Vasectomy

Aside from vasectomy, the only other form of permanent birth control is female tubal ligation (having her “tubes tied”). Except when this is performed during a cesarean section, tubal ligation is a much more invasive procedure than a vasectomy by requiring general anesthesia and skin incisions. Another long-term form of birth control often used by couples is an intra-uterine device (IUD) which is a temporary device placed into the uterus to prevent pregnancy. Hormonal therapies for women include oral contraceptive pills (“the pill”) and depo-Provera injections. Condom use is the only form of birth control that also protects against sexually transmitted diseases.

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.

Traditional Vasectomy

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.

No-Scalpel Vasectomy

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.

You may be given an oral medicine to reduce anxiety and make you relaxed. If you take this medicine, you will not be able to drive yourself home and will need a ride. Before the procedure, the nurse will get you ready by preparing the scrotum and cleaning the skin with an antiseptic. When the surgeon begins, he will isolate the vas between his fingers and then a local anesthetic is injected into the area to numb the skin. A small puncture opening is made into the scrotum. Some deep tugging sensations are often felt toward the beginning as the vas is secured. After the vas is isolated, it is cut and a small segment removed. The ends are sealed with heat, and tiny titanium clips are placed. The ends are then moved apart from one another to prevent failures, a technique called fascial interposition, before being placed back into the scrotum. The same is performed on the opposite side. No stitches are necessary due to the punctures being so tiny. A dressing of ointment, gauze, and jock strap is placed. The procedure takes about 30 minutes for the surgeon to perform, but the total time including preparation and recovery is around 90 minutes. In order to appropriately schedule your time for the procedure, please allow for 2.5 hours total.

You may have some swelling, bruising, and minor pain in your scrotum for several days after the surgery. You should plan to go home after the procedure and rest. Ice packs may be applied intermittently for the first 1-2 days. Scrotal support with a jock or tight underwear is recommended for 2 days. Prescription strength pain medicine is not usually necessary. Strenuous activity should be avoided for 2 weeks, but men can usually return to work in about 2 days depending on the physical demands of the job. Walking and light activity may be resumed after 1-2 days of house rest.

Sex and ejaculating should be avoided for 2 weeks. For the first month or so after vasectomy, mild tenderness or discomfort may be felt during sexual arousal and/or ejaculation, and this almost always resolves. It usually takes 2-3 months after a vasectomy for all remaining sperm in the vas to be ejaculated. Another method of birth control is absolutely necessary until you have a semen sample tested and it shows a zero sperm count.

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 is 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.