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Vasectomy

 
Vasectomy is a common surgical procedure used to make a man sterile (i.e. 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.

What is a vasectomy?

A vasectomy is a surgical sterilization procedure in which the tubes that carry sperm cells from the testicles to the penis (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. The sperm produced in the testicles die and 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 at least 99% effective in preventing pregnancy. 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.

 

Vascectomy 1

Diagram courtesy of EngenderHealth

 

A vasectomy is performed by a general surgeon, urologist, or general practitioner. It is usually performed under a local anaesthetic. A light sedative may also be given. Some men choose to have the procedure performed under a general anaesthetic. 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.

Men who have thick scrotal skin, have had previous operations for groin hernia or torsion (twisting) of the testicle, or have abnormalities like hydrocoeles or varicocoeles 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.  

No-scalpel vasectomy

The no-scalpel technique avoids the need for surgical incisions in the scrotum that require stitches It has been widely used in New Zealand for many years.

During a no-scalpel vasectomy the doctor locates the vas deferens by feeling them beneath the skin of the scrotum and holds them in place with small clamps. A single small puncture is then made in the mid-line of the scrotum, just below the penis, using a special surgical instrument. The same surgical instrument holds the puncture hole open while a loop of one vas deferens is lifted out and a section of 1–2 cm is removed. The cut ends are then folded over and sealed using heat, 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.

Traditional vasectomy

This technique involves making either one or two small incisions in the scrotum near the base of the penis. The vas deferens are located and a loop lifted out through the incision(s). The vas deferens are cut and a 1–2cm section removed. 

After being sealed, the vas deferens are returned to the scrotum and the incision(s) in the scrotum are closed with fine stitches.

Recovery

Some bruising and tenderness is to be expected following a vasectomy. 

Guidelines for recovery generally include: 

  • Resting and restricting activity for two to three days following the procedure
  • Wearing two pairs of supportive underpants or an athletic supporter during the day, and one pair of underpants 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. However, 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 16–20 ejaculations.

Complications

Complications following vasectomy are uncommon.

As with any surgical procedure there is a risk of infection and bleeding. If infection occurs – causing 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. 

Vasectomy reversal

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. Success also depends on the experience and training of the surgeon as vasectomy reversal is a more difficult procedure than a vasectomy. It is estimated that 50% of all reversals will result in pregnancy.

Vasectomy reversal is also known as vasovasostomy. It involves re-joining both ends of the vas deferens after the blocked and scarred portions have been removed. This operation takes approximately two hours and requires microsurgery.

References

Family Planning Association (year not stated). Vasectomy (Web Page) Wellington: Family Planning Association. https://www.familyplanning.org.nz/advice/contraception/vasectomy [Accessed: 08/06/20]
Mayo Clinic (2019). Vasectomy (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/tests-procedures/vasectomy/home/ovc-20177726 [Accessed: 08/06/20] 
Mayo Clinic (2019). Vasectomy reversal (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/tests-procedures/vasectomy-reversal/home/ovc-20169496 [Accessed: 08/06/20] 
Sharlip, I.D.; Belker, A.M.; Honig, S.; Labrecque, M.; Marmar, J.L., Ross, L/S., Sandlow, J.I.; Sokai, D.C. (2015). Vasectomy: AUA guideline (Web Page). Linthicum, MD: American Urology Association. http://www.auanet.org/guidelines/vasectomy-(2012-amended-2015) [Accessed: 08/06/20]

 

Last Reviewed – June 2020

 
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