A vasectomy is a minor outpatient surgical procedure for male sterilization as a permanent method of birth control. It is the most commonly performed urologic procedure in the United States, with an estimated 500,000 or more sterilizations performed annually. Vasectomy is the most effective form of any birth control available, with a 99.95% success rate in preventing pregnancy.
Vasectomy should only be considered by men who are 100% sure that no future children are desired. A vasectomy works by permanently blocking the exit flow of sperm from the testicle. Because the ejaculate is primarily composed of fluid (semen), there is no noticeable change in the ejaculate appearance or volume when a man ejaculates after vasectomy. The testicles continue to produce sperm, but the sperm are effectively reabsorbed by the body, and sexual function, including erections, sexual desire, sensitivity, and ejaculation, are unchanged.
The risk of complications after a vasectomy is very low. There is a 1 in 2000 chance of pregnancy after vasectomy, and this is after “clearance” from a negative semen analysis 3 months after vasectomy. The failure rate is much higher if another birth control method is not used until the semen analysis is confirmed to be sterile. The reason for this is that it usually takes 20 to 30 ejaculations to completely clear sperm from the semen due to the vas deferens above the vasectomy site still containing sperm.
Complications which occur in approximately 1% of men may include:
- Light bleeding under the skin which can cause bruising, and more rarely a larger blood clot in the scrotum called a hematoma which may cause swelling and prolong the recovery period.
- Infection at the site of the skin puncture is rare but a possible risk of any surgical procedure.
- Inflammation of the epididymis, which is the structure comprised of small tubes that move the sperm from the testicles out to the vas deferens, a condition referred to as congestive epididymitis.
- Chronic pain, which is usually mild, may result in approximately 1-3% of men.
The original form of vasectomy is now called a “traditional vasectomy.” This technique involves making two small scrotal incisions over each vas deferens. Although it is still performed in many places and has an excellent success rate, it is a longer procedure, it requires stitches to be placed, and it carries a slightly higher risk of complications that include bleeding, infection, and chronic pain.
The latest and most minimally-invasive approach to vasectomy is the “no-scalpel vasectomy” developed in China in the late 1980’s. A no-scalpel vasectomy is a technique that uses a skin puncture instead of a scalpel to cut the skin. The technique of spreading the skin and tissue overlying the vas, rather than cutting it sharply, allows for several additional benefits over a traditional vasectomy. While equally effective as a traditional vasectomy, the added benefits of no-scalpel vasectomy include more control, less bleeding, a much smaller puncture in the skin, a quicker recovery, and fewer complications. Stitches are not required at the end of the procedure. The UNC urologic surgeons prefer the method of no-scalpel vasectomy for their patients.
One of the most important parts of the vasectomy is the post-vasectomy semen analysis. This is done approximately 3 months after the vasectomy and after 20-30 ejaculations. Most men just need one, but if sperm are still seen it may be necessary to repeat the semen analysis more than once. Semen analyses may be performed at either UNC Hospitals or UNC Fertility. An appointment with your surgeon may or may not be necessary, and if you don’t have an appointment with the surgeon you will be called with the results of the semen analysis.
The UNC surgeons that perform no-scalpel vasectomies prefer to meet the patient in a separate initial consult visit. The vasectomy is usually scheduled within a few weeks after the consult. Research has shown less regret after vasectomy and higher satisfaction if the patient has time to fully consider the surgeon’s preoperative advice. Special plans may be discussed. Rare exceptions to this surgeon preference have been made.
A consent is signed on the day of the initial consultation. The procedure may be performed in the operating room as a joint procedure with another necessary surgery, or for select reasons such as previously diagnosed anxiety or pain disorders, altered anatomy, and previous scrotal surgeries, up to the surgeon’s discretion.
Vasectomy is typically covered by most insurance carriers but may be susceptible to deductible and coinsurance.
Sperm cryopreservation (“sperm banking”) prior to vasectomy is available, but the desire for this service probably means that vasectomy is not the right procedure for you.
If you are considering a vasectomy, you must be absolutely certain that you will never want to father a child. A vasectomy reversal is ultimately desired by 6-8% of men after vasectomy, usually due to an unexpected change in the patient’s family structure. It should be pointed out that a vasectomy is performed with a permanent and effective result in mind (it is never done with a method that is “easy to reverse”). A vasectomy should never be used as a form of temporary birth control. While often effective, the reversal procedure is a big operation compared with a vasectomy, it can be expensive due to not being covered by insurance, and natural conception pregnancy rates are much higher than after vasectomy reversal, even after a successful outcome.