Vasectomy is the most common form of male contraception in this country. Each year, about half a million men in the United States who want to practice reliable birth control without placing the burden on their female partners undergo this relatively simple surgical procedure.
Vasectomy is the clinical term given to the process of dividing the tubes that deliver sperm from the testes. A typical vasectomy is done on an outpatient basis. The procedure typically takes about 30 minutes and involves minimal surgery. Generally, the patient heals quickly with relatively few complications or failures and no discernible negative impact on sexual performance.
What a Vasectomy Does and Does Not Do
In a vasectomy, the physician cuts and ties off the ends of the vas deferens. This prevents sperm from mixing with the seminal fluid. Although the testes will continue to produce sperm, they can no longer pass through the vas deferens. Instead, they die and are absorbed into the body.
Because semen consists of about 95% seminal fluid, there is virtually no discernible difference in the ejaculate. Similarly, because the testes continue to produce the male hormone testosterone, which is absorbed into the bloodstream, the procedure also has no effect on a man’s sex drive.
In recent years, many physicians have adopted a new surgical technique called “no-scalpel” vasectomy. This technique often results in less swelling and pain than the traditional method. The “no-scalpel” procedure is similar to a traditional vasectomy in many respects, but it is done without incisions or stitches. Once the anesthetic takes effect, the physician makes one puncture in the scrotum with a pointed clamp. Each of the two vas deferens are cut and tied. Compared to the conventional vasectomy, the “no-scalpel” approach is slightly quicker (about 10 to 20 minutes), causes less postoperative discomfort and lower incidences of bleeding or infection.
It is important for the patient to realize that the vasectomy does not produce instant sterilization. A substantial amount of sperm still remain in the prostate and vas deferens above the portion that was removed. In most men, it takes from 10 to 14 ejaculations over the next 2 months or so before a sperm count of zero is reached. The patient typically is asked to produce a semen sample for analysis about 6 weeks after the procedure. Until then, another form of reliable birth control should be practiced. Physicians typically consider the procedure successful when the patient produces two consecutive negative sperm samples, taken 2 weeks apart.
In rare cases, patients continue to show sperm in their samples for up to a year after the procedure. This may be the result of poor sperm migration out of the vas deferens or it may indicate that the severed ends of the vas deferens have reattached themselves to one another, a condition called recanalization. The only solution to this problem is a repeat vasectomy.
Vasectomy and Prostate Cancer
In recent years, a controversy has been reported in some medical journals, suggesting that men who undergo a vasectomy may face an increased risk of prostate cancer many years later. Other studies have failed to confirm this and the research which initially suggested a connection between vasectomy and prostate cancer contained few details to explain the mechanism by which such cancer might result. At present, the hypothesis can only be said to remain unproven.
Nevertheless, as a precaution, the American Urological Association (AUA) recommends men over age 40 who have had a vasectomy more than 20 years previously should have an annual test for prostate cancer called a PSA. This is precisely the same recommendation the AUA and the American Cancer Society makes for all men age 50 to 70.