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All About Vasectomy

Vasectomy is permanent birth control for men. It is a surgical procedure that results in sterility. Over 500,000 men in the United States choose to have a vasectomy every year. These men who choose to have a vasectomy performed want birth control that is intended to be permanent. Vasectomy is preferred because many reversible methods are less reliable, sometimes inconvenient, and may have unpleasant side effects for the women in their lives.
Vasectomy is nearly 100 percent effective. It is intended to be permanent. It is safe. It doesn't limit sexual pleasure.

All About Vasectomy

Vasectomy is permanent birth control for men. It is a surgical procedure that results in sterility. Over 500,000 men in the United States choose to have a vasectomy every year. These men who choose to have a vasectomy performed want birth control that is intended to be permanent. Vasectomy is preferred because many reversible methods are less reliable, sometimes inconvenient, and may have unpleasant side effects for the women in their lives.
Vasectomy is nearly 100 percent effective. It is intended to be permanent. It is safe. It doesn't limit sexual pleasure.

HOW VASECTOMY WORKS – THE PRE-OPERATIVE EXAM

Initially, a history is obtained to determine if there are any contraindications to vasectomy such as bleeding disorder, intake of anti-coagulants (blood thinners such as Coumadin, Persantine, Ticlid, and Aspirin), or allergy to Lidocaine, a local anesthetic agent used to anesthetize the skin.
Patients need to understand that vasectomy is a rather permanent procedure, although we do have reversal techniques such as vasovasostomy. With a vasovasostomy, the ends of the vas deferens are reconnected-usually with the aid of a microscope. This is a much more involved and costly procedure, so patients should be sure of their decision before proceeding with vasectomy. The risks of vasectomy are discussed thoroughly in the preop evaluation. These risks include the possibility of infection, bleeding, sperm granuloma formation, chronic testicular pain and rare incidence of recanalization (reconnection of the vas).

Infection can present itself as a skin infection or as epididymitis (inflammation of the epididymis, which is the structure where sperm mature upon leaving the testicle). With a skin infection, the incision sometimes separate and there may be drainage, but this usually heals quickly with antibiotics and local wound care. With epididymitis there may be pain and swelling posterior to the testicle. This too, usually heals quickly with antibiotics.
Bleeding can occur with vasectomy but this is usually only enough to cause bruising of the skin since the scrotal skin is so loose. The bruising can rarely turn the whole scrotum black and blue, however, this is of little concern since the body reabsorbs this blood and normal color returns within a couple of weeks. Less commonly, there is enough bleeding to produce a hematoma (blood clot) within the scrotum. This too, is usually self-limited, taking the body a little longer to reabsorb the blood.

Don't let this discussion dissuade you. The chance of developing infection or bleeding with hematoma formation is 1% or 1 in 100 or less. The chance of having a complication that needs further surgery is about .1% or 1 in 1000.
Sperm granuloma occurs when a few sperm leak out around the cut ends of the vas deferens. The body recognizes the sperm as a foreign substance once outside of the vas and an area of inflammation is produced. If this occurs, the patient may always feel a small swollen area around the area of vasectomy. This is not all bad since creation of a sperm granuloma can reduce the pressure of vasectomy, resulting in more normal sperm if vasovasostomy is ever performed to reconnect the ends of the vas.

Chronic testicular pain can occur but is extremely rare, .01% or 1 in 10,000 cases. It is felt that this is related to high pressure caused by blocking of the vas deferens. Rarely is vasovasostomy indicated to relieve chronic pain.
Recanalization occurs when the channel reforms, allowing sperm to leave the testicle and travel through the vas. If this occurs, the patient may become fertile again. That is, he may be able to produce another child with a sexual partner. Incidence of recanalization is extremely low, .1% to .3 percent or 1 to 3 in 1000 cases. All patients need to understand that they are still considered fertile after vasectomy (that is, able to impregnate their sexual partner), until two semen specimens are checked under the microscope and are clear of live or dead sperm. Since recanalization usually occurs between six and twelve weeks post vasectomy, we check a post vasectomy semen sample at six and twelve weeks out.
Contraception must be used until these semen specimens are determined to be clear of sperm.
If live sperm are detected in the post vasectomy semen check at three months, vasectomy has failed and needs to be reperformed. Remember this only occurs in .1% to .3% or 1 to 3 in 1000 cases. It is very rare.
Again, you do not need to be frightened by discussion of the complications of vasectomy, but you do need to be an informed patient, confident in your decision to proceed with vasectomy. The chance of having a complication that could require hospitalization is about .1% or 1 in 1000 cases.

ALL ABOUT VASECTOMY – THE PRE-VASECTOMY EXAM

The physical exam is carried out by your VasCenter affiliate urologist. The testicles are palpated (felt) to make sure they are normal. The vas deferens is also palpated to make sure that there is a vas on each side. In rare cases, the vas deferens can be absent on one side.
Each patient's anatomy is different. Some scrotums are loose and the vas is easily palpated. In other patients, the scrotum is tight and the spermatic cord thick, making it difficult to palpate the vas. Probably 95% of patients have favorable anatomy and can have vasectomy performed in an office setting under local anesthesia only.
Occasionally, if the anatomy is unfavorable, making the vas difficult to palpate or if the patient is too uncomfortable or too queasy with manipulation of the vas, we will recommend that the vasectomy be performed under local anesthesia plus sedation. In some cases, an anesthetist may be present to provide deep sedation. If the patient receives any type of sedation, whether it be oral sedation or IV sedation, he should arrange to have someone drive him home after vasectomy.

ALL ABOUT VASECTOMY – THE PROCEDURE
Once the patient understands the procedure and has signed the operative consent form he is ready for vasectomy. Click here to view sample operative consent form. He may elect to take Valium by mouth prior to the procedure. He is asked to remove clothing from the waist down and a small area of the anterior scrotum is usually shaved. The skin is then cleansed with a soap solution, usually Betadine, an iodine solution. Another solution can be used if there is an allergy to topical Iodine.
Sterile drapes are then placed and the physician will palpate the vas on one side and manipulate the vas to just beneath the skin level. Lidocaine is then injected to anesthetize the skin. This is done with a very small needle. A sticking, stinging sensation is noted only briefly. Once injected, the skin is immediately anesthetized and the procedure can then be performed.

Depending on the anatomy, your physician may elect to perform small incisions or a no scalpel technique to approach the vas. In either case, the vas is brought into the operative field and small metal clips are applied and a segment of the vas is removed. The vas is then cauterized (burned), internally and externally.

The same procedure is performed on the opposite side, usually through a separate site, although, occasionally both sides can be done through the same incision. Sometimes the skin incision is left open and, sometimes, absorbable sutures are placed to close the incision. There may be spotting of blood from the wounds for twenty-four to forty-eight hours, therefore, a dressing is placed over the wound and can be removed the next day. Dressing may be replaced if the patient is more comfortable with a dressing in place or if there is any continued spotting of blood.

ALL ABOUT VASECTOMY – AFTER THE PROCEDURE
Contact your urologist for any complication including severe pain, swelling, bleeding or temperatures greater than 101. If things are going well, you do not have to return for a postop visit.
The patient is asked to wear tight fitting shorts or a jockey strap for support. He may want to continue this support over the next several days. An ice pack should be placed over the shorts or jockey strap (not against the skin, as a skin burn can develop). This is done fifteen minutes on and fifteen off on the day of the vasectomy. If there is significant discomfort, the ice routine can be continued the next day.
A shower can be taken twenty-four hours out from vasectomy; however, avoid baths or swimming for several days.
Aspirin or Motrin (Ibuprofen) should be avoided, as they may cause an increase in bleeding. Your physician will probably write a prescription for Tylenol with Codeine for pain unless you have an allergy to this medication. Postop pain is usually minimal and most patients do not require much pain medication, but occasionally a patient may have significant pain for several days, requiring additional pain medication.
Heavy lifting or straining and strenuous exercise should be avoided for three to seven days, and then you may gauge activity according to your comfort level.
Avoid intercourse or ejaculation for at least seven days, then intercourse may be resumed with contraception only.
Remember, there are live sperm still present in the vas immediately after vasectomy, and you are not considered sterile until the semen specimen is cleared of sperm at six and twelve weeks postop. Use contraception until given the okay to have intercourse without contraception. You will be given specimen cups to collect the semen specimens in. The more ejaculations there are over the six to twelve week period, the more likely the semen specimens will be negative for sperm when checked.

Some patients develop antisperm antibodies after vasectomy. This correlates with an increase in atherosclerosis (hardening of the arteries) in monkeys, but several studies have detected no increase of atherosclerosis in humans post vasectomy.
In the last few years, some researchers tried to show an increase correlation between vasectomy and prostate cancer. Numerous studies have failed to confirm this. The American Urological Association recommends that patients over forty who have had vasectomy twenty years previously should have an annual prostate exam. This is also recommended for any male over fifty, whether or not vasectomy has been performed.

VASECTOMY GENERAL QUESTIONS AND ANSWERS

Can the operation fail?
Yes, but in fewer than two in 1,000 cases.

How soon can I have sex again?
That depends on you. Most men start again within a week. Others have sex sooner. Some wait longer. It takes about 15-20 ejaculations to clear sperm out of your system. Use another form of birth control for vaginal intercourse until a semen analysis shows there are no longer sperm in your seminal fluid.

How is semen analysis done?
You will provide a sample of your semen by masturbating or by using a special condom during sexual intercourse. The fluid will be examined under a microscope to see if there are any sperm in your semen.

Will vasectomy affect my sexual pleasure?

Your erections, orgasms, and ejaculations will very likely be the same. Most men say they have greater sexual pleasure because they don't have to worry about an unwanted pregnancy. Many say there is no change. Rarely, men lose some sexual desire. More rarely, men lose the ability to become hard. Often, such losses have to do with their emotional condition before the operation.

Will I be as masculine?

Yes. The hormones that affect masculinity, beard, voice, sex drive, etc., are still made in testicles. They still flow throughout the body in the bloodstream.

Will there be fluid when I orgasm still?

Yes. But there will be no sperm in the ejaculate. Your semen is between 2 and 5 percent sperm. The rest is seminal fluid from the prostate and other glands. The change in the amount of fluid is too little to notice.
After vasectomy where do the sperm go?

They dissolve and are absorbed into the body. Dead and unused cells are absorbed by the body throughout life. Antibodies to sperm develop in 50 percent of men who have vasectomies. Normally, antibodies protect the body against viruses and bacteria. Sperm antibodies will not affect your general health. But they may lessen the chance of restoring fertility if vasectomy is reversed.

How much time will I have to take off work?

Most men lose little or no time from work. A few need a day or two to rest. You will have to avoid strenuous labor or exercise for three to five days. Complications may require more days at home. However, prompt medical attention should clear up any problems.

How long will the vasectomy procedure take?
The procedure takes about 15 to 20 minutes.

Will the vasectomy procedure hurt?
You and your urologist will discuss which type of anesthetic to use. Local anesthetic is most usual. Sometimes a general anesthetic is called for. No pain is felt under general anesthesia because you are asleep. Some discomfort may be felt when the local anesthetic is injected or when the tubes are brought into the incision.

Does vasectomy protect against sexually transmitted infection?
No.

Is pregnancy possible after vasectomy?

Some sperm will remain in your system for a short time after the operation. They can cause pregnancy. Your ejaculate will be tested after 15-20 orgasms following the operation. The test will be repeated until no sperm are seen. Only then should you stop using other birth control.

Are there laws covering vasectomy?

Mentally competent adults can legally choose sterilization in all 50 states. No one who is mentally competent can be forced to have the operation. You cannot be denied welfare benefits if you do not want to have a vasectomy. Even threats to do so are against federal law.

Policies and practices vary with individual practices and a physician reserves the right to refuse to do the procedure.

How much does a vasectomy cost?

Fees range between $240 - $1,000 for a consultation, examination, operation, and follow-up sperm count.

Is help with payment available?

Blue Cross and Blue Shield and many private health insurance policies may pay some or most of the cost.

Are there special requirements for vasectomy?
You are not required to have the consent of your wife or partner, but you should discuss the operation with her beforehand. Guidelines vary from practice to practice. However, for a federally funded Vasectomy, you must:

· Be at least 21 years old
· Observe a 30-day waiting period after signing a statement of informed consent
· Be free of the influence of alcohol or other drugs at the time of consent
· Reapply if the procedure is postponed for more than 180 days


  • Vasectomy education section will discuss all relevant areas from frequently asked questions (FAQ’s) to expected costs and complications. Areas include vasectomy, no scalpel vasectomies, and vasectomy reversals.
  • Physician locator will guide you to a VasCenter urologist in your area utilizing your zip code.
  • Special "Women-only" section will be tailored to help women evaluate vasectomy and other urology procedures.
  • Links to other urology information sections will be provided.
  • Links to VasCenter Affiliate websites.

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