects on your sex life. Any problems that develop in relation to having sexual intercourse would result from psychological rather than physical causes. After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in his ejaculate, since sperm make up only a tiny part of the semen. Because the sperm cannot come out after the vas deferens is cut, like other dead body cells, the sperm disintegrate and are reabsorbed by the body.
Some men, even knowing these facts, are still anxious about what a vasectomy will do to their sexual performance. These men should not have vasectomies. Worrying about sexual performance is likely to impair a man’s ability to have an erection or ejaculate, even though the production of sperm and male hormones continues.
A vasectomy is not the answer to a problem of sexual maladjustment or failing libido or sex drive. Therefore, if you are getting a vasectomy in hopes of improving your partner’s attitude toward sex or to increase your libido or sex drive, you are likely to be disappointed. On the other hand, the freedom from fear of producing unwanted children may improve greatly the mutual enjoyment in your sexual relations.
Sterilization: Long-Term Effect and Impact
The purpose of a vasectomy is to prevent sperm from entering the seminal fluid so that the female egg cannot be fertilized during intercourse. Sperm cells continue to be produced in the testes but disintegrate and are reabsorbed. However, the amount of seminal fluid discharged during intercourse does not decrease more than five percent after vasectomy.
A vasectomy is considered a permanent birth control procedure, even though these operations can be reversed if absolutely necessary with vasectomy reversal. If the reversal is performed within five years of the sterilization, the subsequent pregnancy rate is over 60 percent. Although a vasectomy must be thought of as permanent sterilization, the procedure is not always 100 percent effective.
Sperm Banking: Cryopreservation of Sperm Before Vasectomy
Cryopreservation (sperm banking) of semen is available as an option for those men considering permanent sterilization (vasectomy). Although Dr. Boyle does not necessarily recommend sperm banking for all couples, some couples may elect to pursue this. If this interests you, please discuss with Dr. Boyle.
Vasectomy and Long-Term Health Problems
Vasectomy began to be a popular means of permanent sterilization in the 1950s and 1960s. Isolated studies have caused concern from time to time regarding general health hazards that might be associated with elective vasectomy.
Vasectomy and Atherosclerosis
One of these was published in 1979, when it was thought that atherosclerosis might be prematurely initiated after vasectomy. This concept grew out of a small study of a group of monkeys whose blood vessels seemed to contain increased amounts of atherosclerosis following their vasectomies. Further animal studies did not agree with these initial findings, and large epidemiological studies subsequently showed that premature atherosclerosis occurred no more frequently in men who had undergone vasectomies than in men who had not.
Vasectomy and Sperm Allergy
It is true that after vasectomy, approximately 60 percent to 70 percent of men develop anti-sperm antibodies in their blood; in effect, a type of allergy to one’s own sperm proteins. However, it has never been shown conclusively that these antibodies have any significant effect on any other organ systems.
Keep in mind that no form of fertility control, except abstinence, is free of potential complications. It may very well be that the risks associated with female contraceptive measures, such as oral contraceptives and tubal ligation, may be at least as significant as the risk of prostate cancer following vasectomy, if not more significant. We believe that vasectomy still remains one of the best forms of permanent contraception and should be undertaken by the patient after a discussion of all potential risks.
Resuming Intercourse After a Vasectomy
Abstain from intercourse for one week. When sexual activity resumes, you must use another form of birth control. You can get pregnant following a vasectomy because of the residual sperm in your vas deferens. A semen analysis is obtained in a minimum of three months or after thirty to forty ejaculations, whichever is a longer period of time. You must provide a semen sample to document that no sperm are present.
Vasectomy: Follow-up Care
It is very important to check a semen analysis to confirm no sperm present following the vasectomy. Until Dr. Boyle discusses there result of this semen analysis with you, you are considered fertile and can easily achieve a pregnancy. Dr. Boyle will give you a container and an order to check the ejaculate. Abstain from ejaculation for two to three days before collecting your semen sample and try to collect the specimen within an hour of your appointment.