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
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.
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.
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
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
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.
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.
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