One of the most common and popular means for contraception around the world is vasectomy – a brief, surgical procedure used for male sterilization. It is a popular means of birth control for couples that have decided that their family is complete. It is nearly 100% effective and is intended to be permanent.
A vasectomy is chosen by over 600,000 American men annually, and as many as 30 million men worldwide. The vasectomy procedure is uncomplicated, is commonly performed in a doctor’s office and usually takes about 15 to 20 minutes.
The simplest and safest vasectomy method is the No-Scalpel Vasectomy (NSV), which, as the name suggests, requires no scalpel, no incisions (only two tiny punctures in the skin) and no sutures. It is performed with a local anesthetic to numb the area. The No-Scalpel Vasectomy is rapidly becoming the procedure of choice among patients and is also favored by many doctors.
Urologists perform most vasectomies, although up to 30 % are performed each year by family practitioners, depending on the location. Costs range from $500 to over $1,000 and is reimbursed by many health insurance programs
Making A Permanent Decision
When your family nest is full, or you have chosen not to father a child, vasectomy offers a permanent, safe, and worry-free choice in birth control. But is vasectomy for every man or every couple?
There are some general ground rules to consider first, as well as emotional and family concerns to discuss with your partner and physician. While the law may not require that you have the consent of your wife or partner, vasectomy or any contraceptive choice is best discussed and decided as a couple. It is not uncommon to require waiting periods for patients prior to vasectomy surgery so that you’re confident in your decision.
A serious decision not to be made lightly or alone.
Couples should first explore all birth control methods available—both the positive and negative aspects—and discuss their feelings and thoughts about each, before sharing their concerns and choice with a doctor.
Vasectomy is a long-term, low-cost choice for contraception and should be considered permanent. It removes risk and uncertainty of unintended pregnancy, just as tubal ligation does, but without the additional cost, possible hospitalization and surgical time to the woman. And vasectomy does not pose the danger to men that other contraceptive methods may pose for women.
On the other hand, things change. You should be absolutely certain that you do not want to father a child later under any circumstances, even if there are significant changes in your future. While a vasectomy can sometimes be reversed, you should assume that it might not be possible to change your mind later.
Are there some men who should NOT have a vasectomy? Frankly, yes. You may regret having the procedure if you are too young at the time of your decision. Generally, there is no minimum age requirement except that you must be an adult. Common sense, however, suggests that "older is wiser."
Men under the age of 25… or those who divorce young and remarry…or those who have the procedure immediately after the birth of a child… can come to regret the decision made too early in their lives. And regardless of the man’s age, if the female partner is under the age of 25, couples may become dissatisfied with the decision.
Also, the decision to have a vasectomy should not be made based strictly on financial considerations. Your family income or circumstances may change and permit you to expand your family in subsequent years.
What about emotional considerations?
Experience suggests that you should not get a vasectomy to please someone else. The decision to father a child is yours—and your partner’s—and no one else’s.
If you have concerns about the stability of your current relationship, or your decision not to father a child in the future, a vasectomy may not be right for you at this time.
If you and your partner are experiencing sexual problems, fears, an unhappy relationship or just having difficulty communicating with each other about birth control options, it may not be a good time to decide about a vasectomy.
Vasectomy will not solve marital or sexual problems. But it can help you enjoy sexual relations more—free from the fear of unwanted pregnancy. And it can the right choice if the female partner does not want or cannot take birth control pills or use other forms of contraception.
Who are the best candidates for vasectomy?
Because this is a personal decision, there are no absolute rules, and the best answer lies in being informed. However, here are some suggestions to consider as to who is a good candidate:
How Vasectomy Procedure Is Done
It is natural to be apprehensive about a medical procedure. One way to reduce fear is to increase your awareness of what to expect and how a vasectomy is performed.
Here is what to expect.
Whether it is a traditional surgical or the less-invasive No-Scalpel vasectomy procedure, a successful vasectomy blocks the vas deferens, preventing sperm from becoming part of the seminal fluid that leaves the body at sexual climax. The vas deferens are the thin tubes in the scrotum that would normally carry sperm from the testicles to become part of the ejaculate. When the sperm channel is interrupted, the man becomes sterile and can no longer father a child.
A typical vasectomy is done in the doctor’s office. Although your experience may vary somewhat, the following describes what you can expect.
The two most common vasectomy techniques are the traditional vasectomy, and the less-invasive, No-Scalpel Vasectomy (NSV). Both methods accomplish the same result, but the No-Scalpel Vasectomy has become more popular with both doctors and patients. Both methods are considered painless or nearly painless vasectomy procedures and have similar recovery times.
Because the No-Scalpel Vasectomy is widely accepted as simpler and safer, the information presented in this site favors NSV. (For more details about the differences between NSV and traditional vasectomy, read our article: The Various Techniques of Vasectomy.)
Generally: Some expectations and considerations.
What a vasectomy is:
What vasectomy isn't:
What vasectomy doesn't do:
Before: Preparing for your vasectomy.
There are some simple things that you can do to get ready for your office visit in advance of your appointment.
During: The usual steps involved in the No-Scalpel, non-invasive vasectomy.
Your doctor may describe the routine to expect in his office and your experience may differ from these steps. Generally.
The opposite vas deferens is then lifted through the opening for the same procedure. The remaining opening can heal with closure by stitches or naturally without stitches.
After: Care following the vasectomy.
Follow your doctor's instructions. It's a good idea to read written instructions in advance, review them with your partner and make preparations, if needed.
Any discomfort is usually mild and pain relievers should be used if necessary. The local anesthetic begins to wear off after an hour or so. Vasectomy recovery time after a No-Scalpel Vasectomy is usually less than after a traditional vasectomy.
To ensure a speedy, nearly painless vasectomy recovery time, look to your own physician for specific instructions. However, here are a few general guidelines following an uneventful vasectomy:
Vasectomy Risks and Complications
Any surgical procedure carries some risk, but vasectomy is considered to be low-risk, typically not painful, and vasectomy complications are uncommon. It is important to note that vasectomy should be considered a permanent form of birth control, and it does not protect against sexually transmitted diseases or AIDS.
Discuss any concerns and risks associated with vasectomy with your physician. The following is a list of most, but not all, of the risk issues to consider.
Rarely, some men may experience itching and hives, as an allergic reaction to local anesthetic.
Sperm which are no longer released through ejaculation and absorbed by the body may attract antibodies produced following vasectomy.
Generally painless bleeding may occur following vasectomy and collect under the skin, so that the penis and scrotum appear bruised and/or swollen. The scrotum skin is very thin, which may make bruising appear worse than it actually is and is a normal reaction after vasectomy.
A rare vasectomy complication - the patient may experience a dull post vasectomy pain or ache in the testicles that is thought to be caused by a congestion of the epididymis with dead sperm and fluid. If this condition occurs, it usually disappears within six months.
A common name for chronic orchialgia (see above).
One of the more common of the vasectomy complications, epididymitis is a condition which occurs when the larger tube behind the testicle, connected to the vas, becomes inflamed and swollen. The application of heat and the use of anti-inflammatory medication with or without antibiotics usually clear this up within a week.
Pregnancy may result if a man fails to abstain from sex or use alternative forms of birth control during the waiting period, until the testing for live sperm is completed. There is also one chance in 10 thousand that the cut vas will spontaneously rejoin.
Bleeding may occur inside the scrotum causing post vasectomy pain or swelling. When it occurs, it is usually within the first week of the vasectomy. While seldom serious, it should be reported to a physician.
Following vasectomy, the immune system may recognize the absorbed sperm cells as foreign proteins and produce antibodies in response. While many men may experience this immune reaction, current evidence indicates that this reaction generally is not harmful. Immune reactions can also contribute to the development of clogging of arteries, which in turn could lead to heart attacks. However, there is no evidence of an increased risk of atherosclerosis because of a vasectomy.
According to the National Institutes of Health, research that examined this issue found no evidence that vasectomized men were more likely than others to develop heart disease or any other immune illness. (NIH Publication Number 96-4094, April 1996)
If blood collects under the skin following vasectomy, it can become infected. Post vasectomy infection at the incision site or in deeper tissue occurs in less than 5 percent of all cases. Such vasectomy infections usually respond favorably to antibiotic treatment, antimicrobial creams and hot baths, usually within a week.
Some degree of post vasectomy pain or ache is normal following a vasectomy. The use of acetaminophen (Tylenol), with or without codeine frequently is recommended over aspirin, which can cause bleeding. Any painful discomfort normally resolves within a day or two, while a slight ache may remain longer.
Studies looking at the association of prostate cancer with vasectomy have demonstrated conflicting results in the past. To answer this question, a major study involving over 2000 men was performed and reported in the Journal American Medical Association (JAMA 2002; 287:3110-3115). The conclusion was clearly that there is no increased risk of prostate cancer with vasectomy (NIH News Release).
It is usually reported that men who undergo vasectomy and their partners express greater enjoyment and spontaneity of sex. However, occasionally a man may experience sexual problems after vasectomy, but these almost always have an emotional basis. Counseling usually alleviates the problem.
One of the more typical vasectomy sequelae, sperm granulomas occurs when sperm leakage from the testicular cut end of the vas causes a small and usually painless lump. This lump does not pose a danger and frequently resolves over time.