Vasectomy is the most popular form of permanent birth control for men, performed through a tiny puncture site in the wall of the scrotal sac. About 500,000 men in the US choose vasectomy every year. A 0.5 to 1 inch segment of each vas is removed, and the ends are clipped, tied, or cauterized. A simple gauze dressing is place over this site, and an athletic supporter or jockey underwear will keep the dressing in place for a few days. The procedure takes about 15-20 minutes and requires only a local anesthetic. It is  sometimes performed in the doctor's office or as ambulatory surgery. Vasectomy is nearly 100 percent effective. It is safe, it is intended to be permanent, and it doesn't limit sexual pleasure. It is a simple operation and makes men sterile by keeping sperm out of the fluid that spurts from the penis during sex.

What should I expect after the procedure?

The main post-operative risk is with bleeding in the first 6-12 hours, so you should plan on a quiet afternoon and evening at home with your feet up in the recliner. Sometimes an ice pack will limit the swelling. By the next morning, you should be able to get around without difficulty, avoiding heavy lifting or bike riding. Within 2-3 days, you will be able to return to work. Any bruising on the skin should disappear within 5-7 days. Pain is minimal. You might notice a pulling or dragging sensation in the groin area for a few days. A mild pain medication might be helpful at bedtime the first couple of days.

What are the risks associated with vasectomy?

The risks of vasectomy include bleeding/bruising, infection, sperm granuloma (inflammatory reaction to sperm), nodule formation (common, usually non-tender), chronic pain from epididymal congestion and sperm granuloma (rare), and increased risk of kidney stones. Some research has shown an increase in atherosclerosis (hardening of the blood vessels) in monkeys that have had vasectomy, but there is no evidence of increased heart-related problems in humans. Also, some men have expressed concerns about prostate cancer after vasectomy, but research on men with vasectomies shows no increased risk or no proven association between vasectomy and prostate cancer. However, all men between 50 and 70 years old should be screened for prostate cancer every year, whether or not they have had a vasectomy. 

What is the Vasclip procedure?

A newer technique for male sterilzation is the Vasclip (http://www.vasclip.com), which uses a non-absorbable plastic clip around each vas.  The vas is not cut and no segment of the vas is removed.  This is quicker than the standard vasectomy, causes less tissue reaction, thus less bleeding and swelling risk.  However, as it is a newer device, some insurance companies might not cover this.

How do I know when I am safe to eliminate birth control?

Patients will need to continue to use birth control during intercourse until the doctor tests their semen to prove that no more sperm are present. To confirm the success of the vasectomy, doctors check sperm count in 10-12 weeks after the procedure. Once two consecutive sperm counts show no sperm, the patient is considered sterile. Very rarely, tubes grow back together again, and pregnancy may occur. This happens in one out of 1,000 cases in the first year. There is also an extremely small chance of reconnection of the vas called recanalization, occurring years after the procedure. In this unusual situation, the tiny numbers of sperm are severely damaged and usually incapable of fertilizing.

What is the alternative to men having a vasectomy?

Tubal ligation in the woman would be the alternative option for a couple considering permanent birth control. In comparing vasectomy in men to tubal ligation in women, both procedures are effective. Both should be considered to be permanent, although both can be reversed with microsurgery. The major differences are that a vasectomy is a much simpler procedure,  usually performed right in the urologist's office using local anesthesia, while the tubal ligation requires general or spinal anesthesia and involves surgery with a laparoscope introduced into the abdomen through the belly button, thus posing a greater risk of injury to the bowel and other side effects.

What abount sperm banking, just in case?

While vasectomy is considered a permanent procedure, it can be reversed, but will be far more difficult and expensive than the original vasectomy procedure. Patients may want to consider sperm banking, just in case the decision or opportunity arises to father another child in the future. There are several companies providing this service. Patients are charged for the testing of the sperm for surviving the freezing-and-thawing process, and for storage with yearly fees.

How do I arrange for a vasectomy? 

If you are interested in vasectomy, ask your primary care physician for a referral to Urology for vasectomy consultation. At the office visit, you will be counseled on the procedure and risks, and given instructions on medications to avoid prior to the procedure. The vasectomy will then be scheduled for about 1-2 months later, in the office/ambulatory surgery.