Surgery Overview

A vasectomy is considered a permanent method
of
birth control. A vasectomy prevents the release of
sperm when a man ejaculates.

During a vasectomy, the
vas deferens from each testicle is clamped, cut, or
otherwise sealed. This prevents sperm from mixing with the semen that is
ejaculated from the penis. An egg cannot be fertilized when there are no sperm
in the semen. The testicles continue to produce sperm, but the sperm are
reabsorbed by the body. (This also happens to sperm that are not ejaculated
after a while, regardless of whether you have had a vasectomy.) Because the
tubes are blocked before the seminal vesicles and prostate, you still ejaculate
about the same amount of fluid.

It usually takes several months
after a vasectomy for all remaining sperm to be ejaculated or reabsorbed.
You must use another method of birth control until you have a semen sample tested and it shows a zero sperm count. Otherwise, you can still get your partner pregnant.

Surgery to reconnect the
vas deferens (vasectomy reversal) is available.
But the reversal procedure is difficult. Sometimes a doctor can remove
sperm from the testicle in men who have had a vasectomy or a reversal that
didn’t work. The sperm can then be used for
in vitro fertilization. Both vasectomy reversal and
sperm retrieval can be expensive, may not be covered by insurance, and may not
always work.

Advantages

Vasectomy is a safer,
cheaper procedure that causes fewer complications than tubal ligation in
women.footnote 1

Although vasectomy is expensive,
it is a one-time cost and is often covered by medical insurance. The cost of
other methods, such as birth control pills or condoms and spermicide, is likely
to be greater over time.

What happens

During a vasectomy:

  • Your testicles and scrotum are cleaned with an
    antiseptic and possibly shaved.
  • You may be given an oral or
    intravenous (IV) medicine to reduce anxiety and make
    you sleepy. If you do take this medicine, you may not remember much about the
    procedure.
  • Each vas deferens is located by touch.
  • A
    local anesthetic is injected into the
    area.
  • Your doctor makes one or two small openings in your scrotum.
    Through an opening, the two vas deferens tubes are cut. The two ends of the vas
    deferens are tied, stitched, or sealed. Electrocautery may be used to seal the
    ends with heat. Scar tissue from the surgery helps block the
    tubes.
  • The vas deferens is then replaced inside the scrotum and the
    skin is closed with stitches that dissolve and do not have to be
    removed.

The procedure takes about 20 to 30 minutes and can be done
in an office or clinic. It may be done by a
family medicine doctor, a
urologist, or a
general surgeon.

No-scalpel vasectomy is a technique that uses a small clamp
with pointed ends. Instead of using a scalpel to cut the skin, the clamp is
poked through the skin of the scrotum and then opened. The benefits of this
procedure include less bleeding, a smaller hole in the skin, and fewer
complications. No-scalpel vasectomy is as effective as traditional
vasectomy.footnote 1

In the Vasclip implant procedure, the vas deferens is locked closed
with a device called a Vasclip. The vas deferens is not cut, sutured, or
cauterized (sealed by burning), which possibly reduces the potential for pain
and complications. Some studies show that clipping is not as effective as other
methods of sealing off the vas deferens.footnote 1

What To Expect After Surgery

Your scrotum will be numb for 1 to 2
hours after a vasectomy. Apply cold packs to the area and lie on your back as
much as possible for the rest of the day. Wearing snug underwear or a jockstrap
will help ease discomfort and protect the area.

You may have some
swelling and minor pain in your scrotum for several days after the surgery.
Unless your work is strenuous, you will be able to return to work in 1 or 2
days. Avoid heavy lifting for a week.

You can resume sexual
intercourse as soon as you are comfortable, usually in about a week.
But you can still get your partner pregnant until your sperm count is zero. You must use another method of birth control until
you have a follow-up sperm count test 2 months after the vasectomy (or after 10
to 20 ejaculations over a shorter period of time). Once your sperm count is
zero, no other birth control method is necessary.

Most men go back to the doctor’s office to have their sperm count checked. But there is also a home test available.

A vasectomy will
not interfere with your sex drive, ability to have erections, sensation of
orgasm, or ability to ejaculate. You may have occasional mild aching in your
testicles during sexual arousal for a few months after the surgery.

Why It Is Done

A vasectomy is a permanent method of birth control. Only consider this method
when you are sure that you do not want to have a child in the future.

How Well It Works

Vasectomy is a very effective
(99.85%) birth control method. Only 1 to 2 women out of 1,000 will have an
unplanned pregnancy in the first year after their partners have had a
vasectomy.footnote 2

Risk of failure

Pregnancy may occur after
vasectomy because of:

  • Failure to use another birth control method
    until the sperm count is confirmed to be zero. It usually takes 10 to 20
    ejaculations to completely clear sperm from the semen.
  • Spontaneous
    reconnection of a vas deferens or an opening in one end that allows sperm to
    mix with the semen again. This is very rare.

Risks

The risk of complications after a vasectomy is
very low. Complications may include:

  • Bleeding under the skin, which may cause
    swelling or bruising.
  • Infection at the site of the incision. In
    rare instances, an infection develops inside the scrotum.
  • Sperm
    leaking from a vas deferens into the tissue around it and forming a small lump
    (sperm granuloma). This condition is usually not painful, and it can be treated
    with rest and pain medicine. Surgery may be needed to remove
    the granuloma.
  • Inflammation of the tubes that move sperm from the
    testicles (congestive epididymitis).
  • In rare cases, the vas
    deferens growing back together (recanalization) so the man becomes fertile
    again.

What To Think About

Disadvantages

A vasectomy does not protect against
sexually transmitted infections (STIs), including
infection with the
human immunodeficiency virus (HIV). Condoms are the most effective method for preventing STIs. To
protect yourself and your partner from STIs, use a condom every time you have
sex.

Other considerations

If you are considering a
vasectomy, be absolutely certain that you will never want to father a child.

A vasectomy is not usually recommended for men who are
considering
banking sperm in case they decide later to have
children. Discuss other options with your partner and your health professional.

Some doctors or health insurance plans may
require a waiting period from the time you request a vasectomy and the time the
procedure is done. This time allows you to be certain about your
decision.

Researchers are studying other male birth control
methods, such as reversible vasectomy or hormonal methods. Reversible vasectomy
involves plugging the vas deferens and then removing the plug when birth
control is no longer wanted. Hormonal methods include pills or injections that
the man would use to prevent sperm production. So far, no new method has been
shown to be effective enough, with low side effects, to be marketed for
men.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Roncari D, Jou MY (2011). Female and male sterilization. In RA Hatcher, et al., eds., Contraceptive Technology, 20th rev. ed., pp. 435-482. New York: Ardent Media.
  2. Trussell J, Guthrie KA (2011). Choosing a contraceptive: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 20th ed., pp. 45-74. Atlanta: Ardent Media.

Credits

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Adam Husney, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC – Obstetrics and Gynecology

Current as ofMarch 14, 2017