Vasectomy

Vasectomy is a minor surgical procedure used to provide birth control in men by disrupting each vas, thereby preventing sperm from being ejaculated.

Alternatively, contraception may be practiced through abstinence, a condom, the pill, an IUD, diaphragms, spermicides or a sponge.

The benefits of vasectomy are that it is simple, safe and effective. Normally, there are no effects on intercourse or orgasm or the amount of ejaculate, nor are there any known untoward long-term effects on any other organ. The vasectomy can be reversed, but fertility after the reversal cannot be assured should the patient have a change of heart.

Procedure

The procedure involves a scrotal shave on the operating table and a local anesthetic and/or sedation. The procedure usually takes 15-20 minutes and is often done in an outpatient surgical setting. Commonly a small scrotal incision is made on either side after instillation of the local anesthetic. This local anesthetic may induce a little burning. The vas is exposed and a portion taken, the ends are tied and cauterized, and the small scrotal wound is closed. After the procedure is performed on the other side, the patient may return home and avoid strenuous exercise or lifting for about 72 hours. Sexual activity can be resumed at any time. However, it is important to realize that sterility will not be achieved until several weeks after the operation.

Side Effects

Rarely, patients may develop some minor bleeding, an infection or some discomfort. However, routine antibiotics and pain medication are usually not necessary. Similarly, various dressings and scrotal supports are also unnecessary.

Rarely, a patient may develop scrotal discomfort at some time after a vasectomy because of epididymal congestion or a sperm granuloma, but these are uncommon. The sperm granuloma, if severe, can be treated by excision; and the epididymal congestion, if all forms of conservative treatment fail, may necessitate a vas reversal.

Follow-up

Follow-up is mandatory after vasectomy, as sterility usually takes several weeks. Although rare, the procedure can sometimes fail and result in fertility and possibly pregnancy once more, necessitating a repeat vasectomy. Because of this very rare ability for spontaneous recanalization of the vas (and if it occurs it does so within the first few weeks after vasectomy) we routinely wait three months for the man to have his semen analyzed and if clear contraception and further follow up is unnecessary.

NON-INCISION, OR NON-SCALPEL/SCALPEL-FREE, VASECTOMY

This procedure is very similar to the routine vasectomy described above; but instead of the skin being opened with a small incision, it is punctured and then the scrotal skin is stretched open to make the incision and expose the vas. This procedure can be done through one small midline approach or one on either side, depending upon the scrotal anatomy of the patient.

Long-Term Complications of Vasectomy

There are no known long-term complications after vasectomy. In particular, concerns regarding prostate cancer and coronary artery disease appear to be unfounded.

About 3/4 of men who have undergone vasectomy will show sperm antibodies, but these have not been shown to be problematic, nor do they seem to compromise the success rate of a vas reversal, should that be undertaken at a later date.