Approximately 500,000 vasectomies are performed yearly in the United States. Vasectomy is a dependable method of birth control for men who desire permanent sterility. It is a simple 15 minute procedure performed in a doctor's office or clinic with a local anesthetic. The procedure prevents sperm from reaching the man’s ejaculate.
Normal transport of Sperm
The testicle makes testosterone and sperm. Testosterone is released into the blood stream, and sperm travel through a long tube called the vas deferens. The vas deferens travels up in the groin and into the abdominal cavity, before reversing direction and emptying near the prostate. The vas provides a passageway for sperm to travel from the testicle into the ejaculate. The vas deferens feels like a thick cord in the scrotum and can easily be accessed in this location.
A local anesthetic is injected into the scrotal skin and each vas deferens through a tiny needle. This numbs the area in which your doctor will be performing your procedure.
During conventional vasectomy, one or two 1/2-inch scrotal incisions are made to gain access to the vas tubes. These incisions are later closed with sutures, which remain in place for about 5 days until they dissolve or are removed. During no-scalpel vasectomy (NSV), special instruments are used to perform the procedure through a single tiny poke-hole on the front side of the scrotum. The 1/4-inch slit usually seals within hours, so no stitches are needed.
Each vas deferens is tied with a suture and cauterized with an electrocautery device after a segment is removed. The two ends are placed out of alignment in the surrounding tissue. A combination of the sutures, cautery, and the scarring process prevents the ends from growing back together.
It is very important to understand that live sperm are still contained within the portion of the vas that lies within the pelvis and must be released. About 95% of men are sperm-free after 20 ejaculations and 8 weeks. In 5% of men, the semen may still contain some sperm (usually few in number and not active) for months, so it is important to have a semen sample checked and to use other forms of birth control until it is confirmed by microscopic examination that the semen is sperm-free.
After a vasectomy, sperm are still made by the testicle but can no longer pass up through the vas tube. The sperm that are made are ingested by the body and recycled for other uses.
A vasectomy has no effect on the semen output, sex drive, sensation, or erectile function.
Bleeding can occur during or after vasectomy by either method, but it is less common with no scalpel vasectomy. A collection of blood called a hematoma may form, and rarely will require drainage in the operating room.
Infection is also a rare complication. Infection usually presents as painful swelling of one or both testicles, or a redness of the scrotal skin. A discharge may occur as well.
Sperm granuloma is a lump on the vas tube at the vasectomy site. Most resolve on their own with anti-infllamatories, but some require surgical excision.
Recanalization is the development of a channel for sperm flow between the two cut ends of the vas. This may cause an unplanned pregnancy. The risk of this happening is about 1 in 2,000.
Testicular pain may occur on a short term or long term basis.
Devascularization of the testicle causing atrophy (shrinkage) or requiring removal of the testicle is a rare complication. Usually this occurs in men with a history of hernia surgery, an undescended testicle at birth, or other condition or surgery which would compromise the blood supply to the testicles before vasectomy.
All patients considering vasectomy should understand that for all intents and purposes, it is a permanent procedure. Reversal techniques are available, but success rates are far less than 100%. Patients must continue practicing birth control until no sperm are visualized on semen analysis. In addition, vasectomy does not prevent sexually transmitted diseases (STD’s).
Before committing to a vasectomy, couples should consider and discuss all reversible forms of contraception first.
Advantages of Vasectomy
Low expense, dependable (>99% success rates) form of sterlization, usually covered by insurance companies. Financial aid may be available through state programs. Contact our office for more information.