Overview
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.
Sterility
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.
Vasectomy Pre Operative Instructions
Prior to having a vasectomy, a consultation between the patient and the physician is held in the office where questions are answered and the procedure is discussed and scheduled. While it is not required that your partner or spouse be present for this appointment, please keep in mind that the fertility options for both of you are affected. Therefore, it is optimal that they be included in the decision-making process.
A vasectomy is a minor operation performed in the office under local anesthesia. Your physician may also choose to prescribe a medication to help you relax. You may eat a light meal before the procedure.
The following are very important:
- The patient must arrange for someone to drive them home.
- The driver must remain in the office waiting room during the procedure (averages between 30 minutes and 1 hour)
- No blood thinners 1-2 days prior to your procedure. This includes prescription blood thinners and also Aspirin, Advil, Aleve, Iburprofen or anti-inflammatories should be held. Tylenol or ES Tylenol are acceptable.
- For sterilization purposes, the hair around the scrotum and base of the penis should be shaved at home prior to coming to the office for the procedure Do not use an electric razor or Nair for hair removal.
- For comfort and to minimize swelling, the patient should bring an athletic supporter to wear home after the procedure.
Two incisions are usually made, one on each side of the scrotum. Each vas deferens (the tube that carries the sperm) is located and a small piece of it is removed. The incisions usually heal without stitches, however if sutures are required, they are absorbable, therefore suture removal is not necessary.
The patient should not shower or bathe for approximately 12 hours after the vasectomy and should wear the athletic supporter for 3 to 7 days or until he is comfortable without the supporter. Minimal discomfort and swelling are to be expected. Tylenol and ice packs should provide sufficient relief.
You may resume intercourse 10 days after procedure.
Any surgical procedure carries with it some risk. On a comparative basis, a vasectomy is considered a very low-risk procedure. Adverse reactions do not occur very often and when they do, they are usually of minor consequence.
Vasectomy Post-Operative Instructions
Following the procedure:
- go home and lie flat,
- place an ice pack on the scrotum for at least a four-hour period, and
- wear an athletic supporter for 3 to 7 days or until you are comfortable without the supporter.
If you have pain or discomfort immediately after the operation, take two Tylenol tablets at four to six-hour intervals. Tylenol is usually enough to provide relief from the pain. The ice pack will provide additional comfort after the local anesthetic wears off. Make every effort to rest a number of hours after the operation to avoid the discomfort associated with movement.
Restrict your activity the day following your procedure. Restrict physical activity for approximately three days following. You may perform all other usual activities. You may resume intercourse 10 days after the procedure.
A slight oozing of blood (enough to stain the dressing or supporter), some tenderness and mild swelling in the areas of the incisions is normal and should subside within 72 hours. These symptoms should cause no alarm. Report anything unusual such as fever, excessive swelling, extreme pain or excessive bleeding which appears at any time. If there is an unusual amount of pain, large swelling of the scrotum or continued bleeding, do not hesitate to call the office.
You should not shower or bathe for approximately 12 hours after the vasectomy. On the day following, apply soapy water gently to the scrotum, rinse and dry by blotting the skin (not rubbing).
Absorbable sutures may have been used to close the incisions and will dissolve. They do not require removal. If a stitch comes away prematurely, the incision may open a little and there may be a slight discharge from the wound. If this should occur, you may continue to bathe and then place a small gauze sponge inside the supporter over the incision. Continue to wear the athletic supporter with gauze until the incision dries completely.
POST VASECTOMY SEMEN ANALYSIS:
In order to verify sterility, it is necessary to document negative semen specimens. Once you have reached 8 weeks AND 15 ejaculations after surgery, bring one semen sample to the office between 9a–3p Mon–Thursday or 9a–12p Friday. No appointment is necessary. Bring your specimen to the office in the container given to you at the time of your procedure. If, upon examination, no sperm are found, a repeat semen analysis will need to be performed, after an additional 15 ejaculations.
DURING THIS TIME, CONTINUE TO USE CONTRACEPTIVE METHODS.
To verify sterility, we must document 2 consecutive negative specimens (one brought in at a time).
You may drop off your specimens Mon–Thurs. 9a–3p or Friday 9a-12p.
SEMEN COLLECTION INSTRUCTIONS:
We have provided you with 2 sterile containers to bring your specimens to the office. Do not collect the specimen in anything other than the containers we provide. Please place the m in a paper or plastic bag when dropping off at our office. If you misplace the containers, please stop by our office at your convenience to pick up additional containers. The specimen is best produced by masturbation, which ensures that the entire specimen is collected. However, the specimen may be collected at intercourse if withdrawal prior to ejaculation is attempted and the ENTIRE specimen is collected in the container. PLEASE PLACE ONE OF THE SUPPLIED NAME LABELS ON THE CONTAINER OR WRITE YOUR FULL NAME AND DATE OF BIRTH ON THE LABEL OF THE CONTAINER. SPECIMENS SUBMITTED WITHOUT THIS INFORMATION WILL NOT BE EXAMINED.
The first specimen should be brought in once you have reached 8 weeks AND 15 ejaculations after surgery. If, on examination, no sperm are seen a repeat semen analysis should be collected. This should be done after 15 additional ejaculations have been achieved. IT IS IMPORTANT THAT 15 EJACULATIONS ARE ACHIEVED BETWEEN SPECIMEN EXAMS. Continue to use contraception until two consecutive negative specimens are obtained.
Please remember: Any surgical procedure carries with it some risk. On a comparative basis, a vasectomy is considered a very low- risk procedure. Adverse reactions do not occur very often and when they do, they are usually of minor consequence.
Common reactions include:
- Bleeding: External bleeding from the incision is, of course, alarming to the patient. Bleeding is controlled by applying pressure to the incision (holding it between thumb and forefinger) for a full five minutes. Internal bleeding into the scrotum causing uncomfortable swelling sometimes occurs, but this is minimized by strict adherence to the post-operative instructions you will receive. Some blood may escape into the layers of the skin of the scrotum or even the penis to present an area that appears bruised, but it is usually painless and requires no treatment.
- Infection: Infection is possible any time there is an opening into the skin. Infection happens rarely following a vasectomy. Sterile surgical technique is used and the scrotum has a high resistance to infection.
- Suture reaction: A reaction to the sutures is an infrequent problem. A suture reaction is seen when the patient is sensitive or allergic to the suture material used on the inside of the scrotum. A knot forms at the site and may continue to enlarge. If you have sutures in the skin, they may cause a mild irritation, which will resolve with warm soaks.
- Failure to produce sterility: Every attempt is made to ensure sterility has been attained. It is imperative that you bring your specimens in for analysis. To feel confident of sterility we require 2 consecutive negative specimens in a row. Until this is achieved, we ask that you continue contraception.
If you have questions or concerns, please do not hesitate to call our office.