Common Questions about Vasectomy

 

John Curington MD

Exactly what is a vasectomy?

A vasectomy is an operation that blocks the tubes that carry sperm from the testicles. The purpose of vasectomy is to prevent pregnancy. We do a vasectomy by making a very small opening in the skin in the front of the scrotum, then interrupting the tubes. Vasectomy is simple, inexpensive, and effective.

Does vasectomy change your sex drive at all?

For most men, not at all. Simply interrupting the tubes that carry sperm won’t affect drive. Vasectomy does not affect the male hormones produced by the testicles. Some men (and their partners), in fact, feel more comfortable with sex and note an INCREASED sex drive after a vasectomy. It's nice not having to worry.

Does it hurt?

Your vasectomy will be pain free... or almost. You will have little or no discomfort during the vasectomy. The majority of men say that it is easier than going to the dentist or getting blood drawn! The doctor uses local anesthetic to completely numbs the skin and area around the tubes. General anesthesia is not needed. The vasectomy site does NOT involve the testicles or penis, thus you are spared discomfort in these sensitive areas.

How does the local anesthetic work?

The local anesthetic is called lidocaine, and works very well.  The doctor uses an air-sprayer called a Madajet that sprays the lidocaine into the skin. Most men say that the spray of the Madajet feels like getting flicked by a rubber band. In some clinics, the doctor uses a very fine needle (the size of a hair) for the local anesthesia. The very fine needle is also surprisingly gentle. With both systems, the anesthetic completely numbs the skin and area around the tubes. Lidocaine is a very effective anesthetic, and for the few men who need a little more lidocaine, the doctor is happy to oblige.

What is the recovery period like?

Most men feel some soreness for a night or two and then they feel fine. Relax with your feet up on the day of your vasectomy. If you choose, you can return to office work or light activity the following day. A few men will feel discomfort for up to a week, and this generally gets better with time. We recommend wearing tight underwear or a jock strap for the first few days after your vasectomy to decrease discomfort and chances of swelling. Avoid any vigorous activity, including sports and sex, for the first 3-7 days after your vasectomy.

What are the potential complications of a vasectomy?

In general, a vasectomy is a very low-risk procedure. As with any surgery, though, there are risks. You can group the risks into two groups - short-term risks and long-term risks. The short-term risks include bleeding problems, anesthetic reaction, pain, infection, bruising, and bleeding into the scrotum causing a hematoma (a collection of blood in the scrotum). The long-term risks include granuloma formation (the development of a lump of scar tissue), chronic pain in the scrotum, and continuing ability to get someone pregnant. All of these potential complications are unlikely, and any physician will work hard to help prevent complications, but you must remember that every surgery has its risks.

Whoa! You just mentioned “continuing ability to get someone pregnant.” How can this happen?

During a vasectomy, the Dr. Curington performs multiple steps to stop the flow of sperm. He will cut the vasa (the sperm tubes), cauterize the tubes, and tie or clip the ends of the tubes apart. The body is designed to heal very well, though, so even after all this the tubes can still re-join. In spite of the best surgical technique, the body can form a scar that reconnects the tubes. This is very very rare, but it can happen. The odds of this happening are a little less than 1 in 1000. If this is going to happen, this usually happens within the first few months of having your vasectomy. Thus it is very important that you do bring in your post-vasectomy semen sample for analysis. Finding out that the tubes have healed together isn’t much of a problem; we can simply repeat the vasectomy. The big problem would be if you had your tubes heal back together and you didn’t know it. There is also an issue called “late recanalization.” This happens to about one man per 2,000 men who have had vasectomies. We don’t know exactly how this happens, but the tubes can heal together even several years after a vasectomy. This is very very rare, but it does happen. No method is 100% certain. Vasectomy is one of the most effective methods of birth control, but it is important to remember that nothing is certain in medicine or biology. Remember, though, that every contraception method has a failure rate. Compare the failure rate of 2 to 8 pregnancies per 100 women who use oral contraceptives (“birth control pills”) for a year to the 1 case of late canalization per 2000 men who use vasectomy. Though no method is perfect, vasectomy is an excellent method of contraception.

What happens to the sperm after a vasectomy?

The sperm is reabsorbed by your body. Our bodies are very good at reabsorbing cells that are getting old or that don’t get used. For example, you make red blood cells every day and your body does not become swollen with excess blood cells. The body just reabsorbs the blood cells after awhile. Similarly, the body will reabsorb the sperm that are produced by the testes but not used after the vasectomy.

Will I be able to notice any change in my semen?

No, most men will never notice any change in their semen. Most of the semen in made in the prostate and seminal vesicles, with only a small portion of the total volume being made in the testes. After a vasectomy, the prostate and seminal vesicles still make the same secretions, so neither you nor your partner will notice any change in the semen. The only way to tell is with a microscope or a formal lab semen analysis.

I have read that the volume of semen in my ejaculate won’t be changed much. How is this?

Semen is a mixture of substances from several parts of your body. Most of the semen in the ejaculate (or “the come”) is produced not in the testicles, but in the prostate and seminal vesicles. The testes produce only a small fraction of the total volume of the semen. After the vas deferens (the tube from the testes that carries the sperm) is sealed, the seminal vesicles and the prostate still produce their secretions. Thus, the total volume of ejaculate is changed very little.
Nikon Microscope

After my vasectomy, the clinic said I should wait for three months until my semen check. Why is this?

The semen check is a very important part of a vasectomy. You should always consider yourself “fertile” until after a semen check verifies that you no longer have viable sperm in your semen. Bringing in the semen sample for analysis is important, but bringing the sample in too soon can give you a scare. Very often, a few sperm are hiding in the prostate and seminal vesicles, so your sperm count will be positive even though the vas tubes have been successfully sealed. Waiting three months allows the hidden sperm to be flushed out enough that your analysis will be “clear.” Also, there is the very rare chance that the tubes can grow back together after a vasectomy. By the time three months have passed, the semen analysis will likely show if the tubes have grown back together. For most men, the semen check is a simple process and they get exactly the results they expect, but it is important to not skip this vital step.

What is the minimum age for a vasectomy?

There is no minimum age for a vasectomy, but common sense applies here. Since a vasectomy is permanent, you don’t want to enter into this lightly. This is a decision that will influence the rest of your life. From a physician’s point of view, it is important that we do the right thing, and that means not performing a procedure on anyone who is not mature enough to consent. A good general rule is that 21 years old is considered old enough, but even a young man in his mid or late 20s should consider very carefully. Remember vasectomy is permanent. Remember that you change and grow much in your 20s. Remember that relationships change and women change. Taking all this into account, a young man should consider this decision very carefully. From a practical point of view, US federal funding will not cover a vasectomy unless the patient is over 21. The Title X program from the Public Health Service, requires that “The individual is at least 21 years old at the time consent is obtained” and “The individual is not a mentally incompetent individual.” (section 50.203 of Subpart B from the Title X document from the US Department of Health and Human Services).

Will my insurance pay for a vasectomy?

This is a difficult question. Across the world, many national health insurance plans do cover vasectomy. In the United States, the health insurance system is very complex. If you are seeing a physician in the US, the physician's office will likely call the insurance company to check on what your policy covers. If you call your insurance company yourself, you should ask very specifically "Does my insurance policy cover vasectomy?" You will likely need to tell the insurance company representative the specific codes for vasectomy (insurance companies use codes instead of basic language). The specific codes are ICD-9 V25.2, ICD-10 Z30.2, procedure code 55250. Also be sure you ask if you have a deductible, and if you have used up your deductible for this year. This all sounds complicated, and it is. Many men find that calling the insurance company is more painful than the vasectomy itself, but it's worth doing to make sure you understand how much your insurance company will cover. In any case, compared to other methods, vasectomy is very cost-effective. Even if you have to pay cash yourself, vasectomy is a bargain. Since a vasectomy lasts for the rest of your life, the cost of contraceptive coverage per year is very low.

Some men talk about chronic pain after a vasectomy. How common is this?

Major chronic pain after a vasectomy is very rare. The vast majority of men have no issues with this at all. Some studies, though, do report that somewhere around 15% of men will have some chronic pain after a vasectomy. Most men aren’t bothered by this, but there have been reports of the rare man who feels substantial long-term pain after a vasectomy. This is very rare and no-one really knows what causes this. Just like some people feel years of pain after relatively small back injuries, a small minority of patients will feel some pain after a vasectomy. The only way to avoid any chance of having chronic pain after any surgery is to not have the surgery. Fortunately, though, significant chronic pain after a vasectomy is very rare and most men will never have to worry about this.

Knowing everything you know, do you still think vasectomy is a good idea?

Absolutely. There is no method of contraception that is perfect, but vasectomy is a very good method. I've even had a vasectomy myself. The vast majority of men are very happy with their vasectomies and I feel very honored to help men achieve this excellent method of contraception.