Vasectomy

Terms
Vas: The tube that transports sperm from the testes.
Vasectomy: Removal of a small portion of the vas.
Testes: The egg-shaped glands in the scrotum that make sperm and male hormones.
Epididymis: The small gland, outside of the testes, where sperm matures before entering the vas.
Prostate: The gland that makes seminal fluid. When mixed with sperm from the testes, it makes semen.

Reasons for having procedure
Questions
Anatomy
Procedure
Risks
Unique risks
Long-term effects

Reasons

  • You want to enjoy sex without worrying about pregnancy.
  • You do not want to have more children than you can care for and support.
  • Your partner has health problems that might make pregnancy difficult.
  • You don’t want to risk passing on a hereditary disease or disability.
  • You and your partner don’t want to, or can’t, use other kinds of birth control.
  • You want to save your partner from the surgery – and expense – of having her tubes tied.

You must be absolutely sure that you don’t want to father a child under any circumstances. You must talk to your partner since it is certainly a good idea to make this decision together. Talk about other types of birth control and talk to friends or relatives who have had a vasectomy. A vasectomy might not be for you if you are young; your current relationship is not permanent; you are having a vasectomy just to please your partner and you don’t really want it; you are under a lot of stress; or you are counting on reversing the procedure at a later time.

Questions
Will it hurt? When the local anesthetic is injected into the skin of the scrotum, it’s uncomfortable, but as soon as it takes effect, you shouldn’t feel anything. Afterwards, you’ll be sore for a couple of days and may want to take Tylenol.

How soon can I go back to work? You should be able to do routine work within 48 hours after your vasectomy, and heavy exercise and labor within a week.

Will the vasectomy change me sexually? The only thing that changes is that you won’t be able to make your partner pregnant. Your body will continue to produce the same hormones that provide your sex drive. You will make the same amount of semen. Vasectomy won’t change your beard, muscles, sex drive, erections, climaxes or voice. Some men say that without the worry of accidental pregnancy, sex is more relaxed than before.

Is the no-scalpel vasectomy safe? All vasectomies usually are safe and simple. Vasectomy is an operation and all surgery has some risk, but serious problems are unusual. To our knowledge, there are no long-term risks to vasectomy.

When can I have sex again? One week. After that, you must use protection until two negative sperm counts are recorded.

Anatomy
Sperm is produced in the testes. From there, sperm travels into a small gland that is located just outside of the testes, called the epididymis. It is here that the sperm stays for as long as six weeks to mature. The tubes of the epididymis join together at the very end of the epididymis to form one common tube called the “vas” or “vas deferens.” It is the vas that transports the sperm into the body where it enters the prostate gland. The prostate gland is responsible for making the seminal fluid that carries the sperm. The sperm from the testes plus the seminal fluid from the prostate join together to make semen. The semen is then ejaculated through the penis.

Procedure
A “no-scalpel” vasectomy is started by anesthetizing a small area of the scrotum (the skin sac that the testes are in) and then making a very small opening under the penis. This is accomplished after local anesthesia is injected under the skin. The surgeon makes the small opening with a special tool that spreads the skin open rather than cutting the skin. This technique allows quicker healing and less bleeding. The surgeon then moves each vas to the opening, removes a small piece and then seals the ends using heated cautery or a stitch.

With removal of the piece of the vas and the openings blocked, the sperm isn’t able to move into the prostate and, therefore, can’t be ejaculated. Infertility is the result. The operation usually takes 10 to 20 minutes, and most patients get up and walk out of the office soon after.

Risks
As with any operation, there are risks. There is a chance of bleeding, pain or infection.

Despite precautions, complications from vasectomy do happen. Some patients can have bleeding or infection. Some patients have pain in their incisions, and some people with vasectomies have pain around their testes or around the vasectomy site for a period of time. This happens, in part, because of the buildup of sperm that cannot get out. In almost all of these cases, the pressure in the testes that causes sensitivity finally goes away.

Another possible cause of pain is called sperm granuloma. This is caused when the sperm find their way out of the tied or cauterized end of the vas. This cannot be prevented in some circumstances, and the sperm that is released into the tissue is irritating and causes a small nodule. These nodules usually resolve in time as the body seals them off, but can persist and be painful. On rare occasions, a sperm granuloma needs to be removed. This involves simply re-doing the vasectomy.

Fortunately, all of these complications are rare. Most of the time, the pain that occurs is treated with a short course of anti-inflammatory drugs or pain medication.

Another possibility is an infection in the epididymis called epididymitis. This is rare and can be caused by the backpressure or infection or inflammation within the epididymis. Epididymitis is treated with bed rest, elevation and antibiotics, and almost always gets better quickly.

Unique risks of vasectomy
Vasectomy has a few unique risks or complications, and these include the possibility of recanalization. Recanalization means that even though a surgeon removed a piece of the vas and sealed the ends, they grow back together and make the man fertile again. In almost all instances, this happens within the first few months after the vasectomy. To ensure that this has not occurred, patients are required to undergo semen checks to make sure no sperm are seen. Once no sperm has been confirmed on two semen checks, two weeks apart, we feel sure that the patient is sterile and does not need to come in for another sperm testing.

Some patients have very poor migration of sperm in the vas after the vasectomy, and cases of persistence of sperm in semen checks can be seen from six months to a year. Although this is rare, and even if the sperm counts are low, we do not consider you sterile until we have had two completely negative sperm counts two weeks apart. If, after a prolonged period of follow-up, sperm continue to persist in the semen checks, particularly sperm that are active, we believe that a recanalization has occurred. This requires a repeat vasectomy on both sides.

Long-term affects of vasectomy
Another potential complication of vasectomy is the long-term effect of the procedure. Arguments have existed for years about the possible side effects. Large studies throughout the country have looked at groups of patients who have had and not had vasectomies, and almost all of these studies have shown absolutely no difference in any medical problems. However, a recent study suggested the possibility that there may be a slight increase in the chances of developing prostate cancer among men who have had vasectomy. This difference does not show up for more than 20 years, and the structure of the study is open to some criticism. Larger studies have not shown this same finding, and more studies are under way. We would be glad to talk to you about this if you have any questions.

For a patient appointment with a Washington University urologist, call (314) 362-8200 (Center for Advanced Medicine and Barnes-Jewish West County Hospital).