Vasectomy

 

A permanent decision
Few decisions in life are permanent, but having a vasectomy is one of them. So, before you make this decision, you and your partner must be sure that you do not want any more children. Is there any circumstance that might make you change your mind?

For instance, if you divorced or became a widower and remarried, would you want more children? If you choose to have a vasectomy, you should have no doubts about these issues, as there are no guarantees it can be reversed with later surgery (vasectomy reversal).

 

Vasectomy does not affect your ability to have sex.

Sterilisation will not affect your ability to have erections or orgasms, and does not visibly change your semen.

There is no conclusive evidence that vasectomy causes health problems.

You may have heard that sterilisation causes prostate cancer, heart disease or other health problems, but there is no conclusive evidence that this is true. If you are concerned, your doctor can give you more information. Note, however, that having a vasectomy does not protect you from sexually transmitted infections.

vasectomy will not solve marital or relationship difficulties.

The only aspect of your life that a vasectomy changes is your ability to father a child. Sterilisation is not a solution for sexual or marital problems.

Your reproductive system
To understand how a vasectomy works, you need to know how sperm is produced, stored and released by your reproductive system.

 

How a vasectomy works
When you have a vasectomy, the two vas deferens are cut to keep sperm from travelling from the testes to the penis. This is the only change in your reproductive system. The testes still produce sperm, but since they have nowhere to go, they die and are absorbed by your body.

Your prostate and seminal vesicles still produce fluids, so your semen does not look or feel any different. Your male hormone level remains the same, so your hair distribution, the pitch of your voice and your sexual drive do not change.

The vas deferens are cut, preventing sperm from moving to the penis.
The seminal vesicles and prostate secrete the same amount of fluid as before.
Erection and ejaculation continue as before, but the semen contains no sperm.
The testes still produce sperm and hormones.

Note: Because some sperm remain in the upper part of the reproductive system after a vasectomy, it takes several weeks and numerous ejaculations before the semen is completely free of sperm.

 

The vasectomy procedure
A vasectomy is an outpatient procedure that can be done in a doctor's rooms, clinic or hospital. Several days before your vasectomy can be performed, you'll be asked to read and sign a consent form that states you're aware of the possible risks and complications and understand that the procedure, though usually successful, is not guaranteed to make you sterile. Be sure that you have all your questions answered before signing this form.

 

Preparing for surgery

Avoid taking aspirin for three days before your procedure, and ask your doctor about any other medications you take. On the day of your surgery, shower and thoroughly clean your scrotum. Eat a light snack instead of a heavy meal before your surgery. Wear a clean pair of underpants to the doctor's rooms or hospital. If you're nervous about your surgery, the doctor may give you some medication to help you relax.

 

During surgery

You will be asked to undress and lie on the examination table. Sterile drapes are placed over you to help prevent infection. You are given injections of a local anaesthetic in your scrotum or lower groin. This prevents you from feeling pain. Once the anaesthetic takes effect, two small incisions are made in the skin of the scrotum with a scalpel or a pointed clamp (no-scalpel method).

Each of the vas deferens is lifted through the incision and cut, and a section may be removed. You may feel a pulling sensation during this process. The two cut ends are tied or clipped closed, or they may be sealed by heat (cauterised). The incisions are closed with one or more stitches.

 

After surgery

If you have been given medications to help you relax, you will need to have someone drive you home. The local anaesthetic begins to wear off after about two hours. Any discomfort you feel is usually mild. If you need it a pain medication can help.

 

Healing

Once you're home, you can do several things to aid your recovery:

Stay off your feet as much as possible for the first two days to lessen the chance of swelling. An ice pack or bag of frozen peas can also help keep the swelling down.
Wear snug cotton briefs or an athletic support.
Ask your doctor how long to wait before having a shower (usually 24 hours).
Wait until your doctor says it's okay to return to work.
Avoid heavy lifting or exercise for at least five days after surgery.
Ask your doctor when you can begin having sex again. Remember, you must use another form of birth control until your doctor says you are completely sterile.

For about a week your scrotum may look bruised and slightly swollen. You may have a small amount of bloody discharge from the incision site. You may also fell a little pain. These symptoms are normal.

 

Possible risks and complications
Even with a minor operation like vasectomy, problems can occur. If you experience any of the following or any other symptoms you're concerned about call your doctor.

The following complications might occur during the first few days after your surgery:

Internal bleeding in the scrotum sometimes occurs, usually within two days of surgery. Symptoms include increasing pain, excessive swelling, a large black-and-blue area, or a growing mass.
Infection may occur. Some signs of infection are fever, chills, drainage from the incision site and a very painful incision site.
Other complications, though rare, may occur in the first few months after surgery. These are the most common:

Sperm granuloma is a lump at the site where the vas deferens is tied off. It's caused by leaking sperm. The lump usually dissolves by itself, but surgery is needed to remove it.
Congestion is a build-up of sperm in the epididymis. It may cause inflammation of the epididymis (epididymitis) and some aching about 3 to 12 weeks after surgery. It usually disappears without treatment.
Sperm antibodies are a common response of the body to absorbed sperm. There's no evidence that these antibodies are harmful, but a large number of them may make it difficult to become fertile again, if you should ever change your mind.
Testicular discomfort lasting several years after the procedure occurs rarely.
Spontaneous return of fertility occurs very rarely. This can happen if the cut ends of the vas deferens reconnect (recanalisation). It's usually detected by a semen test after surgery, although it occasionally occurs after the semen test has been done.


Sex after a vasectomy
A vasectomy will not alter your sexual functioning. When you start having sex again, you'll still have erections and orgasms, and your sexual relations will feel the same as before. If you had a good relationship with your partner before vasectomy, it shouldn't change because of vasectomy.

 

Until you're sterile
It is absolutely essential that you continue to use some other form of birth control after your vasectomy until your doctor tells you that your sperm count is zero. To make sure no sperm are left in your semen you'll have a postoperative semen exam. This is commonly done about three months after surgery. You usually collect the semen at home in a small jar, and bring it to the lab. You are sterile only when these semen samples show no evidence of sperm.

 

After you're sterile
After your doctor tells you you're sterile, you no longer need another form of birth control. You are free to have sex without the fear of unwanted pregnancy. However, keep in mind that vasectomy does not protect you from sexually transmitted infections. If you're not in a mutually monogamous relationship, practice safe sex by using condoms.

 

 

Vasectomy reversal


You and your partner have decided you want a child. But you've had a vasectomy, a procedure that made you sterile (unable to father a child). You're now considering surgery to reverse your vasectomy. You and your partner should seriously discuss with your doctor what your options are and the issues involved before you proceed with reversal.

 

Factors to consider
When deciding on vasectomy reversal, you should consider these factors:

The procedure is not guaranteed to restore your fertility. The most important factor is the length of time since the original vasectomy was performed. The more time has passed, the less likely fertility will be restored.

Even if sperm are restored to the semen, pregnancy is not guaranteed. During the time you were infertile your body may have created sperm antibodies. These substances may prevent you from fathering a child, even if your sperm count returns to normal.

 

The reversal procedure
Your doctor can give you specific instructions on how to prepare for the procedure. In general, avoid aspirin for seven to 10 days before the procedure, and ask your doctor whether to stop taking any other medications. And bring a set of clean underpants with you to the hospital or clinic.

 

During the procedure
To keep you comfortable and help you relax you'll be given anaesthesia. You may receive local or regional anaesthesia, which means you'll be awake but relaxed, or general anaesthesia, which means you'll sleep during the procedure.

Once the anaesthesia takes effect, the doctor makes an incision in your scrotum. The cut ends of each of the vasa deferentia are lifted out and examined under magnification. A section of each cut end may be removed. The end closer to the testicles will be cut until fluid flows freely. This fluid may be looked at under a microscope to find whether sperm are present. If sperm and fluid flow, the two cut ends are sewn together.

If necessary, the vas may be attached directly to the epididymis (see our vasectomy topic for more on the anatomy). When both vasa are reconnected, the incisions in the scrotum are sutured closed.

 

After the procedure
You may need to stay in the hospital for several hours. When you are allowed to go home, have someone available to drive you. Any discomfort you feel is usually mild. If you need it, a pain reliever may help.

Healing


Several things to aid your recovery:

Stay off your feet as much as possible for the first day to lessen the chance of swelling. An ice pack or bag of frozen peas placed on your scrotum for short periods can help keep swelling down.
Wear snug cotton briefs or an athletic support.
Avoid heavy lifting or exercise for at least two weeks.
Ask your doctor how long to refrain from sex. You may notice blood in your semen - this is normal.
Ask your doctor when you can return to work.
Risk and complications


Problems after vasectomy reversal are uncommon, but include the following:

Risks associated with general anaesthesia.
Infection. Some signs are fever, chills, drainage from the incision site and pain.
Internal bleeding of the scrotum. Symptoms include increasing pain, excessive swelling, a large blue-and-black area, or a growing lump.


Failure to restore fertility.
Restoring the flow of sperm
Before your vasectomy, sperm travelled through your reproductive system and were released during ejaculation. During the vasectomy, the sperm pathways were cut. To reverse your vasectomy, those pathways need to be restored to allow sperm to travel out of your body once again.

 

How the procedure works
After your original vasectomy, your testes continued to release sperm, but these sperm were blocked from travelling to the penis. During a vasectomy reversal, the two cut ends of the vasa deferentia are reconnected. If the procedure is successful, sperm can once again travel to the penis and leave the body during ejaculation.

 

Parenthood
About two to three months after the reversal procedure, your sperm count will be checked. It will be checked again every two to three months until the sperm count is within normal range or a pregnancy results. The average wait for a pregnancy is 12 months, so patience is often necessary. If more help is required, new types of fertility treatment may still give you a second chance at parenthood. Ask your doctor for details.