Vasectomy

Overview  

A Vasectomy is a minor surgical procedure to cut and close off the tubes (vas deferens) that deliver sperm from the testes; it is usually performed as a means of contraception. The procedure typically takes about 30 minutes and usually causes few complications and no change in sexual function. About 500,000 vasectomies are performed annually in the United States. A vasectomy is less invasive than a tubal ligation (i.e., the procedure used to prevent a woman’s eggs from reaching the uterus) and more easily reversed. An increasing number of couples choose it as a means of permanent birth control.

Male Reproductive System

 
To understand a vasectomy, it is helpful to understand the male reproductive system and how it functions. The testicles, or testes, are the sperm- and testosterone-producing organs. They are located in a sac at the base of the penis called the scrotum. Each testicle is connected to a small, coiled tube called the epididymis, where sperm are stored for as long as 6 weeks while they mature. The epididymes are connected to the prostate gland by a pair of tubes called the vas deferens. The vas deferens are part of a larger bundle of tissue, blood vessels, nerves, and lymphatic channels called the spermatic cord. During ejaculation, or when you cum, seminal fluid produced by the prostate gland mixes with sperm from the testes to form semen, which is ejaculated from the penis.

Preparation

Preparations that are required prior to undergoing your vasectomy include the following:

  1. Wash the scrotum to help prevent infection using an antibacterial soap. We will also ask you to clip the hair on the front of the scrotum so it does not get in the way of tying sutures.
     
  2. Avoid taking aspirin for two weeks before the procedure as aspirin can "thin" the blood and can cause excessive bleeding.
     
  3. Take your muscle relaxant medication prior to the office visit and arrange for a ride to the office and home again as you will not be able to safely drive with this medication is your system.
     
  4. Bring an athletic supporter to wear home to help support the scrotum and minimize swelling.

See Full Pre-Operative Instruction sheet

No Scalpel Vasectomy Procedure

Dr. Rohde performs no scalpel vasectomies on an outpatient basis in the comfort of his office. Dr. Rohde recommends the no-scalpel method because he finds it is safer as it minimizes the risk for bleeding and infection, and significantly reduces postoperative discomfort! As more encouraging studies are reported, more vasectomies are being performed by other doctors using the No Scalpel approach. In General the procedure takes about 30 minutes. The patient remains clothed from the waist up and lies on his back. The scrotum is first cleansed with a surgical cleanser and then the patient is draped with surgical drapes. The middle of the scrotum is then numbed with an injection of local anesthetic (lidocaine). Once the skin is numb further numbing medication is placed far up the vas deferens to provide anesthesia for the procedure.

A special surgical clamp developed in China specifically for the No Scalpel procedure is used to hold the vas deferens while a puncture opening (instead of a cut) is made in the scrotum with another specially designed tool, the dissector. This opening is about 1/4 of an inch in size. The dissector is then opened to stretch the skin, making a small opening through which the vas deferens is lifted out, cauterized, cut, sutured, and put back in place. Because the opening is so small and the scrotum is composed of layers of muscle, the opening almost closes completely on its own and does not require suturing. Tape strips are applied to hold the opening together.  The patient then places an athletic supporter (jock strap) with some gauze inside to provide support for the scrotum and then goes home immediately after the procedure.
 

The Vasclip® is an alternative method to occlude the vas deferens that does not involve cutting, cauterizing, or suturing the vas deferens. In this procedure, a small plastic device is clamped around the vas deferens to prevent sperm from entering the semen. Because the vas deferens is not cut or cauterized, Vasclip may result in a shorter recovery time and fewer complications (e.g., swelling, inflammation, infection) than traditional vasectomy. This procedure has not been shown to be more effective than traditional vasectomy, and in most cases, the device is not covered by insurance. Statistics on reversal are not yet available, and the procedure should be considered permanent.

Postoperative Care

Rest and limited mobility are required for 1 to 3 days following the procedure to reduce swelling and to allow the vas deferens to heal. Although it is not necessary to remain immobile, excessive motion, lifting, and excessive walking increases the chance for inflammation and bleeding in the scrotum. Moderate discomfort is normal for a week or more. Anti-inflammatory drugs and prescription painkillers may be used. Ice packs applied 15 minutes on and 15 minutes off for the first 5-6 hours after the operation can minimize swelling and discomfort. Strenuous exercise and lifting should be avoided for a 7 days afterward. The degree of discomfort should dictate activity, as overexertion can postpone healing and a return to normal routine. Because we want the vas deferens to scar shut completely we ask you to take a week off before returning to sexual activity.

See Full Post-Operative Instruction sheet

Sterility


Vasectomy does not result in immediate sterilization. Sperm may live for weeks in the vas deferens, between the sutured end and the ejaculatory ducts that lead to the penis. For most men, it takes about 20 ejaculations and before the ducts are free of sperm. This number of ejaculations may take weeks to months to accomplish depending on your level of sexual activity. Two semen samples are produced and collected for analysis 2 months and 4 months after the procedure. When the sperm count is zero, the man is sterile. Men who undergo no-scalpel vasectomy should use another form of birth control until semen analysis confirms sterility!

After sterility, semen is still ejaculated, but it lacks sperm. The testes continue to produce sperm, but sperm are prevented from reaching the prostate because they are blocked in the tied-off vas deferens, where they die and are absorbed into the body. Because semen is only about 5% sperm, there is no noticeable difference in the amount of semen ejaculated after vasectomy. The procedure does not affect testosterone production or libido.

Complications


Serious complications are rare. Up to 10% of men experience more pain, bleeding, or inflammation than others, and discomfort may persist longer than expected. This may be caused by a temporary buildup of pressure within the vas deferens. In rare cases, sperm is present in the semen for up to a year after surgery. This may be the result of poor sperm migration out of the vas deferens after surgery, or it may indicate that the severed ends of the vas deferens have reattached, a condition called recanalization. The solution to this problem is repeat vasectomy. Occasionally, a condition called sperm granuloma develops, in which residual sperm make their way out of the tied ends of the vas deferens, producing irritation and a small nodule. These usually heal in time, although surgical removal is occasionally required.

There is no evidence that vasectomy increases a man’s chance for prostate cancer. Nevertheless, as a precaution, the American Urological Association (AUA) recommends that men over 40 who had a vasectomy more than 20 years previously should have an annual test for prostate cancer. Annual exams are recommended for all men age 50 to 70.

Prostate Risk Information Sheet