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IS VASECTOMY FOR YOU?
Vasectomy is a simple, safe, and effective surgical procedure that makes a man sterile (unable to father a child). Because a vasectomy should be considered irreversible, it’s a serious step to take. You and your partner should understand all the facts and share in the decision.
A PERMANENT DECISION
Few decisions in life are permanent, but having a vasectomy should be considered one of them. So, before you make this decision, you and your partner must be sure that you don’t want any more children. Is there any circumstance that might make you change your mind? For instance, if you divorced or became a widower and remarried, would you want more children? If you choose to have a vasectomy, you should have no doubts about these issues. Although a vasectomy should be considered permanent, the procedure can be reversed with up to a 70% success rate.
FACTS
A vasectomy does not affect your ability to have sex.
Sterilization won’t affect your ability to have erections or orgasms, and doesn’t visibly change your semen.
There is no conclusive evidence that vasectomy causes health problems.
You may have heard that sterilization causes prostate cancer, heart disease, or other health problems, but there’s no conclusive evidence that this is true. If you’re concerned, your doctor can give you more information. Note, however, that having a vasectomy does not protect you from sexually transmitted diseases.
A vasectomy will not solve marital problems.
The only aspect of your life that a vasectomy changes is your ability to father a child. Sterilization is not a solution for sexual or marital problems.
HOW A VASECTOMY WORKS
When you have a vasectomy, the two vas deferens are cut to keep sperm from traveling from the testes to the penis. This is the only change in your reproductive system. The testes still produce sperm, but since they have nowhere to go, they die and are absorbed by your body. Your prostate and seminal vesicles still produce fluids, so your semen doesn’t look or feel any different. Your male hormone level remains the same, so your hair distribution, the pitch of your voice, and your sexual drive does not change.
THE VASECTOMY PROCEDURE
A vasectomy is an outpatient procedure that is done in our office and takes approximately 30 minutes. Before your vasectomy can be performed, you will be asked to read and sign a consent form that states you are aware of the possible risks and complications and that you understand the procedure, though usually successful, is not guaranteed to make you sterile. Be sure that you have all your questions answered before signing this form.
PREPARING FOR SURGERY
The day of your surgery, shower and thoroughly clean and shave your scrotum (unless instructed otherwise by your surgeon). Eat a light snack instead of a heavy meal before your surgery, unless instructed otherwise by your surgeon. Bring a pair of clean tight fitting cotton briefs or an athletic supporter with you to the doctor’s office. If you are at all nervous about your surgery, we advise asking our office for oral medication to help you relax (we need to know this at least one day before the surgery so that a prescription can be called to your pharmacy). If you are given this medication to relax someone must drive you to and from the procedure.
DURING SURGERY
You will be asked to undress and lie on the exam table. You will be cleaned with antiseptic soap by the doctor. Sterile drapes are placed over you to help prevent infection. You are given injections of a local anesthetic into the skin of your scrotum. This causes a very minor discomfort. This anesthetic prevents you from feeling pain. Once the anesthetic takes effect, one or two tiny incisions are made in the skin of the scrotum with a small instrument or scalpel. Each of the vas deferens is lifted through the incision and cut, and a section is removed. You may feel a pulling sensation during this process. The two cut ends are usually sealed by heat (cauterized). A suture is placed to separate the two ends from each other. The two cut ends are sealed by heat (cauterized) and placed apart from each other. The incision may be closed with two or three stitches. The entire procedure usually takes less than 30 minutes.
AFTER SURGERY
If you have been given medication to help you relax, or your procedure was done under anesthesia, you will need to have someone drive you home. The local anesthetic begins to wear off after an hour or so. Any discomfort you feel is usually mild. We highly recommend that you stay supine (lying down) for the first six to eight hours after the procedure and keep an ice pack on the incision. You may experience swollen, achy testicles for the first week or so after the procedure.
HEALING
Once you are home, you can do several things to aid your recovery:
Stay off your feet as much as possible for the first two days to lessen the chance of swelling. An ice pack or bag of frozen peas can help keep swelling down (this is especially important for the first six to eight hours after the procedure).
Wear snug cotton briefs or an athletic supporter for support.
You may bathe the next morning after your procedure.
Avoid heavy lifting or exercise for at least five days after surgery.
Wait at least five days before having intercourse. Remember that you must use another form of birth control until your doctor says you are completely sterile.
For about a week your scrotum may look bruised and slightly swollen. You may have a small amount of bloody discharge from the incision site. You may also feel some mild discomfort. These symptoms are normal.
POSSIBLE RISKS AND COMPLICATIONS
Even with a minor operation like vasectomy, problems can occur. If you experience any of the following or any other symptoms you are concerned about, call your doctor.
The following complications might occur during the first few days after your surgery:
- Postoperative Pain - Some men experience mild discomfort in the scrotum after the operation. Acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve) will help relieve some of this discomfort. Bedrest and a scrotal supporter are also recommended.
- Hematoma - Very rarely, a small blood vessel may leak in the scrotum forming a clot. A small clot will probably dissolve with time, but a larger one can be painful and may require reopening of the scrotum and drainage.
- Infection - Infections may occur after vasectomy. Some signs of infection are fever, chills, and redness and swelling around the incision site.
Other complications, though rare, may occur in the first few months after surgery. These are the most common:
- Sperm granuloma - Sometimes a lump (called a sperm granuloma ) can form at the site where the vas deferens is tied off. It is caused by leaking sperm. Usually these small lumps cause no problems.
- Congestion - Because sperm are still produced after a vasectomy they can buildup in the epididymis and testicle. It may cause inflammation of the epididymis (epididymitis). It usually disappears without treatment but can sometimes require antibiotics and anti-inflammatory medications. It is uncommon to last more than six months.
- Recanalization - After vasectomy, at least 15-20 ejaculations are required to clear viable sperm from the reproductive system; usually it takes a few months before sterility is complete. Failure of vasectomy with spontaneous return of fertility occurs very rarely. This can happen if the cut ends of the vas deferens reconnect (recanalization). Recanalization usually occurs within a few months of surgery but can occur much later. For this reason we recommend that you test your semen a few months after the procedure and yearly thereafter.
SEX AFTER VASECTOMY
A vasectomy will not affect your sexual functioning. When you start having sex again, you will still have erections and orgasms, and your sexual relations will feel the same as before. If you had a good relationship with your partner before vasectomy, it should not change. Until you are sterile it is absolutely essential that you continue to use some other method of birth control after your vasectomy until your doctor tells you that your sperm count is zero. To make sure no sperm are left in your semen, you will have a postoperative semen exam. You usually collect the semen at home in a small container (which we can provide the day of your vasectomy) and bring it to the office. Submit two consecutive ejaculate specimens. The first specimen should be obtained no earlier than two (2) months after the procedure. (The best specimen should be obtaiined after at least fifteen (15) ejaculations.) The second specimen should be obtained at least three (3) months after the procedure. Each of these two specimens must not demonstrate any sperm before your doctor can consider that the operation has caused you to be sterile. If at any point in the future there is concern about continued sterility an additional specimen can be tested.
AFTER YOU ARE STERILE
After you are told by your doctor that you are sterile, you no longer need another form of birth control. You are free to have sex without the fear of an unwanted pregnancy. However, keep in mind that a vasectomy does not protect you from sexually transmitted diseases. If you are not in a mutually monogamous relationship, practice safe sex by using condoms.
IF YOU CHANGE YOUR MIND ABOUT HAVING CHILDREN
Some unforeseen event in your life after your vasectomy may make you want to have more children. Although a vasectomy must be considered irreversible, a surgical procedure called a vasovasostomy might restore fertility. During this procedure, the cut ends of the vas deferens are reconnected to allow the free flow of sperm. It is a major operation that is expensive and not always covered by insurance. It is also not guaranteed to restore your ability to father a child. As an alternative, sperm banks can freeze sperm collected before your vasectomy and store it in case you want a child in the future. However, achieving pregnancy with stored sperm is also expensive and uncertain.
WHEN THE TIME IS RIGHT
Choosing sterilization requires careful consideration. Once you have decided that vasectomy is right for you, you can enjoy newfound freedom and spontaneity. And you can feel comfortable knowing that your family will not get unexpectedly larger.
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