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 is effectively reabsorbed by the body, and sexual function, including erections, sexual desire, sensitivity, and ejaculation, are unchanged.
Alternatives to Vasectomy
There are numerous different methods of birth control.(Read More)
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.
Risks of Vasectomy
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.(Read More)
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.
Types of Vasectomy
There are two main types of vasectomies that can be performed:
- Traditional Vasectomy
- Non-scalpel 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.
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.
The No-Scalpel Vasectomy Procedure at UNC and What to Expect
Learn about the procedure here.(Read More)
Immediately After a Vasectomy(Read More)
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.
Follow-up after Vasectomy(Read More)
Other Considerations(Read More)
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.