Vasectomy

Vasectomy Meaning

A vasectomy to cut or tie off the vas deferens (which carries sperm) renders men sterile but does not affect potency. Semen is produced primarily by the seminal vesicles (60 percent) and the prostate (30 to 35 percent) with lubricant from Cowper's (bulbourethral) glands. The vas deferens carry sperm from the testicles during ejaculation but provide only a very small amount of the volume of semen. Therefore, if you have a vasectomy to prevent the sperm from entering the semen, you will notice no difference in the character or volume of your semen.

Conventional Vasectomy

In conventional vasectomy, according to Cornell University Center for Male Reproductive Medicine and Microsurgery, the surgeon locates the vas deferens cords on both sides and provides a local anesthetic in the surgical area either by injection or by a less uncomfortable pressure gun. Then, the surgeon makes a small incision (1 to 2 cm) over the vas deferens on one side (and later on the other) and pulls a loop of the vas deferens out.

Severing the Vas Deferens

The surgeon can use different methods, including cutting the vas deferens and tying off or cauterizing (burning) the ends or placing small metal clips on the cut ends. Some remove a portion of the vas deferens. Others suture or clip a part of the sheath (covering) of the vas deferens over the cut end. The vas deferens is placed back inside the incision and the opening is sutured closed, and then the surgeon uses the same procedure for the other side. The surgeon may choose to leave the cut end closest to the testicle open as this reduces discomfort.

Microsurgical Vasectomy

According to Vasectomy Medical, a newer microsurgical vasectomy requires only one very small (4 mm) puncture opening in the scrotum. The surgeon uses this opening to insert a small instrument to grasp the vas deferens on one side and then the other. The rest of the procedure is similar---the vas deferens is pulled through and cut, cauterized, or tied off. Because the surgical opening is very small, there is almost no bleeding and less discomfort after surgery, and the opening does not need suturing as it will heal on its own.

Vasectomy Procedure :

* Your testicles and scrotum are cleaned with an antiseptic and possibly shaved.

* You may be given an oral or intravenous (IV) medicine to reduce anxiety and make you sleepy. If you do take this medicine, you may not remember much about the procedure.

* Each vas deferens is located by touch.
 
* A local anesthetic is injected into the area.
 
* Your doctor makes one or two small openings in your scrotum. Through an opening, the two vas deferens tubes are cut. The two ends of the vas deferens are tied, stitched, or sealed. Electrocautery may be used to seal the ends with heat. Scar tissue from the surgery helps block the tubes.

* The vas deferens is then replaced inside the scrotum and the skin is closed with stitches that dissolve and do not have to be removed.

The procedure takes about 20 to 30 minutes and can be done in an office or clinic. It may be done by a family medicine doctor, a urologist, or a general surgeon.

What To Expect After Surgery

Your scrotum will be numb for 1 to 2 hours after a vasectomy. Apply cold packs to the area and lie on your back as much as possible for the rest of the day. Wearing snug underwear or a jockstrap will help ease discomfort and protect the area.

You may have some swelling and minor pain in your scrotum for several days after the surgery. Unless your work is strenuous, you will be able to return to work in 1 or 2 days. Avoid heavy lifting for a week.

You can resume sexual intercourse as soon as you are comfortable, usually in about a week. However, you can still get your partner pregnant until your sperm count is zero. You must use another method of birth control until you have a follow-up sperm count test 2 months after the vasectomy (or after 10 to 20 ejaculations over a shorter period of time). Once your sperm count is zero, no other birth control method is necessary.

A vasectomy will not interfere with your sex drive, ability to have erections, sensation of orgasm, or ability to ejaculate. You may have occasional mild aching in your testicles during sexual arousal for a few months after the surgery.

Why It Is Done

A vasectomy is a permanent method of birth control. Only consider this method when you are sure that you do not want to have a child in the future.

How Well It Works

Vasectomy is a very effective (99.85%) birth control method. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy.3

Risk of failure

Pregnancy may occur after vasectomy because of:

* Failure to use another birth control method until the sperm count is confirmed to be zero. It usually takes 10 to 20 ejaculations to completely clear sperm from the semen.
* Spontaneous reconnection of a vas deferens or an opening in one end that allows sperm to mix with the semen again. This is very rare.

Vasectomy Complications :

The risk of complications after a vasectomy is very low. Complications may include:

* Bleeding under the skin, which may cause swelling or bruising.

* Infection at the site of the incision. In rare instances, an infection develops inside the scrotum.
 
* Sperm leaking from a vas deferens into the tissue around it and forming a small lump (sperm granuloma). This condition is usually not painful, and it can be treated with rest and pain medication. Occasionally, surgery may be needed to remove the granuloma.
 
* Inflammation of the tubes that move sperm from the testicles (congestive epididymitis).

* In rare cases, the vas deferens grows back together (recanalization), and the man becomes fertile again.

What To Think About

Advantages

Vasectomy is a permanent method of birth control. Once your semen does not contain sperm, you do not need to worry about using other birth control methods.

Vasectomy is a safer, cheaper procedure that causes fewer complications than tubal ligation in women.1

Although vasectomy is expensive, it is a one-time cost and is often covered by medical insurance. The cost of other methods, such as birth control pills or condoms and spermicide, is likely to be greater over time.

Disadvantages

A vasectomy does not protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV). Condoms are the most effective method for preventing STDs. To protect yourself and your partner from STDs, use a condom every time you have sex.

Other considerations :

If you are considering a vasectomy, be absolutely certain that you will never want to father a child. Think through whether this might change after any of the following life events:

* One of your living children dies (if you are a father).

* You divorce and lose custody of your children.

* You have a new partner who wants children.

* Your financial situation improves and you can afford another child.

* Your children grow up and leave home.

A vasectomy is not usually recommended for men who are considering banking sperm in case they decide later to have children. Discuss other options with your partner and your health professional.

Surgery to reconnect the vas deferens (vasectomy reversal) is available. However, the reversal procedure is difficult. Sometimes a doctor can remove sperm from the testicle in men who have had a vasectomy or a reversal that didn't work. The sperm can then be used for in vitro fertilization. Both vasectomy reversal and sperm retrieval can be expensive, may not be covered by insurance, and may not always work.

Some older studies showed a risk of prostate cancer in men who have had vasectomies. However, many years of research have found no clear evidence that vasectomy is linked to prostate cancer.1

Some doctors or health insurance plans may require a waiting period from the time you request a vasectomy and the time the procedure is done. This time allows you to be certain about your decision.

Researchers are studying other male birth control methods, such as reversible vasectomy or hormonal methods. Reversible vasectomy involves plugging the vas deferens and then removing the plug when birth control is no longer wanted. Hormonal methods include pills or injections that the man would use to prevent sperm production. So far, no new method has been shown to be effective enough, with low side effects, to be marketed for men.

Vasectomy Methods	Conventional Vasectomy	Microsurgical Vasectomy