The most common procedure performed on men in the United States and Canada is a vasectomy. If your family planning is complete and you have decided that you do not wish to father any additional children, you might consider a vasectomy as your preferred method of contraception.
Vasectomy is a long-term, low-cost choice of contraception. For all practical purposes it should be considered a permanent form of sterilization that removes the risk and uncertainty of unintended pregnancy.
Let’s look at how a vasectomy works. The vas deferens are the thin tubes in the scrotum that would normally carry sperm from the testicles to become part of the ejaculate. When this sperm channel is interrupted, the man becomes sterile and can no longer father a child.
The two most common vasectomy techniques are the traditional surgical vasectomy that is accomplished through an incision, and the less-invasive no-scalpel vasectomy performed through a very small opening in the scrotum. Both methods are considered painless or nearly painless and have similar recovery times.
There are some simple things that you can do in advance of your appointment. First, do not take aspirin or other anti-inflammatory medication, such as Nuprin, Advil, or Motrin, for 10 days before the procedure as they may increase the risk of bleeding after the procedure. You should shower thoroughly before the procedure and wear loose, comfortable clothing. The procedure will take only 15 minutes or so, but you should plan on being in the office for about an hour. Although a local anesthetic is all that is required, it is best if you arrange to have someone pick you up after the procedure is completed.
A small area, about the size of two postage stamps, will be shaved on the top of the scrotum. Antiseptic solution will be applied to the scrotum and sterile drapes will be placed over you to guard against infection. After a local anesthetic is administered a small opening is made in the scrotum. Either the right or left vas deferens is lifted through this tiny opening. The vas is cut, and a section may be removed. You may feel a pulling sensation during this process as the two ends of the vas are heat sealed, tied or clipped, before being returned to the scrotum. The opposite vas deferens is then lifted through the same small opening and the procedure is repeated. The small opening in the scrotum can heal with closure by sutures or naturally without any sutures at all.
Discomfort following the procedure is usually mild and can be controlled with an ice pack placed over the scrotum. Your Dr. may prescribe a mild pain medication and antibiotics. It is best to go directly home and lie down for the remainder of the day and limit the time spent on your feet as much as possible for the first couple of days. You should wear snug cotton briefs, jockey underwear or an athletic supporter to help apply pressure against the procedure area and for support of the scrotum during the first week. It is normal to have a small amount of blood or spotting but contact your doctor immediately if you experience fever, chills, increasing pain, drainage, which may be a sign of infection or an enlarging mass, which may suggest internal bleeding or infection.
It is important that you understand that you are not sterile right after the procedure as sperm is present above the area where the vas deferens is divided and ligated (show slide with sperm in the vas above the ligation). Your semen will be examined by your doctor under a microscope to be absolutely certain that no sperm is seen in the ejaculate. Therefore, you will need to continue to use contraception until it is confirmed that you are sterile. (consider showing a photo of sperm examined under a microscope with the sperm moving)
The complications associated with a vasectomy include bleeding, infection. These are not very common and if you follow your physician’s instructions you are not likely to experience these problems. The procedure is successful in 99% of men who have a vasectomy. If there is still sperm in the ejaculate after several months after the procedure, then you may need to have the procedure repeated. It is very unlikely to experience a failure after you have had your semen specimen examined and confirmation that there is no sperm present. Once you are considered sterile, no follow-up semen examinations are required.
A vasectomy renders a man sterile. It does not protect a man from sexually transmitted diseases. A vasectomy does not affect a man’s libido or sex drive nor does it contribute to erectile dysfunction or impotence, and the risk for prostate or testicular cancer is not increased after a vasectomy.
If you have any questions about the procedure check with your doctor. They are your best source of information as you consider whether or not a vasectomy is the right choice for you.
We want to thank Neil Baum, M.D. of New Orleans for allowing us to add the above video to our web site.