John J. Bauer, M.D. www.flinturology.com Urology Services, Inc. G-1121 West Hill Rd. Flint, Michigan 48507 Tel: 810.232.8888 Fax: 810.232.9190 Email: jbauer@flinturology.com [map]

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What is a vasectomy?

As you probably know already, a vasectomy is a surgical procedure that renders a man sterile. What you may not know are the specifics of the procedure and the period that follows. This literature is designed to give you a better understanding of both, before the surgery takes place. To begin with, you should have some basic knowledge of the anatomy and physiology of the male reproductive system. Sperm cells travel from the testicles through the vas deferens, become part of the seminal fluid (which is produced by the seminal vesicles and the prostate gland), and are ejaculated through the penis. When the surgeon performs a vasectomy, he cuts through the vas deferens extending from each testicle. He then removes a small segment of the vas deferens and ties off the two remaining ends. The object of the procedure is to make it impossible for the sperm to become part of the seminal fluid. Since conception cannot take place in the absence of sperm, a vasectomy results in permanent male sterilization.

Will I be sterile as soon as the operation is over?

No. Contrary to what many people believe, you may not be sterile immediately after the operation. This is because there are some sperm residing above the area where the vas deferens is cut during the procedure. Until all of these sperm cells have been ejaculated, you will still be fertile. In general, it takes several months following vasectomy for sperm to disappear. Patients need to bring a semen sample to the office about 2 months after the surgery. The physician will examine the seminal fluid under a microscope to be sure that no sperm are present. Only when this has been confirmed can you be sure that the surgery has been a success.

Are the effects of the surgery permanent?

Yes. Essentially, once the surgery has been declared successful, you will be permanently sterile. The chances of the two cut ends of the vas deferens being spontaneously rejoined are extremely rare, probably no more than 1 in 200 to 1 in 1,000. For this reason, it is most important that you are completely sure that you want no more children before you consent to the surgery.

Suppose I change my mind later on. Can the operation be reversed?

Your physician can reconnect the two ends of the vas deferens, and once this is done, you may possibly be fertile again. However, after the procedure, called a vas reanastomosis, fertility is restored in fewer than 40% of the patients on whom it is performed. Therefore, you should consider the vasectomy to be an irreversible procedure.

How will the procedure affect my sex life?

Although the vasectomy will make you sterile, it will have no effect whatever on your potency - that is, your ability to have sexual intercourse. In fact, many couples find that their sex life improves after the vasectomy because they no longer have to worry about the surprise of an unwanted pregnancy.

Will I still ejaculate in the normal manner?

Yes. Most of the seminal fluid that the male ejaculates during intercourse is produced by the seminal vesicles and the prostate gland. Only a small amount of the seminal fluid consists of sperm. Therefore, after a vasectomy, ejaculation will take place in the same way as it did before. The only difference is that there will be less fluid ejaculated, and this difference is barely noticeable.

I've heard that the vasectomy can be performed in the physician 's office. Is this true?

This is a matter to be discussed with your physician, and you should follow his recommendation. Although the procedure is relatively uncomplicated and can be performed with minimal difficulty in the physician's office, many physicians find it more convenient to perform the vasectomy in a hospital setting.

Is a vasectomy painful?

As with any operation, no matter how minor, there will be some discomfort associated with it. However, with proper anesthesia, this discomfort will be kept to a minimum. Your physician will discuss the type of anesthesia to be used. As a rule, local anesthesia and some supplemental sedation are all that is required. In some cases, general anesthesia may he needed, but this is a matter to be left to the discretion of your physician.

Are there any complications associated with a vasectomy?

The problems that occur after the operation are usually quite minor. There will be some pain and tenderness in the area where the surgery is performed. There may also be some swelling and discoloration (black and blue marks). Your physician will probably prescribe some medication to keep the post-procedure discomfort to a minimum. As with any surgery, the possibility of an infection is always present. However, this is usually quite rare following a vasectomy. In a very small percentage of patients, a blood vessel inside the scrotum continues to bleed after the operation. If this happens, the scrotum will swell and become very tender. Should you experience this problem, contact your physician. He may have to re-open to tie off the "bleeder". This could require a return to the hospital and the administration of general anesthesia.

Are there any long-term complications?

As far as medical science can determine at this time, there are no long-term complications associated with vasectomy. Recent reports in the lay press have focused attention on scientific studies that raise the question of an increased risk of heart disease or an increased risk of prostate cancer. The current consensus is there is no clear proven risk between vasectomy and other health conditions.

How soon after the operation can I have sexual intercourse?

You may resume your normal sexual activity one week after the surgery. Remember, however, that you may not be sterile until some time after the operation, and therefore you should continue to use some form of birth control until your doctor confirms that all sperm have disappeared from your semen.

What about after the operation. What must I do?

Wear the athletic supporter or suspensory for the first 24-48 hours after the operation. After that you need only wear it if it makes you more comfortable. Do not engage in any strenuous physical activity for the first week, and work your way back to your normal routine over a period of about one to two weeks. You may shower on the day after the surgery. Just be sure that you wash the scrotal area gently, and rinse with warm water. When you dry the scrotum, do so by blotting the water with a soft towel. If your physician uses stitches to close the incisions, they will dissolve themselves and you will not have to return to have them removed. However, because the incisions are so small, many physicians do not use stitches. In such cases, there may be a slight discharge from either or both of the incision sites. This need not concern you. Simply place a small sponge or gauze pad over the incision, replacing it on an as-needed basis, until the wound is completely healed. Even with such a discharge, you may still shower each day.

One final word..

Discuss any questions you have about the procedure with your physician before the surgery takes place. Follow all his instructions completely. Be as certain as you possibly can be that you want no more children before you consent to the surgery.