What is a vasectomy?
A vasectomy is the disconnection of the vas deferens. This long tube carries sperm from each of the testicles to the seminal vesicles (organs which make semen or ejaculate fluid). Think of the vas deferens as the tunnel the swimmers take to get to the swimming pool. A vasectomy blocks the tunnel so that no swimmers ever reach the pool.
How is the procedure performed if there is no needle and no scalpel?
I use a needle-less device known as a Madajet used to inject Lidocaine (a numbing medicine) through the skin and into the vas deferens. Not only does the injection hurt less than a needle, but it uses a very small amount of medication and this allows the procedure to be performed more quickly.
Next I use a delicate instrument to create a < 5 mm hole in the skin of the scrotum. This technique decreases bleeding complications and allows the skin to heal without stitches.
Is the procedure completely painless?
No, not completely, though the vast majority of men report less pain than anticipated. Most commonly patients report a dull ache in the groin and testicles at different times during the procedure.
I really don’t want to feel pain or know what’s going on. Can you “knock me out?”
We do offer nitrous oxide via the ProNox system in our office. This is “laughing gas” like you’ve seen at the dentist’s office. Some men go completely asleep and others are still awake but less anxious. The medicine can have an amnesia effect (you forget what happened) even if you seem awake. Overall most men are happy they chose “the gas”. It is optional however and not covered by insurance ($99 fee).
How do you make sure the two ends of the tube don’t reconnect?
I use three techniques to ensure the vas deferens is disconnected for good:
- Cut the tube.
- Cauterize or burn the inside of the tube causing a blockage.
- Sew the two cut ends of the tube away from each other by placing your own tissue in between.
Do you leave anything permanent inside my body? Will I need stitches on my skin?
No. I do not use any metal clips or permanent stitches. Following the procedure the skin is held together with an instrument for two minutes to seal the incision.
Does the procedure really take less than 10 minutes?
The average time for me to perform the procedure is 6-7 minutes. Men with testicles that cling tightly to their body, have thick scrotal skin, or other anatomical variations may make a vasectomy more challenging. Expect to be in the office 30-45 minutes.
Is there anything I need to do prior to the procedure?
Please arrive at least 15 minutes prior to the procedure. It’s always a good idea to confirm with your insurance company and our billing department what your out-of-pocket expense will be for the procedure. Otherwise we ask that you shave your scrotum (the sac) to the best of your ability prior to the procedure. Trimming pubic hair can also be helpful. Lastly, please bring compression shorts or a jock-strap to wear home for the first week. Need a pair? Click here to purchase.
When can I resume physical activity?
No strenuous activity beyond walking for at least 3 days after the procedure. Some men decide to take it easy for up to 7 days after the procedure. Every body heals differently. Be smart and listen to your body for warning signs such as swelling of the scrotum and increased pain. And contact us with any questions or concerns.
When can my partner and I resume sexual activity?
You may resume sexual activity after 3 days however YOU MUST USE OTHER FORMS OF CONTRACEPTION UNTIL YOU HAVE A LEFT A SEMEN SAMPLE SHOWING NO SPERM.
How do I leave this “sample” and do I really need to do it?
YES YOU MUST. You will leave a semen sample with our lab after you have had a MINIMUM of 20 ejaculations AND it has been a MINIMUM of 8 weeks after the vasectomy. Once completed, a fresh (<30 minutes old) sample will be brought to our lab for analysis. If you live more than 30 minutes from our lab, we can help you to locate a lab closer to your home and/or provide a private room to leave a fresh sample.
Until you receive a call from our office with news of a negative sample, you must continue using contraception.
What are the risks of the vasectomy procedure?
The immediate risk, other than pain, is bleeding. Bleeding within the scrotum (a hematoma) usually presents with increasing pain, swelling and bruising. Luckily, this happens to only 1% of men. Should this occur please contact our office or the on-call physician immediately.
To minimize your risk of bleeding please limit your activity as directed above for at least 3 days. It is also important to notify a staff member if you or any family member have any bleeding disorders. Lastly, you want to make certain that you are not taking any medications with blood thinners. Click here for a list of common over-the-counter blood thinners. If you take a prescription blood thinner than you will need permission from your primary care doctor to stop this prior to the vasectomy.
What are the other risks?
Chronic testicular pain from the procedure is seen in 1/1000 men. This can often be managed with medication, rarely is another surgery needed to improve the pain. Vasectomy failure is rare. The causes may include a difficult vasectomy and variation of anatomy including an extra unrecognized tube. Performing the semen sample as instructed will catch this and prevent an unwanted pregnancy.
Do I need antibiotics?
No, the risk of infection is so low that current guidelines recommend against antibiotics.
Does having a vasectomy affect my “manhood”?
A vasectomy does nothing to affect a man’s erections, sexual desire, male hormone levels, or sexual performance. Testosterone, the main male hormone, is made by the testicles and released into the blood stream without the help of the vas deferens. Remember, semen is made far away in the seminal vesicles and prostate. Erections are regulated by hormones, blood flow, and nerves.
Does a vasectomy cause prostate cancer or other diseases?
Having a vasectomy does not cause any diseases. Men who have had a vasectomy are more likely to undergo regular health screenings later in life. Therefore, they are more likely to be diagnosed with silent diseases like prostate cancer because they are going to their doctor and getting evaluated.
If my wife and I aren’t sure about having more children, should I have the vasectomy? Can it be reversed?
A vasectomy is meant as a permanent form of contraception. If you or your wife are not certain, then I recommend holding off on the procedure. If you’ve had a vasectomy and desire more children, then a vasectomy reversal (vasovasostomy) can be performed. In this situation, I recommend you consult a urologist with expertise in vasectomy reversals. There are no guarantees that a reversal will lead to a natural pregnancy.