Vasectomy





Definition

A vasectomy is a surgical procedure performed on adult males in which the vasa deferentia (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, cauterized (burned or seared), or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but they die and are absorbed by the body.


Purpose

The purpose of the vasectomy is to provide reliable contraception. Research indicates that the level of effectiveness is 99.6%. Vasectomy is the most reliable method of contraception and has fewer complications and a faster recovery time than female sterilization methods.

The cost of a vasectomy ranges between $400 and $550 in most parts of the United States. Some insurance plans will cover the cost of the procedure.


Demographics

Approximately 500,000 vasectomies are performed annually in the United States. About one out of every six men over the age of 35 has had a vasectomy. Higher vasectomy rates are associated with higher levels of education and income.


Description

Vasectomies are often performed in the doctor's office or an outpatient clinic using local anesthesia. The area around the patient's scrotum (the sac containing the testicles that produce sperm) will be shaved and cleaned with an antiseptic solution to reduce the chance of infection. A small incision is made into the scrotum. Each of the vasa deferentia (one from each testicle) is tied in two places with nonabsorbable (permanent) sutures and the tube is severed between the ties. The ends may be cauterized (burned or seared) to decrease the chance that they will leak or grow back together.

"No scalpel" vasectomies are gaining in popularity. Instead of an incision, a small puncture is made into the

In a vasectomy, an incision is made in the man's scrotum. The spermatic cord is pulled out (B) and incised to expose the vas deferens, which is then severed (C). The ends may be cauterized or tied off (D). After the procedure is repeated on the opposite cord, the scrotal incision is closed (E). (Illustration by GGS Inc.)
In a vasectomy, an incision is made in the man's scrotum. The spermatic cord is pulled out (B) and incised to expose the vas deferens, which is then severed (C). The ends may be cauterized or tied off (D). After the procedure is repeated on the opposite cord, the scrotal incision is closed (E). (
Illustration by GGS Inc.
)
scrotum. The vasa deferentia are cut and sealed in a manner similar to that described above. No stitches are necessary and the patient has less pain. Other advantages include less damage to the tissues, less bleeding, less risk of infection, and less discomfort after the procedure. The no-scalpel method has been used in the United States since 1990; as of 2003, about 30% of vasectomies are performed with this technique.

The patient is not sterile immediately after the procedure is finished. Men must use other methods of contraception until two consecutive semen analyses confirm that there are no sperm present in the ejaculate. It takes about four to six weeks or 15–20 ejaculations to clear all of the sperm from the tubes.

In some cases vasectomies may be reversed by a procedure known as a vasovasostomy . In this procedure, the surgeon reconnects the ends of the severed vasa deferentia. A vasectomy should be considered permanent, however, as there is no guarantee of successful reversal. Vasovasostomies are successful in approximately 40–50% of men.


Diagnosis/Preparation

No special physical preparation is required for a vasectomy. The physician will first assess the patient's general health in order to identify any potential problems that could occur. The doctor will then explain the possible risks and side effects of the procedure. The patient is asked to sign a consent form which indicates that he understands the information he has received, and gives the doctor permission to perform the operation.


Aftercare

Following the surgery, ice packs are often applied to scrotum to decrease pain and swelling. A dressing (or athletic supporter) which supports the scrotum can also reduce pain. Mild over-the-counter pain medication such as aspirin or acetaminophen (Tylenol) should be able to control any discomfort. Activities may be restricted for one to two days, and sexual intercourse for three to four days.


Risks

There are very few risks associated with vasectomy other than infection, bruising, epididymitis (inflammation of the tube that carries the sperm from the testicle to the penis), and sperm granulomas (collections of fluid that leaks from a poorly sealed or tied vas deferens). These complications are easily treated if they do occur. Patients do not experience difficulty achieving an erection, maintaining an erection, or ejaculating. There is no decrease in the production of the male hormone (testosterone), and the patient's sex drive and ability are not altered. Vasectomy is safer and less expensive than tubal ligation (sterilization of a female by cutting the Fallopian tubes to prevent conception).

According to both the World Health Organization (WHO) and the National Institutes of Health (NIH), there is no evidence that a vasectomy will increase a man's long-term risk of testicular cancer, prostate cancer, or heart disease.


Normal results

Vasectomies are 99% successful in preventing conception. As such, male sterilization is one of the most effective methods of contraception available to consumers.


Morbidity and mortality rates

Complications occur in approximately 5% of vasectomies. The rates of incidence of some of the more common complications are:

  • mild bleeding into the scrotum: one in 400
  • major bleeding into the scrotum: one in 1000
  • infection: one in 100
  • epididymitis: one in 100
  • sperm granuloma: one in 500
  • persistent pain: one in 1,000

Fournier gangrene is a very rare but possible complication of vasectomy in which the lining of tissue underneath the skin of the scrotum becomes infected (a condition called fasciitis). Fournier gangrene progresses very rapidly and is treated with aggressive antibiotic therapy and surgery to remove necrotic (dead) tissue. Despite treatment, a mortality rate of 45% has been reported for this condition.


Alternatives

There are numerous options available to couples who are interested in preventing pregnancy. The most common methods are female sterilization, oral contraceptives, and the male condom. Female sterilization has a success rate of 99.5%; oral contraceptives, 95–99.5%; and the male condom, 86–97%.


Resources

BOOKS

"Family Planning: Sterilization." Section 18, Chapter 246 in The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

PERIODICALS

Hartanto, Victor, Eric Chenven, David DiPiazza, et al. "Fournier Gangrene Following Vasectomy." Infections in Urology 14, no.3 (2001): 80-82.

ORGANIZATIONS

Alan Guttmacher Institute. 1120 Connecticut Ave., NW, Suite 460, Washington, DC 20036. (202) 296-4012. http://www.agiusa.org .

Planned Parenthood Federation of America. 810 Seventh Ave., New York, NY 10019. (212) 541-7800. http://www.plannedparenthood.org .

OTHER

The Alan Guttmacher Institute. "Contraceptive Use." 1999 [cited February 28, 2003]. http://www.agi-usa.org/pubs/fb_contr_use.html .

"Facts About Birth Control." Planned Parenthood Federation of America. January 2001 [cited February 28, 2003]. http://www.plannedparenthood.org/bc/bcfacts1.html .

"Facts About Vasectomy Safety." National Institute of Child Health and Human Development. September 3, 2002 [cited February 28, 2003]. http://www.nichd.nih.gov/publications/pubs/vasect.htm .

"Vasectomy: Questions and Answers." EngenderHealth. 2000 [cited February 28, 2003]. http://www.engenderhealth.org/wh/fp/cvas2.html .

VasectomyMedical.com . February 4, 2003 [cited February 28, 2003]. http://www.vasectomymedical.com .


Donald G. Barstow, RN Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Vasectomy is a minor procedure that can be performed in a clinic or doctor's office on an outpatient basis. The procedure is generally performed by a urologist, who is a medical doctor who has completed specialized training in the diagnosis and treatment of diseases of the urinary tract and genital organs.

QUESTIONS TO ASK THE DOCTOR



  • How often do you perform vasectomies?
  • What is your rate of complications?
  • How long will the procedure take?
  • What will the procedure cost? Will my insurance cover the cost?
  • Do you perform vasectomy reversal? What is your success rate?

User Contributions:

Dr.H.Azari
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Oct 6, 2007 @ 9:21 pm
Please send me new information about non-scalpel vsectomy
saleem
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Dec 5, 2007 @ 11:11 am
Twenty years ago after my wife delivered 3rd child I was thinking to do vasectomy because I thought i may not need any more children, but twenty years after i have second wife and she need a child after she mention it i was thinking to ask an advice with a Doctor. Well i did it and the Doctor said if PVC pipe can joint why not vasectomy repair. Doctor you think i can get a child ?
chetan
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Jan 1, 2008 @ 7:07 am
Pls tell me if there is any long term pain associated with vasectomy and if there is any lump sort of forming at the region where the vas deferens are cut. also does it affect the quantity, quality and colour of fluid u ejaculate? is vasectomy common among urologists in mumbai - India and how much does it cost here? Thank u so much..
Shannon
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Feb 16, 2008 @ 12:12 pm
I would like to know how much it would cost to have a reversal done? My fiance and I met 3 years ago, he has 3 children and I have 2 but there is always the thought of having more. If we were to do a reversal vasectomy, what are the chances fertiliztion? Thank you so much for your time.
Shannon Garner
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Jan 4, 2010 @ 11:11 am
My husband just had a vasectomy last week. I heard somewhere that after the procedure, he should not lift anything heavier than 5 lbs for at least 3 weeks. I am not sure how reliable this information is and, since we have a 1-year-old daughter, it is hard to avoid lifting her at least. Does he really have to not lift anything for 3 weeks?
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Jul 17, 2010 @ 4:04 am
my husband has done vasectomy 3 years ago , if we want child , can his vasectomy repair ? how many % chances that we can get a child ? how long we have to wait for the result after the procedures ? we want more child.
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Dec 23, 2010 @ 8:08 am
i had a vasectomy 1 year ago and i pass semen when i urinate is this normal after a vasectomy
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Dec 30, 2010 @ 4:16 pm
I have have had a vasectomy performed in Germany by a German doctor when I was there in the Service with the US Army. The procedure was performed because they said it was too and dangerous for my wife then to have a tubal ligation, as she had medical complications. But she could not be allowed to get pregnant anymore. So, I went along with it and they placed silver clips at the ends of my vasa deferentia at both sides. That was in 1976. That area has always been tender ever since I had this done in Germany. I am now 70 years of age. Lately I have been having severe pain in my left scrotum and it has also been swelling at times. It is hard to wear slacks anymore as that area is tender to the touch and can not place and pressure from my trousers there even when I walk. I went to my Urologist and they sent me to do an ultra sound test and they said everything was normal. I had no fluid building up or leaking nor blood or anything they could find. I told the doctor I had trouble getting an erection, and that i wanted the clips to be removed. He said that it was not a good idea, so he gave me a pump to try out. I tried the vacuum pump, and it pulled my testicle (left one) into the tube and caused me more pain. It keeps drawing my testicle into the tube and I can not use the pump for that reason. I need to find a doctor that can just take the darn clips out. Do you know of any doctor in Orlando, or near Orlando, FL that can perform such a surgery As soon as possible? PLEASE DO NOT POST THIS NAME AND ADDRESS ON ANY INTERNET SITE. THANK YOU. Mr. IAM.
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Mar 5, 2011 @ 12:12 pm
Two years ago i had the procedure done and the doctor that did it said that only my left side needed to be done, because of the fact that i only have one kidney on my left side. Is this true? If not, and only one did was done, i'm i then still able to produce sperm from the left tube? I would really like to know if that the case...in a new relationship and she wants to have a baby. Thank You so much, looking to hear from you soon.
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May 22, 2011 @ 5:17 pm
my boyfrend severed vasectomy in 2008 ...n got devorsed same year, i met him a yar a go we met can it be reverse, a what percentage may it work? are there side effect,and where can we go for that procedure? thank you
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Jun 21, 2011 @ 5:05 am
That is very good comment you shared.Thank you so much that for you shared those things with us.Im wishing you to carry on with ur achivments.All the best.
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munnakr
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Sep 14, 2011 @ 11:11 am
CAN VIAGRA PILL REVERSE VASECTOMY.BECAUSE I AM VASECTOMY PERSON AND I AM TAKING VIAGRA [ILL.
SO PLEASE ADVICE ME
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Sep 18, 2011 @ 12:00 am
I would like to know that some answers the follwing,
I have no children in past 4 years
and my problem was sperm route tube is nil
any chance to tube fittment in artificial?
because I am try two times for ICSI treatment and no result in each time
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Nov 28, 2011 @ 1:01 am
Very nice post thanks for share it.

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shawn
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Jun 12, 2012 @ 12:12 pm
if some body have diabitis ,he will do have vasoctomy?
Miles
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Oct 10, 2012 @ 7:07 am
Hello! I'm 36 years old and had a vasectomy one year ago and have been experiencing pain on the lower right side of my abdomen area when I go hard during sex or if my wife is on top, but never had this issue before the vasectomy. Also I have had 2 prostate infections and the treament has been Trimethoprin but this second infection that i currently have had been bothering me for going on 2 weeks now despite the Trimethoprin. So i called the urologist and was told to take a 15 day dose of Cipro 500mg 2x a day. After reading the side effects im afraid of taking it and i feel like maybe i could be prescribe something less strong but yet strong enough to clear the infection. It's been horrible having burning urination\ejaculation, and having blood present. Fortunately i've not had back
pains or a fever.
What should I do also im really concerned about Fournier gangrene, can it develop over a year later ?

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