A vasectomy is a form of permanent birth control for men. It is a simple surgery that involves cutting the tubes which transport sperm. To decide if this procedure is right for you, it's important to understand the process, effectiveness, and risks.
How Vasectomy Is Done
Sperm are made in a man's testicles. The sperm travel to the man's penis through tubes called vas deferens. The sperm mix with other fluids to become semen, which is released when a man ejaculates. This procedure stops sperm from becoming part of the semen. If there are no sperm in a man's semen, he cannot get a woman pregnant. The procedure does not affect a man's ability to ejaculate or to have sex.
Day of the Procedure
A vasectomy surgery must be done by a doctor and may be done in the doctor's office or in a special surgical center. The surgery itself takes only a few minutes. The entire experience will last a few hours, including preparation time and rest or observation afterward. Usually, the man can go home the same day.
Recovery Time
It takes a week or two to heal completely after the surgery. The scrotum may look and feel bruised at first. It may appear swollen and feel tender. Many men will want to take a day or two off from work after the procedure. Men who do heavy lifting at work may need more time off. Once healing is complete, there may be a small scar from the incision.
Types of Vasectomies
Today, there are several different methods doctors can use to perform a vasectomy. It's helpful to understand the options before you undergo this procedure.
Surgery with an Incision
To do the procedure, the doctor injects a numbing medicine into the man's scrotum. Then, the surgeon makes a small cut on one side of the scrotum and pulls out part of one vas deferens tube. The doctor cuts the tube and seals the ends; some physicians cut a small section out of the tube to try to prevent the tube from growing back together. The same procedure is repeated on the other side. The incisions are closed with stitches. Some doctors prefer to reach both tubes through a single incision in the front of the scrotum.
No-Incision Methods
Many doctors use a newer way which does not require stitches. Instead of making incisions, the doctor makes one small puncture to get at both tubes. The tubes are then cut, tied, or cauterized with heat. The puncture is small enough to heal without stitches. This method is often called a "no-scalpel" vasectomy; the risk of infection or bleeding is lower with this method of surgery.
Clip Implant Procedures
Some surgeons use small clip-like devices to close off the vas deferens during a vasectomy. The tubes are not burned, tied, or cut. This procedure may be associated with fewer complications and less healing time. If necessary, a vasectomy procedure using a clip can be reversed as well. One of these devices, Pro-Vas, is available for use now. Another version that was available is called the Vasclip; this brand is not available currently because of the high failure rate.
Other Procedures
There are studies looking at other ways to perform vasectomies. Small devices that are injected or inserted into the vas deferens to block the flow of sperm are being evaluated, but more information about the safety and efficacy of these devices is needed before their use becomes widespread.
Risks and Side Effects
Vasectomy is a very safe procedure. Complications do not happen very often, but these are the most common ones:
- Swelling
- Bruising of the scrotum
- Blood clot formation in the scrotum
- Blood in semen
- Infection
A less common side is pain that may be caused by sperm leaking out around the place where the tubes were cut; the sperm can irritate the surrounding tissue. Rest and anti-inflammatory medicine usually helps. Any infection after surgery can be treated with antibiotics.
In the past, doctors thought that vasectomy might increase a man's risk of heart disease and prostate cancer. Newer studies have not shown any increased risk. This procedure also should not affect sexual performance.
Effectiveness
After the surgery, the man will need to return to the doctor's office a month or two for tests to make sure the procedure worked. For two months after the tubes are cut, semen can still contain sperm that were left in the tubes. Therefore, it's important to use another form of birth control until tests show that there are no sperm in the semen.
This procedure is one of the most effective methods of birth control. Occasionally the vas deferens tubes will heal in a way that lets sperm get through, but this is not common. In general, only about one to three in 1,000 couples will become pregnant after a vasectomy.
Vasectomy does not protect against any sexually transmitted diseases.
Vasectomy Reversal
Sometimes, a man who has had a vasectomy will change his mind and decide he wants to have a child. A reversal is a much more complicated surgery than the procedure itself, and reversal is not always successful. This procedure is typically performed in an outpatient surgical center with the patient under general anesthesia. The surgeon usually has to use a surgical microscope to reattach the ends of the vas deferens. Reversal can cost thousands of dollars and is usually not covered by insurance.
Recovery After Reversal
The recovery period should be relatively painless; most men are back to light work within a week. But for manual or physical labor, it may take longer before the man can return to work. The physician will perform sperm analyses periodically after the procedure to assess the sperm count until a pregnancy occurs. This could happen in a few months, but it could also take years.
The reversal procedure is associated with few complications; risks include bleeding or infection. You should discuss what type of pain medications you might need afterwards, since some doctors caution against aspirin use because of the risk of increased bleeding.
Odds of Successful Reversal
The age of the man should not affect the success of the reversal. The amount of time that has passed since the original vasectomy plays more of a role in a man's chances of having the procedure reversed successfully. If it has been less than three years since the original surgery, the chance is about 75% that he will be able to get a woman pregnant. However, if it has been more than 15 years, the chance falls to only 30%. If a couple is interested in a vasectomy reversal, they should start the investigation as soon as possible to increase their odds.
If there is a question about the fertility of the woman, she should undergo a fertility work up to be sure that she is still ovulating prior to the man undergoing a vasectomy reversal. It could be important to make sure that the woman is still able to get pregnant if age or fertility is a factor.
Talk to Your Physician
A vasectomy is a safe and effective method of birth control. It is reversible in many cases, but you should discuss the pros and cons of this decision with your significant other and your physician. If you do decide upon a reversal at a later date, investigate to find the surgeon with the best results in your area.
