Vasectomy

A vasectomy is a simple and safe minor procedure that severs and ties the ends of the vasa deferentia, the tubes through which sperm passes into the ejaculate. A vasectomy prevents the flow of sperm out of the testicles, but it doesn’t reduce a man’s testosterone level or affect his sex life. He will have a normal erection and ejaculation response. Further, a vasectomy has no effect on a man’s overall health.

There are two vasectomy procedure choices, the traditional vasectomy and the no-scalpel vasectomy. Both take about 20 to 30 minutes to complete.

A newer procedure, the Implantable Vas Deferens Ligation Clip (vasclip), has been successful but is still considered investigational and may not be covered by insurance.

Vasectomy may be reversible with an outpatient procedure called vasovasostomy, which reconnects the vas deferentia. However, the possibility of reversal should never be assumed.

PRE-PROCEDURE GUIDELINES

Before a vasectomy, the physician counsels the patient and his partner regarding their desire not to have children. The physician will examine the scrotum and the testicles for any signs of abnormalities and make sure that each vas is readily felt.

For the reversal procedure, if the testicles are normal in size, no additional tests are required. The physician may perform or request additional hormone studies and/or a biopsy before considering reversal if the testicles are small or have been exposed to treatments that may affect fertility.

The physician instructs the patient to stop taking aspirin up to 10 days prior to a vasectomy or vasovasostomy to prevent excessive bleeding. Also, the patient should wash the genital and scrotal area thoroughly before the procedure and bring an athletic supporter to wear home after the procedure. The physician may instruct the patient to shave the scrotal area before the procedure, or it may be shaved for the patient just prior to the procedure.

WHAT TO EXPECT

Traditional Vasectomy. The patient is given a local anesthetic to the scrotal area. The surgeon will make 1 to 2 small incisions on either side of the scrotum and pull the vasa deferentia through these incisions. The vasa deferentia are severed and either tied or cauterized then secured with a suture or surgical clamp.

No-scalpel vasectomy. The surgeon feels for the vasa deferentia tubes under the skin of the scrotum and holds them in place with a clamp. A tiny hole is made in the skin. The hole is stretched to allow the surgeon to pull out tubes, which are cut and either tied or cauterized.

Both procedures are safe and effective and recovery time is similar for both.

Vasovasostomy. In a vasovasostomy, the surgeon reconnects the cut ends of the vasa deferentia by making a small incision in the scrotum directly over the area where the vasectomy was performed. The physician exposes the vas deferens through the incision and places clamps above and below the site where the vas deferens was separated. The physician trims small parts above and below the original cut and sutures the ends together. The procedure can take 2 to 4 hours and requires general anesthesia.

POST-PROCEDURE GUIDELINES

For both procedures, the patient should arrange for someone to drive him home.

Vasectomy. The patient will be instructed to place ice packs on his scrotum; over-the-counter pain medication is recommended for the pain. Most patients recover from the vasectomy operation in less than 1 week. During the week, the patient is instructed to:

• • Stay off his feet as much as possible;

• • Avoid strenuous exercise and sexual intercourse;

• • Wait 2 days before showering;

• • Avoid tub baths for approximately 1 week; and

• • Wear tight-fitting shorts or an athletic supporter to protect the scrotal area.

The physician will instruct the patient to use some form of birth control for approximately 12 to 16 weeks after recovery. The patient must have his ejaculate tested for sperm at 6 weeks and again around 3 months after the procedure.

Vasovasostomy. When the patient leaves the clinic, the physician will pack a scrotal support with cotton gauze and instruct the patient to wear the support at all times, except when showering, for up to 6 weeks. In some cases, the physician may recommend that the scrotal support be worn while the patient is upright until the patient’s partner has become pregnant. Following a vasectomy reversal, the physician will instruct the patient to:

• • Stay home from work for at least 3 days;

• • Avoid strenuous exercise, lifting heavy objects, and athletic activities for 3 weeks; and

• • Avoid sexual intercourse or ejaculation for 1 month.

POSSIBLE SIDE EFFECTS AND COMPLICATIONS

Vasectomy. One possible side effect of vasectomy is epididymitis. Complications are rare; however, if they occur, they may include:

• • Impregnating partner;

• • Infection;

• • Sperm granuloma (a lump where the tubes were tied);

• • Congestion, or sperm build-up;

• • Sperm antibodies;

• • Testicular discomfort; and

• • Natural reconnection of the vasa deferentia.

Vasovasostomy. Complications are rare; however, if they occur, they may include:

• • Sperm antibodies;

• • Testicular discomfort;

• • Bleeding and bruising; and

• • Testicular shrinking.

In some cases, the reversal may not be successful, and the man may require additional surgery.