A. A vasectomy is one of the most commonly performed surgical procedures. Vasectomy is considered a permanent method of contraception. Although a vasectomy is considered nearly 100% effective, no method of birth control can be considered completely effective.

Q. How effective is a vasectomy?

A. During a vasectomy, a small portion of the vas deferens (the tube that carries sperm from the testicle to the outside world) is removed and the ends of the vas are sealed
[see diagram].

Q. How long does the procedure take and how painful is it?

A. On average, a vasectomy takes approximately 15 - 20 minutes to perform. In most cases, the procedure is performed with local anesthesia although in certain cases a mild sedative may be administered. During the procedure, a small incision (approximately ¼ inch long) is made directly over the vas deferens. The vas is then isolated and a small segment (approximately ½ - 1 inch) is removed. The ends of the vas are then sealed with permanent sutures and/or surgical clips. Many surgeons also cauterize the ends. The vas is then returned to the scrotum and the small incisions are allowed to heal or closed with 1 or 2 stitches.

Most patients are sent home with a mild pain reliever although in most cases nothing stronger than Tylenol ® or ibuprofen is required. It is recommended that the patient place an ice pack on the scrotum for 24 - 36 hours in order to minimize swelling and discomfort. A scrotal support (jock strap) is also recommended for 1 week. Non-strenuous activity can be resumed approximately 24 - 36 hours after the procedure. Normal activity and exercise can be started 1 week after the vasectomy. It is also suggested that sexual intercourse be delayed for 1 week following the procedure.

Q. What is a "no-scalpel vasectomy"?

A. A no-scalpel vasectomy is a technique for performing a vasectomy which avoids the use of a scalpel. Instead, a small puncture is made in the scrotal skin and the "incision" is made by spreading the skin rather than cutting the skin. Since the blood vessels under the skin are "pushed" apart rather than cut, the risks of bleeding are minimized. Also, specially developed instruments allow the surgeon to utilize a smaller incision which ultimately results in less pain after the procedure. All surgeons at Abington Urological Specialists utilize the no-scalpel vasectomy technique.

Q. What are the risks of a vasectomy?

A. Although the risks are considered small, any invasive procedure does carry with it a certain degree of risk. Risks of the procedure include the small chance that a blood vessel under the skin may bleed and cause bleeding into the scrotum - this is called a scrotal hematoma. Significant bleeding occurs in less than 0.5% of cases. The small skin punctures or incisions may become infected which may require treatment with antibiotics and local wound care. As already noted, the vasectomy may fail (in less than 0.1 % of cases) which may ultimately lead to a pregnancy. Other risks include a small risk of chronic testicular discomfort which is usually treated with mild pain relievers.

In the past, there have been articles published indicating an association between vasectomy and other medical conditions such as prostate cancer and cardiovascular disease. Although some of these studies have shown an association between vasectomy and medical conditions, none of these studies have shown that a vasectomy actually causes any of these conditions. In fact, a recent review in the journal Fertility and Sterility (August 1998) stated that there is insufficient data to show any causative relationship between vasectomy and prostate cancer. A vasectomy is considered one of the safest and most effective methods of birth control with minimal risks and side effects.

Q. How soon can I begin unprotected intercourse?

A. Immediately following a vasectomy, a man is not considered sterile! Although sperm can no longer exit the testicles, sperm may remain in other parts of the reproductive system - especially the seminal vesicles. Thus, it takes a minimum of 4 weeks and 15 - 20 ejaculations before sperm are no longer seen in the ejaculate. Thus, a man can not be advised to have unprotected intercourse until a post-vasectomy semen analysis reveals no sperm. Every man who undergoes a vasectomy must have a post-vasectomy semen analysis. If sperm are still noted in the semen after 3 months, a semen analysis is usually repeated 1 month later. In very rare cases, if sperm persist in the ejaculate, the vasectomy may need to be repeated. It is extremely important that the couple use an alternate form of birth control until the semen analysis reveals no sperm.

Q. Is a vasectomy reversible?

Although there are surgical procedures to reverse vasectomies, these are not universally successful. Vasectomy is considered a permanent form of birth control which is intended to make a man permanently sterile. A vasectomy should not be performed with the concept that "it can always be reversed later". For more information on vasectomy reversal, see link to "Vasectomy Reversal".

Q. Can anything be done to safeguard my future fertility prior to a vasectomy?

A. Although a vasectomy is not considered reversible, patients may be offered the ability the preserve a semen sample in a sperm bank. Life circumstances do change and on rare occasions children are lost to disease or accidents. Although a man undergoing vasectomy may never anticipate utilizing a frozen semen sample, the chance to place a semen sample in a sperm bank may offer the patient "piece of mind". Semen samples may be cryopreserved for a nominal fee through the Toll Center for Reproductive Sciences based at Abington Memorial Hospital.

Related Links

• http://www.noscalpelvasectomy.com
• http://www.avsc.org/contraception/cnsv.html