Vasectomy- Facts, Questions & Answers
March 28, 2024
Witham Health Services
Witham Urology Associates – Facts About Vasectomy
Dr. Zachary Gordon
Phone: 765-485-8730 Fax: 765-485-8739
Witham Urology Associates
2705 N. Lebanon Street
North Pavilion, Entrance B,
Suite 265, Pod #4
Lebanon, IN 46052
What is a Vasectomy?
If you are thinking about getting a vasectomy, you are not alone. Each year, more than 500,000 men in the U.S. choose vasectomy as permanent birth control. During a vasectomy, each of the two vas deferens (the tubes that move sperm) are sealed off. This blocks sperm from reaching the semen that is ejaculated from the penis. After a vasectomy, the testicles still make sperm, but the sperm are absorbed by the body. Although vasectomy is still not 100% reliable in preventing pregnancy, a vasectomy prevents pregnancy better than any other method of birth control, except abstinence.
What are the Alternatives to Vasectomy?
Vasectomy is a permanent form of contraception (birth control). some people later regret this decision. For example, if your partner is currently pregnant but loses the pregnancy, you may wish to try to conceive another child in the future. There are permanent and non-permanent alternatives to vasectomy available. If you change your mind after vasectomy, you still have the options of:
• Vasectomy reversal to reconnect the tubes (vas deferens) that carry sperm from the testicle into the semen so your semen will have sperm again.
• Finding sperm surgically and attempting conception with in vitro fertilization, In vitro fertilization is when eggs are collected from the ovaries and fertilized by sperm in a lab. These options are not always successful, and they may be expensive.
Frequently Asked Questions
• Will I or my partner notice a difference during sex after a vasectomy?
After recovering from a vasectomy, a man and his partner should notice no difference during sex. An uncomplicated vasectomy does not cause erection problems. Ejaculation and orgasm should feel the same. The amount of semen does not decrease more than five percent. The only change your partner may be able to feel is a small lump at the vasectomy site if one has formed.
• Can a vasectomy fail?
There is a small chance (less than 1%) that a vasectomy may fail. This occurs when sperm leaking from one end of the cut vas deferens find a channel to the other cut end.
The Procedure
Vasectomy is a minor surgery that should take about 20 minutes. It is typically performed in the office with only local anesthesia. You will be awake during the procedure, but after injection of the local anesthetic (lidocaine) in the scrotum, the area will become numb and you should not feel any sharp pain at all. Some patients may also be given a medication, such as Xanax (alprazolam), to take just prior to the procedure to help reduce anxiety. A vasectomy can be performed using a variety of different methods and surgical techniques. With a standard or conventional vasectomy, the urologist makes one or two small cuts in the scrotum. One vas deferens tube is cut and then either tied with a suture, closed with a small clip, or sealed with heat/cautery. The tube is replaced inside the scrotum, and the procedure is then repeated on the other side. Lastly, the skin incision is closed with one or two stitches. In contrast to the conventional vasectomy, Dr. Gordon performs the procedure using a minimally invasive no-scalpel vasectomy technique. With this technique, a small clamp with a pointed tip is used to make one small puncture in the middle of the scrotal skin. The size of this small skin puncture is only about 5mm, or approximately the size of a pea. One of the vas deferens tubes is then lifted out through this small skin puncture and cut. The two ends of the tube are sealed with heat/cautery, and then put back in place within the scrotum. Through this same small skin puncture, the procedure is then repeated on the other vas deferens tube. There are no scalpels, sutures or clips used with this technique, and the single small skin puncture is closed with only surgical skin glue at the end of the procedure. Compared to a conventional vasectomy, this technique works just as well, and in fact, is associated with the highest success and lowest complication rates. Additional benefits of a no-scalpel vasectomy include less bleeding, swelling and pain, as well as a smaller hole in the skin.
What to Expect After the Procedure
After a vasectomy it is normal to experience:
• Scrotal numbness for 1–2 hours after the procedure.
• Mild pain, swelling and/or bruising of the scrotum for the first few days. Surgical skin glue was used to close the small scrotal skin puncture. This glue will dissolve or fall off within approximately 5-10 days.
Risks
The risk of complications or bad side-effects after a vasectomy is very low, but may include:
• Bleeding – excessive bleeding under the skin occurs in 1-2% of men, and may lead to a scrotal hematoma (a pool of clotted or partially clotted blood) around the vas. When this occurs, it usually resolves without additional treatment. However, you should notify Dr. Gordon’s office if the swelling is severe and your scrotum becomes larger than the size of an orange.
• Infection – infection after a vasectomy is also rare, occurring in only 1-2% of men. When an infection does occur, it is usually a superficial skin infection around the puncture site, and can typically be treated with a short course of oral antibiotics. It is very rare for an infection to occur inside the scrotum.
• Sperm granuloma – a sperm granuloma is a small nodule that may develop over time at the cut end of the vas, and represents the body’s natural inflammatory reaction to sperm leaking from the vasectomy site. The development of an asymptomatic sperm granuloma is relatively common, occurring in 15-40% of men, and is not considered a complication of vasectomy. However, on rare occasions, a sperm granuloma may be cause significant scrotal discomfort or pain in 2-3% of men. When this occurs, a symptomatic sperm granuloma can typically be treated with anti-inflammatory medications, such as ibuprofen.
• Post-Vasectomy Pain Syndrome – chronic scrotal pain or discomfort persisting several weeks or months after vasectomy may occur in 1-2% of men. Although the exact cause of this persistent pain/discomfort is not known, when it occurs, it can typically be treated with anti -inflammatory medications, such as ibuprofen. Additional surgical treatment is rarely necessary.
• Vasectomy Failure – vasectomy is considered a failure if any moving sperm are seen on semen analysis at six months after vasectomy, in which case repeat vasectomy is usually necessary. The risk of requiring a repeat vasectomy is less than 1%.
• Pregnancy After Vasectomy – vasectomy is not 100% reliable in preventing pregnancy even after post-vasectomy semen analysis confirms that your vas deferens are blocked. In very rare cases, the vas deferens may grow back together, which would allow you to have children again. The risk of pregnancy after vasectomy is approximately 1 in 2,000 for people whose post-vasectomy semen analysis shows no sperm, or rare non-moving sperm.
How to Prepare for the Procedure
• Two Days Before
- Please wash and then shave or closely trim the hair on the underside of your penis and front and sides of your scrotum. Ideally, this should be done two nights before your procedure, rather than the night before or day of surgery.
- Please avoid any alcohol for two days before and after the procedure.
• The Day of Your Vasectomy
- Please take a shower with normal soap and water on the day of your procedure.
- Please eat a normal breakfast or lunch before your procedure.
- Wear (or bring with you) a pair of tight-fitting underwear or an athletic supporter to wear after the procedure to support the scrotum and minimize swelling. Please do not wear boxer shorts, as they do not provide the necessary scrotal support.
- Wear comfortable loose-fitting pants or shorts over your supportive underwear.
- You are encouraged to bring and listen to any music/podcast or watch any video or play any games on your mobile device during the procedure.
Recovering at Home
• Stay off your feet as much as possible for the first two days.
• Avoid heavy lifting or strenuous exercise for seven days.
• You may return to work and resume normal, non-strenuous activity after about two days.
• Take acetaminophen (Tylenol) and ibuprofen (Advil or Motrin), “around the clock” for the first 2–3 days (see pain management below for specific details).
• You may shower after 24 hours, but avoid tub baths, hot tubs, and swimming pools for seven days.
• Wear snug athletic underwear, compression shorts, or a jockstrap/athletic supporter for at least the next three days. Remove it to shower after 24 hours, but then replace it afterwards.
• Apply a cold pack or bag of frozen peas on the area every 20 minutes to help reduce swelling, inflammation, and discomfort for the first 24 hours (see pain management below).
• You may resume having sex after seven days, if comfortable enough.
• You must continue using other forms of birth control until your post-vasectomy semen analysis at 12 weeks confirms the absence of sperm. Until the sperm count is zero or there are very few non-moving sperm, sex without another method of birth control may lead to pregnancy.
Pain Management
The best strategy for controlling your pain after vasectomy is around the clock pain control with acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). It is recommended that you alternate and stagger the timing of when you take each of these medications in order to maximize pain control.
• Take your medications by following this dosing schedule:
- Take acetaminophen 1000mg every eight hours (maximum 3000mg daily)
- Take ibuprofen 600mg every six hours with food (maximum 2400mg daily)
• Ice your scrotum on and off this schedule:
- Apply ice or a cold pack to the scrotum for 20 minutes, then remove for 20 minutes. Repeat all day on the day of your procedure. You can use the bag of frozen peas to mold to the area. Continue this until you go to sleep. Ice again the following day if needed.
• Elevate the scrotum the first day and night. This will aid healing and help to minimize swelling.
When to Call Your Doctor
• Severe pain that is not relieved by pain medication and use of ice packs
• Lots of bleeding or drainage from the skin puncture site
• Lots of swelling or redness
• Foul odor
• Fever over 101.5° Fahrenheit
Follow-Up
Following a vasectomy, you are not immediately sterile (having no sperm in your semen). You will need to use another form of contraception or birth control until it is confirmed that the vas deferens tubes are blocked and the procedure was a success. This confirmation is done by post-vasectomy semen analysis (PVSA). Success of this procedure is confirmed when the PVSA shows no sperm, or only rare non-moving sperm.
• You will need to drop off a semen sample to the Witham Main Laboratory in Lebanon 12 weeks after vasectomy for this PVSA (see below for lab location and contact information).
• The semen sample should be collected at home within one hour of drop off to the lab.
• Collection should be obtained by masturbation without the aid of lubricants.
• All specimens must be kept between 70°F to 100°F. This can be done by carrying container in a pocket or inside the shirt. Do not place the container in the refrigerator or freezer.
• Label your container with the date and time of collection.
• Even after the PVSA confirms that your vas deferens are blocked, vasectomy is not 100% reliable in preventing pregnancy. The risk of pregnancy after vasectomy is approximately 1 in 2,000 for people whose post-vasectomy semen analysis shows no sperm, or rare non-moving sperm.
Things to Think About
The choice to have a vasectomy is a very personal one. Talk with your partner, and think about what is best for you and your family. Below are some things to keep in mind:
• Vasectomy is safer and cheaper than tubal ligation (blocking the fallopian tubes to prevent pregnancy) in women.
• The one-time cost of a vasectomy may be cheaper over time than the cost of other birth control methods, such as condoms or the pill.
• A vasectomy does not protect against sexually transmitted diseases (STDs). Use condoms to protect against STDs.
Lastly, it is important to note vasectomy is a permanent method of birth control. This may be a plus or a minus based on your own situation. You should not have a vasectomy if you may want to father children in the future. Although it is possible to have a vasectomy reversed, the reversal procedure is much more complex and expensive. Also, reversing or “undoing” a vasectomy does not always result in pregnancy. Therefore, it is important to think through all your choices carefully before deciding to have a vasectomy.
Key Points to Remember
• Vasectomy is intended to be a permanent form of contraception.
• Vasectomy does not produce immediate sterility.
• Following vasectomy, another form of contraception is required until absence of sperm is confirmed by post-vasectomy semen analysis (PVSA).
• Even after absence of sperm is confirmed, vasectomy is not 100% reliable in preventing pregnancy.
• The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have a negative PVSA.
• Repeat vasectomy is necessary in less than 1% of vasectomies.
• Patients should refrain from ejaculation for approximately one week after vasectomy.
• Options for fertility after vasectomy include vasectomy reversal and sperm retrieval with in vitro fertilization. These options are not always successful, and they may be expensive.
• The rates of surgical complications such as symptomatic hematoma and infection are approximately 1–2%; however, these rates vary with the surgeon’s experience and the technique used to perform the procedure.
• Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1–2% of men. However, very few of these men require additional surgery.
• Other permanent and non-permanent alternatives to vasectomy are available.