Vasectomy: Patient Information

June 5, 2021 John Polidan

Every year, about half a million men in the USA have a vasectomy as a means of permanent birth control. It is a minimally-invasive surgical procedure that is the most effective means of contraception, second only to abstinence. During a vasectomy, each vas deferens (the tube that transports sperm) is cut and sealed, preventing the sperm from being present in the semen. It is a simple, safe, and time-honored means of achieving permanent male fertility control. There is usually little discomfort associated with the surgery and most men are able to resume normal activities within a few days. There is no need for fear or anxiety as our team will do everything to ensure that your experience is as comfortable—emotionally as well as physically—as possible.

Courtesy Andrew Siegel MD February 2021

Vasectomy versus tubal ligation

The female version of a vasectomy is tubal ligation (blocking the fallopian tubes to prevent pregnancy). This is an effective technique as well; however, vasectomy is a skin-deep procedure versus tubal ligation, which is a much more invasive procedure because it requires going into the abdomen. Additionally, a vasectomy can be performed under local anesthesia with or without intravenous sedation whereas tubal ligation requires general anesthesia. Furthermore, there exists a simple test for the effectiveness of vasectomy (semen analysis), but no such test for tubal ligation (aside from a costly and uncomfortable x-ray test). Vasectomy is safer and less expensive than tubal ligation. Another consideration is that the one-time cost of a vasectomy may prove less expensive over time than the cost of other birth control methods including oral contraceptives and condoms. In general, insurance companies will cover vasectomy for no reason other than they are less expensive to their bottom line than are all the costs associated with additional pregnancies.

Reproductive anatomy

The testicles are responsible for sperm production. After sperm cells are manufactured, they ascend into the epididymis, a comet-shaped structure located behind the testicles. From the epididymis arises the vas deferens that runs up the groin in the spermatic cord, then courses behind the bladder where its terminal end forms the ejaculatory duct. This duct empties into the urethra, the channel that conducts urine and semen through the penis.

Preparation for Vasectomy

It is important not to eat or drink anything for 8 hours prior to the procedure. If you are on aspirin or a blood thinner, please stop the medication one week prior to the vasectomy. On the day of the vasectomy, cleanse and shave the scrotum while showering or bathing. It is recommended that you wear jockey shorts that have plenty of elastic support.

Procedure

Vasectomy is a minor surgical procedure, which is usually performed in the ambulatory surgery center. It is done under local anesthesia with intravenous sedation while being monitored under the expert care of an anesthesiologist. Intravenous sedation makes the procedure much more comfortable for the patient and easier for the surgeon. The entire procedure typically takes 20 minutes or so.

After sedation is established, the scrotum is cleansed with antiseptic solution. The area is draped with sterile surgical towels so that only a small area of skin is exposed. A long-acting local anesthetic is administered and via two tiny punctures in the scrotum, the vas is accessed. There are many different ways to interrupt the sperm flow—I prefer removing a ½ inch segment of each vas deferens, doubly clipping each end, and using cautery to seal the edges. The small puncture in the skin is closed with a suture that will dissolve on its own. The specimens are sent out to a pathologist for standard review.

Instructions After Vasectomy

Restriction of activity for the first 24 hours will reduce the chance of swelling, bruising, bleeding, and pain. It is normal to experience swelling, minor pain, and spotting from the incision for several days.
Application of an ice pack to the scrotum intermittently for the first 24 hours—20 minutes on and 20 minutes off—is effective to help reduce swelling.
Mild discomfort is typical and is treated with prescription-grade anti-inflammatory medication that will be prescribed.
Wearing elastic, supportive jockey shorts is helpful to keep the scrotum immobilized. The best underwear for men after vasectomy is Adjustable Pouch Underwear, made by UFM (Underwear for Men) ufmunderwear.com Vasectomy. Use coupon code “NJU” for a 25% discount.
Restrict heavy lifting, exercise and sex for about 5-7 days. Sedentary activities can be resumed as soon as you are feeling well enough.
Use contraception until the semen analysis shows absence of sperm in the semen.

Follow-Up

It is imperative to obtain a semen analysis to ensure absence of sperm in the semen. It can take weeks to months until all the sperm are cleared and may require as many as 20 or so ejaculations to achieve this. It is important to continue using contraception until the sperm count is determined to be zero. You will be sent home with instructions, a prescription and a specimen cup and can obtain the semen analysis 6 weeks after the vasectomy.

Risks of Vasectomy

Temporary bleeding, bruising, pain.
Ongoing pain due to congestive epididymitis—on rare occasions the epididymis can become painfully swollen with sperm congestion, which is usually easily treated with anti-inflammatory medication and rest
Infection—very rare because the scrotum has such a wonderful blood supply
Sperm granuloma—a small, hard lump that feels like a bead at the end of the divided vas deferens; this can occur when sperm leak from the severed vas and inflame the surrounding tissue. This is usually treated with rest and anti-inflammatory medication and, on rare occasions, surgery is required to remove it.
Recanalization (leading to failure of the procedure)—when the cut ends of the vas deferens grow back together and fertility is re-established, an extremely rare situation occurring in approximately 1/1000 patients.

Common Questions and Answers

Will my testicles still make sperm after my vasectomy?
Yes; but your body absorbs and disposes of them.

Will I notice a difference in my ejaculate volume?
Since the sperm only contribute a small amount to the seminal volume, there should be no noticeable difference in the volume of the semen.

Does vasectomy protect me against sexually transmitted diseases?
No, no, no…I repeat no! Use protection!

Is sex different after vasectomy?
No, although some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex after vasectomy is more relaxed and enjoyable than ever before.

Does vasectomy affect my ability to get an erection or change the way I urinate?
No.

Does vasectomy affect my testosterone level?
No.

Is vasectomy reversible?
It is reversible with the best results achieved in the initial 10 years following vasectomy. Vasectomy reversal is a complicated procedure requiring general anesthesia and microscopic reconnection of the blocked vas deferens. It typically takes several hours to perform. It’s a big deal whereas a vasectomy is a little deal.

Is it true that vasectomy can cause prostate cancer?
Vasectomy does not cause prostate cancer; however, men who undergo vasectomies have relationships with urologists, the specialists who are attuned to prostate issues, and therefore, men who undergo vasectomy are more likely to undergo prostate cancer screening and diagnosis than the average man who does not see a urologist.

Why should I bother with sedation? How about just local anesthesia?
I never met a patient who enjoyed having a needle placed into his scrotum and local anesthetic injected. With sedation, there will be no awareness of that happening. Furthermore, with the inevitable anxiety that patients experience concerning surgery on their genitals, there is typically a reflex contraction of the muscles that lift the testicles high in the scrotum and sometimes into the groin, making the procedure technically more difficult. The sedation promotes emotional and physical relaxation and makes the procedure technically much easier for the surgeon and much more pleasant for the patient.

How does one do a semen analysis?
It involves masturbating into a specimen cup. Place the cup into a paper bag and bring it to the designated lab along with the prescription for the semen analysis. Try to get it to the lab as quickly as possible. The specimen will be studied under the microscope for the presence of sperm.