Overcomes limitations of traditional and minimally invasive methods.
Male Sterilization (Vasectomy)
PURPOSE OF A VASECTOMY
The purpose of a vasectomy is to render a man sterile. This is considered permanent contraception and will make a man unable to father children. There are other forms of contraception, including condoms, birth control pills, diaphragms, spermacides, Norplant, Depo Provera, IUD’s and female tubal ligation. A vasectomy should be considered irreversible.
HOW VASECTOMY WORKS
Sperm is produced in the testicles which sit in the scrotum. The sperm are then transported by a tube called the vas deferens up into the groin area and then back to the prostate in the base of the penis. If the vas deferens tube is cut or blocked off, the flow of sperm from the testicle to the penis is stopped. The sperm account for approximately 2% of the volume of the semen ejaculated at orgasm. The majority of the semen is produced in the prostate gland. A vasectomy will not affect that volume significantly. The testicles produce the male hormone testosterone which will not be affected by a vasectomy. The upper part of the vas deferens and the prostate may still contain residual sperm after a vasectomy so it is important to ejaculate 15-18 times after the vasectomy to clear those areas of the sperm. Other forms of contraception will be needed until at least two negative semen samples for sperm are evaluated.
THE VASECTOMY PROCEDURE
A Vasectomy can be performed in the doctor’s office under local anesthetic. Prior to the procedure you need to read all of the information, understand it fully and sign the consent form. Both you and your spouse need to sign the consent form and bring it to the office with you. You must understand that it is usually successful, but it is not guaranteed to make you sterile. You also need to understand the possible risks and complications as listed below. You will need to stop any aspirin containing products for five days before the procedure. If you have any other health problems, specifically with your testicles, you need to alert the doctor and nurse prior to the procedure. Please feel free to ask any questions about the vasectomy before signing the consent form. The morning of your surgery, please shower, thoroughly cleanse your scrotum and shave the hair on the upper portion of the scrotum where it is attached to the penis. Please bring a clean pair of cotton briefs to the doctor’s office to wear home. You may eat a light meal before your surgery.
Usually the discomfort associated with the procedure is the local anesthetic that is injected into the skin. This discomfort will last between 5 – 10 seconds. You should then be completely numb for the remainder of the procedure. The procedure will take 20 – 30 minutes.
AFTER THE VASECTOMY
After the surgery we advise that you go home and assume a recumbent or lying position for the rest of the day. An ice pack can help with the discomfort and minimize swelling. Some swelling and bruising is expected, but signs of infection such as redness, fever or excessive swelling of the scrotum need to be brought to the doctor’s attention. You may shower the morning after the vasectomy, but no tub baths or Jacuzzis for two weeks. You should avoid heavy lifting or exercise for seven days. You will be given an antibiotic pill and a mild pain pill. Most of the pain should be resolved in 2 – 3 days. If your pain persists past five days, please call our office.
Sexual activity can be resumed in ten days, but remember that you must use another form of birth control until you have had two negative semen samples.
After the initial 10 days, it is important to have 15 – 18 ejaculations to clear the portion of the vas deferens past the site of blockage. You may bring in your first semen sample for a sperm count after 20 ejaculations. You will need to bring a second sample approximately 2-3 weeks after initial specimen to make sure it is clear of sperm. You must collect your semen sample at home in a small, sealed container, two sterile containers will be provided or you may use any clean container with a lid that seals. You must have your name, date of birth, date of procedure and doctor performing procedure labeled on the container. The specimen should not be more than 10 hours old. Please call ahead of time to make sure there is a physician available to analyze your specimen. We generally have a doctor here Monday thru Friday, 9am to 4:00 pm. After you drop off your specimen and the physician analyses it, we will call you if it is positive. If it is negative, you will receive a post card in the mail.
After you have had two negative semen samples in a row, 2-3 weeks apart, you no longer need another form of birth control. Having recanalization or sperm in the semen after two negative semen samples is extremely rare, but it is possible. You may check a semen sample at our office at any time after your two required checks. Keep in mind that a vasectomy does not protect you from sexually transmitted diseases.
If you change your mind about having children, a vasectomy can be reversed. This procedure, a vasovasostomy, is where the two ends of the vas deferens are sewn back together. This procedure requires a general anesthetic, is expensive and almost never covered by insurance. The success rates for successful pregnancy after a vaso are generally low so if you wish to store sperm in a sperm bank prior to your vasectomy, you will need to have that arranged.
POSSIBLE RISKS AND COMPLICATIONS
- Internal bleeding in scrotum. This usually occurs the night of surgery and would include excessive swelling and a large black and blue area in the scrotum. If the skin of your scrotum looks shiny or it loses all of the wrinkles, please call our office.
- Infection can occur at the site of the incision which is signified by fevers, chills, drainage or increased pain.
- Recanalization of the vas deferens can occur either early or late. This happens when one end of the vas deferens leaks sperm out between all of the obstructions and gets back into the other end of the vas deferens. This will be detected by your semen samples after surgery and is rare. It can happen even after two negative sperm samples, but this is very rare. It is important for you to return your semen samples to the office to make sure they are negative. This is the only way we can determine the success of the procedure. If sperm is found in the semen sample after an appropriate length of time and number of ejaculations, then we recommend that you have your vasectomy repeated in order to achieve sterilization. Initial failure rate is 1 in 1,000; late failure is 1 in 10,000.
- Pain in the testicles and scrotum is to be expected for 2 – 3 days. It may sometimes last as long as 2 – 3 weeks. You should notify your doctor if the pain lasts longer than 5 days or is not steadily improving. Usually this pain is caused by inflammation in the testicles after a vasectomy. Rarely chronic pain in the testicles can occur and may last several years. Other procedures such as vasectomy reversal may be needed, but this is very rare.
- Other health problems have been attributed to vasectomies, but there is no conclusive evidence. This includes a link to prostate cancer, although many studies have found this not to be true.