Vasectomy

Vasectomy is the most popular form of permanent birth control for men, and about 500,000 men in the US choose vasectomy every year. At Emory we routinely perform the no-scalpel vasectomy (NSV), which is an innovative technique by which we can perform the entire procedure through a tiny puncture site in the scrotal skin. With the NSV, a tiny puncture hole is used and blood vessels are spread apart instead of cut (as is commonly done during a traditional vasectomy) obviating the need for a scalpel during this procedure. The no-scalpel vasectomy has been shown to have lower rates of bleeding (hematoma), lower rates of infection, and lower level of pain during the procedure when compared to a traditional vasectomy.

The procedure takes about half an hour and requires only a local anesthetic. It can be performed in a doctor's office as well as an ambulatory surgery center. Vasectomy is nearly 100 percent effective. It is a safe and simple operation that makes men sterile by keeping sperm out of the semen. It is intended to be permanent, and it doesn't limit sexual pleasure. After a vasectomy sexual intercourse will be exactly the same with the only difference being that if one were to microscopically examine a man’s ejaculate, one would not see sperm cells. In all other aspects, a man’s ejaculate will remain the same.

In addition to the NSV, we also offer a no-needle, no-scalpel vasectomy (NNNSV). The NNNSV uses a high pressure jet injector to anesthetize the area without the use of a needle. This allows the surgeon to do the procedure without the need for a conventional vasal block with local anesthetic, which often is the most anxiety provoking portion of the procedure.

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. You will be given a prescription for pain medication on the day of your procedure. An ice pack applied to the scrotum will help limit the swelling in the first 24-48 hours. By the next morning, you should be able to get around without difficulty, but avoiding heavy exercise, lifting or bike riding for one week. Within 2-3 days, you will be able to return to work. Any bruising on the skin should disappear within 5-7 days. Pain at the entry site is usually minimal. You might, however, notice a pulling or dragging sensation in the groin area for up to 2-3 weeks, though some men feel hardly anything at all. Tight underwear of a scrotal supporter (“jock strap”) will help ease this sensation of “heaviness” in the scrotum. You should abstain from ejaculation for 2 weeks after the procedure.

What are the risks associated with vasectomy?

The risks of vasectomy include bleeding/bruising, infection, sperm granuloma (inflammatory reaction to sperm), and chronic pain (post-vasectomy pain syndrome). No surgical procedure is perfect and vasectomy is no exception. There is a small chance of either early failure (1 chance out of 500) or late failure (1 chance out of 1000), meaning that sperm returns to the ejaculate after the count has gone to zero. Vasectomies sometimes can fail because of a process called “recanalization” where a tiny microscopic connection is formed between the two cut ends of the vas. This can result in return of sperm to ejaculate, but what number of sperm and whether the sperm move (are “motile”) is highly variable. Usually, the numbers are extremely low and they look damaged. The chance of pregnancy with this low level of sperm is exceedingly low, below 1%. Otherwise, vasectomy has little consequence for a man’s long-term health.

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

Patients will need to continue to use birth control during intercourse until their doctor tests their semen to prove that no more sperm are present. To confirm the success of the vasectomy, doctors check sperm count sometime 8-12 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, use of oral contraceptive pills, an intrauterine device, and condoms would be the alternative option for a couple considering a vasectomy. 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. 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 about 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 and it is often not covered by insurance plans. Patients may also consider sperm banking (“freezing sperm”), 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, blood tests necessaryfor sperm storage, and for storage yearly fees.

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