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Summary

Vasectomy, also called male sterilisation, is performed to provide a permanent means of birth control to couples. In this procedure, a man’s vas deferens (the tubes that carry sperms) are either sealed or cut off. This procedure is 99.99% effective and even though vasectomy is said to be reversible, the surgery for reversal is complicated and is not always successful. So only opt for it if you are sure that you do not want to have a child. 

Vasectomy is either performed in a surgeon’s clinic or in an outpatient centre. You will usually be discharged on the same day of surgery. You may require 7 to 9 days for complete recovery. After the surgery, you would need to visit the clinic once or more than once for semen analysis to make sure that your semen contains no sperm.

  1. What is vasectomy?
  2. Why is vasectomy recommended?
  3. Who can and cannot get a vasectomy?
  4. What preparations are needed before vasectomy?
  5. How is vasectomy done?
  6. How to care for yourself after vasectomy?
  7. What are the possible complications/risks of vasectomy?
  8. When to follow up with your doctor?

A vasectomy is performed to cut and seal the vas deferens - two tubes, that carry sperms from the testes to the urethra (the tube within the penis). Sperms from the urethra are released (ejaculated) during an orgasm along with semen (the fluid released through the penis during orgasm). Once the vas deferens is cut, sperms are not able to get into the semen, and a man would not be able to get a woman pregnant.

This surgery provides permanent male contraception. A man who has undergone this procedure would continue producing sperms, but since the sperms cannot get out of the body, they die and are absorbed by the body. After the surgery, you will be able to have an erection and ejaculate semen (without sperms).

Vasectomy is close to 100% effective in controlling pregnancies; the failure rate of this procedure is far less than any other means of birth control. Appearance of sperms in semen after a vasectomy can only be seen in 1 out of 10,000 cases. However, vasectomy is not recommended as a short-term/temporary means of birth control as the procedure for reversal of a vasectomy is much more complex and is not always successful.

This surgery is recommended for men who do not want to get their partner pregnant in the future.

If you want to undergo a vasectomy, a surgeon may provide information regarding the advantages and risks associated with the surgery and recommend counselling before you agree to the procedure.

You may undergo this surgery if:

  • You have decided with your partner on not having a child or an additional child in the future
  • You and your partner do not want to use any other means of birth control
  • Pregnancy would be unsafe for your partner due to existing health conditions such as systemic lupus (a disease wherein your immune system affects the healthy cells of the joints, kidneys, etc.)
  • You or your partner have a genetic disease that you do not want to transfer to a child

A surgeon may not recommend this surgery if you:

  • Are under 30 years of age 
  • Do not have any children
  • Have existing scrotal pain caused by conditions such as epididymitis, orchitis, etc.

You may consider opting for sperm cryopreservation or sperm banking, a method of freezing and storing your sperms in case you wish to have a child in the future.

You can expect the followings before surgery:

  • The surgeon will recommend a preoperative counselling session wherein he/she will inform you about what to expect during and after the surgery, such as:

    • The surgery should be considered permanent
    • The complications related to the surgery are low
    • The surgery is not associated with any serious side effects
    • It takes some time after surgery to achieve sterility and, until then, you may need to use other alternate means of contraception
  • You will need to sign a consent form allowing the surgeon to perform the surgery. Read the form carefully and ask the surgeon if you do not understand anything.
  • You need to tell the doctor if you have any of the following:
    • Skin diseases including those of the scrotum (ball sac), such as infected pimples.
    • Allergy to tape, latex, and local anaesthetics such as benzocaine or lidocaine.
    • A history of injury or surgery on your reproductive organs and recurrent or recent genital infection or urinary tract infection
  • The surgeon may ask you to quit smoking as early as possible since smoking can affect your recovery following surgery.
  • Inform your healthcare provider about all the medicines that you take (especially medicines that affect bleeding like aspirin), including vitamins, herbs, supplements, and non-prescription medicines at least 2 weeks prior to the surgery.
  • You would be asked to stop taking the following medicines 1 week before the scheduled date of surgery since they can increase the risk of bleeding during and after surgery:
    • Apixaban
    • Aspirin
    • Clopidogrel
    • Dabigatran
    • Edoxaban
    • Ibuprofen
    • Naproxen
    • Rivaroxaban
    • Ticlopidine
    • Warfarin
  • Shave all the hair from your scrotum, including any pubic hair that falls onto the scrotum in the morning or the night before the surgery. Avoid using an electric razor to remove the hair; instead, opt for a single-use disposable razor.
  • On the day before and on the day of the surgery, wash your scrotum thoroughly to prevent the risk of infection.
  • Your doctor may tell you if you need to follow any dietary guidelines or fast before the surgery.
  • On the day of the surgery, the surgeon may ask you to:
    • Wear loose and comfortable clothes.
    • Take certain medicines before surgery.
    • Arrange for assistance to drive you home after surgery
    • Carry scrotal support or jockstrap (an undergarment that will protect your scrotum) to wear after the surgery

A vasectomy may be performed either in the surgeon’s office or outpatient surgery centre, wherein you will be able to go home on the same day after the surgery. The surgery may take only about 30 minutes. Before the surgery, you would be asked to:

  • Remove any jewellery or objects that could interfere with the surgery
  • Remove your clothes and wear the hospital gown
  • Empty your bladder (urinate)

The medical staff will make you lie on your back on an examination table. They may shave your scrotal area, if not shaved, and clean it with an antiseptic solution. Local anaesthesia will then be injected into your scrotal area to numb the area. The surgery can be performed by either of the following two methods - Incision vasectomy and no-scalpel vasectomy. Both the procedures are performed under local anaesthesia, which is a type of anaesthesia that numbs a specific area of the body and keeps you awake at the same time. Here is the procedure for the two types of vasectomy:

Incision vasectomy (conventional vasectomy)

  • The surgeon will make a small incision (cut) in the upper portion, on each side, of your scrotum.
  • He/she will locate your vas deferens and cut a small section of the tubes one by one. You may feel a pulling sensation when the surgeon lifts the vas deferens before cutting it.
  • The cut ends of the tubes will either be clipped, tied off or closed with a tool that seals the cut with heat, using electric current.
  • Finally, the surgeon will close the cut made on your skin using dissolvable stitches, which disappear within a week.

No-scalpel vasectomy: No cut or incision is required in a no-scalpel vasectomy. The method involves the following steps:

  • The surgeon will make a tiny puncture in your scrotal skin using a needle-like instrument to locate the tubes.
  • He/she will grasp and cut the vas deferens and seal or tie them like in incision vasectomy.
  • No stitches are required. The holes heal on their own. A dressing may be placed on the wound. 

The no-scalpel vasectomy is associated with little bleeding. In addition, this method is associated with less pain and fewer complications as compared to incision vasectomy.

You may take up to 9 days to completely recover after a vasectomy.

  • You may experience swelling, mild comfort, and bruising on your scrotum for a few days after the surgery. The surgeon may recommend some painkillers. Using an ice pack or a pack of frozen vegetables over the dressing. In addition, repeated application of ice pack covered in a towel for 36 hours can help to reduce the swelling.
  • You need to wear scrotal support or tight-fitting underwear for a few days after the surgery to provide relief from swelling or discomfort. Change your underwear every day.
  • You can expect some oozing (discharge) from the cut. Make sure to change the dressing if you find it soiled or stained to prevent the build-up of fluids. Sterile gauze (thin fabric) squares are easily available and can be used for dressing.
  • The skin at the incision site may separate due to oozing blood. You can bring together the skin by pinching it with your fingers and sterile gauze to help it heal.
  • It is usually safe to have a shower or bath after the surgery. However, after the bath, you should dry your genital area thoroughly and gently.
  • It is normal to see some blood in the semen in the initial few ejaculates following surgery.
  • Avoid any heavy lifting or sports for a minimum of 1 week following surgery to prevent complications. You can resume going to work 1 or 2 days after surgery.
  • You can resume your sex life once you feel comfortable. You will have to use some method of contraception for 8 to 12 weeks after the surgery as it takes some time for the semen to be completely sperm-free.

Vasectomy is 99.99% effective and provides permanent birth control. When compared with female contraception methods such as tubal ligation, vasectomy is simpler, effective, less expensive, and has fewer complications.

When to see the doctor?

Call your doctor if you have any of the following:

  • Fever
  • Difficulty urinating
  • Bleeding from the incision site
  • Swelling around the site of surgery that worsens over time
  • Lump in the scrotum

A vasectomy is associated with the following risks:

  • You may have epididymitis (pain or swelling in epididymis - a tube inside testis that carries and stores sperms) or orchitis (pain or swelling in one or both testis due to bacterial or viral infection) usually during the first year following surgery.
  • You may have sperm granuloma, a pea-sized non-dangerous lump in the scrotum formed due to leakage of sperms from the cut vas deferens. This lump is usually absorbed by the body.
  • You may experience short-term bleeding, bruising, swelling, or infection after the surgery.
  • You may experience long-lasting pain after surgery.
  • The vas deferens may grow back in rare cases and may cause an unwanted pregnancy.

The surgeon may ask you to visit the clinic after 12 weeks for semen analysis. Sometimes, more than one visits are needed for semen analysis to confirm that your semen is sperm-free.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Vasectomy
  2. American Academy of Family Physicians [Internet]. Leawood (KS). US; Vasectomy: What to Expect
  3. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms
  4. Handelsman DJ. Male contraception. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 142.
  5. Celigoj FA, Costabile RA. Surgery of the scrotum and seminal vesicles. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 41.
  6. Dohle GR, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A, et al. European association of urology guidelines on vasectomy. Actas Urol Esp. 2012 May;36(5):276–81. PMID: 22033172.
  7. National Health Service [internet]. UK; Vasectomy
  8. Crow MK. Etiology and pathogenesis of systemic lupus erythematosus. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 79.
  9. Iozza I, Cianci S, Di Natale A, Garofalo G, Giacobbe AM, et al. Update on systemic lupus erythematosus pregnancy. J Prenat Med. 2010 Oct;4(4):67-73. PMID: 2243906.
  10. Hahn BH, McMahon MA, Wilkinson A, et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64(6):797–808. PMID: 22556106.
  11. Arntfield RT, Hicks CM. Systemic lupus erythematosus and the vasculitides. In: Hockberger RS, Walls RM, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier Saunders; 2018:chap 108.
  12. Crow MK. Systemic lupus erythematosus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 266.
  13. van Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis. 2014;73(6):958–967. PMID: 24739325.
  14. Fertility preservation program in Pittsburgh area [Internet]. US; The Benefits of Freezing Your Sperm
  15. Tuggy M, Garcia J, eds. Atlas of Essential Procedures. Philadelphia, PA: Elsevier Saunders; 2010.
  16. Cleveland Clinic. [Internet]. Cleveland. Ohio. US; Vasectomy (Male Sterilization)
  17. Urology Care Foundation. American Urological Association [internet]. Maryland. U.S.; What are Epididymitis and Orchitis?
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