The Urological Institute
of Northeastern New York
Albany Medical Center's
South Clinical Campus
23 Hackett Blvd.
Albany, NY 12208
(518) 262-3341
Vasectomy is permanent birth control for men. It is a minor surgical procedure, usually performed in the office, to interrupt the sperm transportation system. The decision to proceed with vasectomy is a very personal one. A vasectomy is chosen by men who have completed their families or by men who do not want children. It is important that you have an understanding of the procedure to decide whether or not a vasectomy is an appropriate form of contraception for you.
Vasectomy is a simple procedure. It makes men sterile by keeping sperm out of semen - the fluid that is released from the penis during sex. Sperm are the reproductive cells in men.
The testicles produce sperm and testosterone, and are located in the scrotum. Once produced, the sperm exit the testicle through a tube called the epididymis and stay until they are mature. Each epididymis is connected to the prostate by a tube called the vas deferens. This muscular tube joins in the lower portion of the scrotum into the groin, and then continues to the prostate. The vas deferens joins the seminal vesicles at the ejaculatory duct. During ejaculation, seminal fluid produced by the prostate mixes with sperm to form semen.
A vasectomy blocks each vas deferens and keeps sperm out of the seminal fluid. The sperm are absorbed by the body instead of being ejaculated.
In general, vasectomies are performed in the urologist's office. In rare cases, the procedure may be done in the operating room under light sedation or anesthesia. The decision to proceed for surgery may be based on your anatomy, anxiety level, and need for other surgical procedures.
On the day of the procedure, you will be asked to sign a surgical consent form. You will need to shave the scrotum and you will be brought into the procedure room. You will have an antiseptic solution applied to the scrotum and a local anesthetic will be injected to numb the area. You will still be aware of some pulling and tugging sensation during the procedure, but the local anesthetic should eliminate any sharp pain.
You are awake during the procedure and, if you are extremely anxious, additional medications may be provided. With the no-scalpel vasectomy, a small incision is made with a special clamp. The instrument is then used to make a tiny puncture in the skin and stretch the opening so that the vas deferens tube may be lifted out, cut, cauterized, and clipped to help complete the procedure.
You should return home immediately after the procedure and avoid strenuous activity or sexual relations. Swelling or discomfort may be minimized by placing an ice pack on the scrotum for 20-30 minutes each hour for the first 4-6 hours after the procedure. Most patients can expect to recover completely in less than a week and many are able to return to work or activity within 1-2 days after the procedure.
Vasectomy is not immediately effective. Sperm remains in the system beyond the blocked tubes. You must use other birth control until the sperm are used up. Sexual activity can be resumed within a few days following vasectomy, however, it is important to realize that, even with a vasectomy, there will still be sperm present for up to 12 weeks after the procedure.
A simple test called a semen analysis is used to show when there is no more sperm in the seminal fluid. Two semen analyses are obtained at 6 and 12 weeks after the procedure. At least one of these specimens should demonstrate that there are no sperm present in the ejaculate. The time until disappearance of sperm from the ejaculate varies from patient to patient, but it takes at least 10-15 ejaculations to clear the system. If sperm continues to be present in the ejaculate, the patient must continue to use some alternative form of barrier contraception. The patient should not assume that his vasectomy is effective until the semen analysis testing has been completed.
In the immediate postoperative period, there is a risk of bleeding into the scrotum. If you notice a significant increase in the size of the scrotum or significant discomfort, you should contact your urologist immediately. If you experience fever, scrotal redness, or tenderness, you should be evaluated for an infection. Discomfort is usually minimal and should respond to mild pain medications which will be prescribed at the conclusion of your procedure.
More severe pain may indicate infection or other complications. You may notice a small bump or benign lump in the area that may develop over time called a sperm granuloma. This is caused by leakage of sperm from the cut end of the vas deferens into the scrotal tissues. It may occasionally be painful or sensitive to touch or pressure.
In very rare cases, a post-vasectomy pain syndrome may occur. This is chronic pain that follows a vasectomy and usually happens in less than 1/200 patients. The cause of this syndrome and its incidence are unclear, it is generally treated with anti-inflammatory agents and, in some cases, patients will elect to undergo vasectomy reversal to help with this severe pain.
Can my partner tell if I had a vasectomy?
There is no significant change in the ejaculate after vasectomy since the sperm present in the ejaculate fluid are relatively low. Your partner may, on occasion, be able to feel the vasectomy site, and this is particularly true if you have developed a granuloma.
Will my sense of orgasm be altered by having a vasectomy?
No. In general, ejaculation and orgasm are not affected by vasectomy. The only exception to this is the rare patient who has developed post-vasectomy pain syndrome.
Can I become impotent after a vasectomy?
An uncomplicated vasectomy should not have any effect on erectile function.
Can a vasectomy fail?
First, it is important to be sure the vasectomy has been successful and that a sperm count has been obtained prior to stopping all other forms of contraception. Even if vasectomy has been demonstrated to be effective, there is a small chance that a vasectomy may fail. This occurs as a result of sperm leaking from one end of the cut vas deferens, the testicular end, and finding a channel to the abdominal end. Because of this phenomenon, some urologist recommend having an additional semen analysis performed at a one year time after completing the procedure.
Can something happen to my testicles?
Rarely, the testicles may be injured during the vasectomy as a result of infection, or an injury to the testicular artery. Other complications such as hematoma or infection may also occur.
Can I have children after my vasectomy?
Yes, but if you have not stored frozen sperm, you will require an additional procedure. The vas deferens can be micro-surgically reconnected in a procedure called vasectomy reversal to allow normal conception to occur. Alternatively, sperm can be extracted from the testicle or epididymis and utilized for in vitro fertilization. These procedures are costly and usually are not covered by insurance. Additionally, they are not successful 100% of the time. Therefore, one should carefully consider non-surgical alternatives prior to deciding to proceed with a vasectomy.
Can a vasectomy cause prostate cancer?
Lately, there have been some published studies and debates regarding whether vasectomy may predispose a man to other health problems. In the early 1990s, there were studies that tried to link vasectomy to a future risk of prostate cancer. Most of these studies have not been proven and, at this time, there is no conclusive evidence that men who have undergone vasectomy have a higher risk of cardiovascular disease, prostate cancer, testicular cancer or other problems.