John J. Bauer, M.D.
[For complete vasectomy surgery details, go to Vasectomy Details.]
Choosing To Have A Vasectomy
Every year in the United States about one-half million men choose sterilization by vasectomy as their method of birth control. They choose vasectomy because it is a simple, safe, and effective surgical procedure that prevents sperm from reaching an egg and fertilizing it.
A vasectomy only affects your ability to father a child. Nothing else is changed. However, because it is very difficult and expensive to reverse a vasectomy, and reversal often is not successful, having a vasectomy must be viewed as a serious step to take. The decision should be discussed and shared with your partner.
You and your partner should make sure that you understand all the facts. You should be comfortable with your decision and not view sterilization as a solution for sexual or marital problems.
There are many issues you and your partner need to think about. You must be certain that you do not wish to have any more children. You should consider the possibility of divorce and remarriage. Might you want children if you were to marry again? You should consider other forms of birth control if you have any doubts about these issues.
If you decide to have a vasectomy, you will be asked to sign a consent form beforehand which states that you are aware of the risks involved. Make sure all your questions have been answered before you sign this consent form. Also, check with your insurance company to see if it covers vasectomies. Many insurance policies do. Reading through this booklet should help to answer your questions about what a vasectomy is, what steps or procedures are involved, and what the benefits, discomforts and risks are.
|How A Vasectomy Works
Sperm cells are produced in the testes and stored in the epididymis where they mature. They then move down a long tube called the vas deferens. See figure 1. Along the way they are nourished by sticky white fluids secreted by the prostate and seminal vesicles. They may stay in the vas deferens for many weeks before being ejected through the urethra when orgasm occurs.
Figure 1. Area of the vas deferens that is cut in a vasectomy
When you have a vasectomy, the vas deferens is cut and blocked near the testes. The sperm then cannot travel down the long tube and be ejected. The testes will still produce sperm, but because they have nowhere to go, they die and are absorbed by your body. The fluids produced by the prostate and seminal vesicles, however, will still be ejected.
Nothing in your male reproductive system is changed by a vasectomy. Your male hormone level and sex drive will remain the same. Your secondary sexual characteristics, such as hair distribution and voice pitch, will not be affected. It does not interfere with urinating, and it does not affect your ability to have an erection. Only your ability to conceive is changed.
The "No-Scalpel" Procedure
Unlike a traditional vasectomy, the "no-scalpel" procedure is done without incisions or stitches. Generally this procedure results in faster healing and fewer post-operative complications. It can be done in the doctor's office or on an outpatient basis, and usually takes 15 to 20 minutes. You still will be asked to sign a consent form beforehand, however, stating that you understand there can be risks involved and that the procedure cannot be guaranteed to make you sterile.
Figure 2. Area around scrotum to be shaved.
|Preparing For the Procedure
|During the Procedure
After you undress, you will be asked to lie on the exam table. The area around the incision will be sprayed with betadine. A local anesthetic will be injected into the scrotum to prevent you from feeling pain. Then the doctor will make one puncture into the scrotum to do the vasectomy. (See figure 3.) Both tubes will be pulled through this puncture to be cut. The cut ends will then be tied or clipped shut, or they may be sealed by heat. You may feel a slight pulling while the tube is being lifted out and cut, but there will be no need for stiches.
If desired, your spouse may be present in the room at the time of your procedure.
Figure 3. Puncture in Scrotum with vas deferens pulled through.
After the Procedure
Immediately after the procedure you will probably rest on the exam table for some minutes. When you first get up you may feel a bit wobbly, but you will not feel pain. The anesthetic probably will not wear off for an hour or two. Any discomfort you feel will be greatest during the first 24 hours.
At Home After Your Vasectomy
Instructions for Submitting a Semen Sample to the Lab
Even though "no scalpel" vasectomy is a minor surgical procedure, with any surgery there is the possibility of complications. Complications that may occur soon after your vasectomy include:
Internal bleeding in the scrotum. This usually occurs within two days of surgery and may cause increasing pain, great swelling or an enlarging mass. If you have these symptoms, please call the doctor.
Infection. Symptoms include fever, chills, drainage, and pain. Although infections are rare, they usually start a short time after surgery. Call the doctor if you think you have an infection.
Other rare complications that may arise in the first few months after surgery include:
Sperm granuloma. This is a lump created by a leakage of sperm where the vas deferens is tied off. It occurs in about 3% of all vasectomies. The lump usually dissolves by itself, but sometimes surgery is needed to remove it.
Congestion. This may occur 3-12 weeks after surgery. It is caused by sperm left in the epididymis, and may lead to some aching. Congestion usually disappears without the need for treatment.
Sperm antibodies. The body commonly forms antibodies in response to the proteins formed from the absorbed sperm. While these antibodies are not harmful, they can make it difficult to restore fertility at a later date.
Spontaneous formation of a new vas deferens (recanalization). Very rarely a new tube is formed through the scar tissue left by the vasectomy. Usually this can be detected by a semen test after surgery.
However, recanalization occurs in 1 out of 4,000 men after a negative semen test has been performed 12 weeks or longer after surgery.
Other Health Risks
There have been reports that vasectomy increases the risk of prostate cancer. However, the December 1995 Yearbook of Urology reported that recent studies, including one of 40,000 men, show that there is no increased risk of prostate cancer after a vasectomy.
Studies by the National Institutes of Health (NIH) and the Harvard Medical School have shown no link between vasectomy and heart disease. A further study of 20,000 vasectomized men by the NIH has also shown that these men have no more health problems than men who have not had a vasectomy. Only one condition, a temporary inflammation at the site of the surgery called epididymitis, is more common in vasectomized than nonvasectomized men.
Living with a Vasectomy
A vasectomy should not change anything except your ability to have children. It has no effect on sexual functioning. You still have the ability to have an erection and an orgasm, and the amount of semen ejected will not decrease noticeably. The same sensations and satisfactions should be present as before.
If you had a good relationship with your partner before the vasectomy, then it should be good afterwards. In fact, some couples report that their mutual enjoyment actually improves because they are no longer afraid of unwanted pregnancy. Sex may be more spontaneous because birth control is no longer necessary after your sperm count has been reported as zero.
A Change of Heart
Sometimes an unforeseen event in your life may make you wish your vasectomy could be reversed. While a vasectomy must be considered irreversible, there is a surgical procedure that may restore your fertility. It is called a vasovasostomy. In a vasovasostomy the previously cut vas deferens is reconnected. This theoretically allows the sperm to move down the tube again.
However, this procedure does not always work. The longer it has been since you had the vasectomy, the less likely your fertility will be restored. A vasovasostomy is also a major operation that is quite expensive, and insurance usually will not pay for it. Therefore, there is no guarantee your ability to father a child will be restored.
Another option that might allow you to have children is a sperm bank. Before you have your vasectomy, your sperm are collected and frozen. Then they are stored until you wish to have a child. However, sperm banks are available only in certain parts of the country, and you must pay to store the sperm. Like a vasovasostomy, results cannot be guaranteed. At present success in achieving pregnancy with "frozen sperm" is very uncertain.
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