Vasectomy is a common, simple and safe surgical procedure used to make a man sterile (unable to get a woman pregnant).
Two techniques are commonly used in New Zealand – a traditional surgical method and a “no-scalpel” version. It is generally accepted that both are equally effective but that the no-scalpel method is increasingly popular due to greater patient comfort during and after the procedure.
Sperm are made in the testicles and are stored in a structure called the epididymis. During ejaculation sperm flow from the epididymis through two muscular tubes called the vas deferens to the prostate gland. Here the sperm mix with fluid produced by the prostate gland and the seminal vesicles to form semen.
A vasectomy is a surgical sterilization procedure in which the vas deferens are cut and sealed. Following vasectomy, sperm continue to be produced in the testicles, but are no longer contained in the semen. As the sperm produced in the testicles die, they are reabsorbed by the body.
Vasectomy is regarded as a simple, safe and effective form of male sterilization and is intended to be permanent (although a vasectomy reversal
procedure is available). It is estimated that vasectomy is between 99% and 99.6% effective. Vasectomy can fail if a canal develops between the two ends of the vas deferens through which the sperm can travel (recanalisation). This occurs in less than 1% of cases.
Diagram courtesy of EngenderHealth
A vasectomy is performed by a general surgeon, urologist or general practitioner. It is usually performed under a local anaesthetic (administered by injection or by a high speed spray technique often referred to as "no needle" anaesthesia). A light sedative may also be given. Some men choose to have the procedure performed under a general anaesthetic so that they are not awake during the procedure. This will likely require referral to a hospital and add to the cost.
There are two main surgical techniques for performing a vasectomy - the traditional vasectomy and the no-scalpel vasectomy. The type of surgical technique used will depend on the patient's medical history and the preference of the patient and the doctor. Men who have thick scrotal skin, or have had previous operations for groin hernias or torsion (twisting) of the testicle, or have abnormalities like hydrocoeles
may not be suitable for the no-scalpel technique.
Both vasectomy techniques are performed in either a doctor’s surgery or a day-stay clinic and take approximately 30-45 minutes. The no-scalpel technique has been shown to produce less bleeding and discomfort, and has a lower risk of complications than the traditional technique. The cost of the procedure is likely to be between $300 and $500.
In preparation for vasectomy the scrotum must be shaved and cleaned with an antiseptic solution. During the vasectomy the man will be lying on a surgical table and the area around the penis and scrotum will be draped with sterile surgical guards in order to keep the area clean.
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The no-scalpel technique avoids the need for incisions in the scrotum that require stitches It has been widely used in New Zealand for a number of years.
During a no-scalpel vasectomy the doctor locates the vas deferens by feeling them beneath the skin of the scrotum. Once located, both vas deferens are held in place with small clamps.
Using a special surgical instrument, a single small puncture is then made in the midline of the scrotum, just below the penis. The same surgical instrument holds the puncture hole open while a loop of vas deferens is lifted out. The vas deferens is cut and a 1-2cm section removed. The ends of the vas deferens are then folded over and cauterised, or sealed with special clips or stitches. The vas deferens is then returned to the scrotum through the puncture hole and the other vas deferens is brought out through the same puncture hole and the procedure is repeated. After the procedure the puncture wound contracts to about 2mm in length, is not visible to the man and does not require stitches or a dressing.
This technique involves making either one or two small incisions in the scrotum near the base of the penis. One at a time, the vas deferens are located and a loop carefully lifted out through an incision. The vas deferens are cut and a 1-2cm section removed. The ends of the vas deferens are then folded over and are sealed with special clips or stitches. In some cases the ends of the vas deferens may be cauterised (sealed using heat). Once both vas deferens have been cut and tied, they are returned to the scrotum and the incision(s) in the scrotum are closed with fine stitches. A small dressing may be used to cover the incision(s).
Some bruising and tenderness is to be expected following a vasectomy. After the procedure the doctor will give detailed recovery instructions and it is important to follow these carefully. Guidelines generally include:
- Resting and restricting activity for two to three days following the procedure.
- Wearing two pairs of supportive underpants during the day and one pair at night to give good support to the healing scrotum.
- Taking pain relief such as paracetamol for any discomfort
- Applying ice packs to the area to help decrease pain and swelling.
Most men can return to light work two days after the procedure. It is usually recommended that heavy lifting or vigorous exercise be avoided for at least a week.
Sexual activity can be resumed 2-3 days following the surgery, or when it is comfortable to do so. Until the success of the operation has been confirmed, another form of contraception must be used. The success of the operation is confirmed when two successive semen samples are shown to be free of sperm. These laboratory tests are usually undertaken 2-3 months after the vasectomy, or after 16 to 20 ejaculations.
Side effects, complications
Complications following vasectomy are uncommon. If any complications are suspected, medical advice should be sought.
As with any surgical procedure there is a risk of infection and bleeding. If infection occurs (pain, redness, swelling) antibiotics may need to be given. Any bleeding from the incision site is usually minimal and resolves quickly.
Blood that pools within the tissues is known as a haematoma. A haematoma in the scrotum can cause the area to be bruised, swollen and painful. The haematoma should resolve over several days as the blood is absorbed by the body. Other complications that can occur as a result of a vasectomy include:
Granuloma - where scar tissue forms between the two cut ends of the vas deferens. It feels like a small lump the size of a pea and should resolve after a few months.
Testicular pain - some men experience an aching discomfort in the testicles after a vasectomy which usually resolves after a few days. However, in some cases the discomfort may last for some months or longer. The discomfort is thought to be due to congestion in the area where the sperm is stored.
In many cases it is possible for a vasectomy to be reversed. However, the success of the reversal depends on the age of the man and the time since the vasectomy. The chances of a successful pregnancy are improved if the man is young and the interval between operations is less than 10 years. It is estimated that 50% of all reversals will result in pregnancy.
Reversal involves rejoining both ends of the vas deferens after the blocked and scarred portions have been removed. This operation takes approximately two hours and requires microsurgery.
Barstow, D. G. (2006) Vasectomy. The Gale Encyclopedia of Medicine. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thomson Gale.
Family Planning Association (2012) Vasectomy (PDF) Wellington: Family Planning Association
Sharlip, I.D.; Belker, A.M.; Honig, S.; Labrecque, M.; Marmar, J.L., Ross, L/S., Sandlow, J.I.; Sokai, D.C. (2012) Vasectomy: AUA guideline (PDF). Journal of Urology 188(6 Suppl.): 2482-91 http://www.auanet.org/content/media/vasectomy.pdf
Last Reviewed – 29 April 2013
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