Vasectomy is simpler than tubal ligation and can be performed in an office setting with local anesthesia. Most vasectomies in this country are performed by urologists.

Xylocain, a local anesthetic, is injected into the skin. The physician makes a tiny incision in the skin over the vas deferens, cuts the tube, ties the ends, and puts a stitch or two in the skin to close it. The whole procedure takes twenty or thirty minutes. Most men find it less traumatic than they had imagined.

A vasectomy carries no risk to internal organs, since the vas deferens is outside the body cavity

A vasectomy carries no risk to internal organs, since the vas deferens is outside the body cavity

What are the risks or possible complications of a vasectomy?

A vasectomy is a low-risk procedure, and most men do not have any problems. Rarely, difficulties with bleeding arise, for example a hematoma (a swollen area filled with blood) or a blood clot in the scrotum. To help avoid these complications, some doctors recommend that men not take aspirin or aspirin-like products for a week before the procedure. Another risk is infection. If an infection develops, antibiotics may be needed, but they are not used routinely. A few men have an allergic reaction to the material used in the stitches, which usually goes away on its own. A few men report a nagging kind of discomfort in the scrotum on one side or the other for several weeks after the procedure, but this reaction also is uncommon.

How much does a vasectomy cost?

If a vasectomy is performed in an office setting, as perhaps 99 percent are, it costs in the range of five hundred to six hundred dollars. If it is done in a surgicenter, there is an additional surgical fee for the use of the operating room and possibly for an anesthetic.

How long is the recovery period?

After the procedure, the patient can simply get up and go home. The recuperation period is really very short: if someone has a vasectomy on Friday, he should take it easy over the weekend and go back to work on Monday. He should not resume vigorous physical activity — jogging or running, for example — for a week or two.

Are pain medications necessary after a vasectomy?

Some men need no pain medication at all; some need only ibuprofen. However, some physicians prescribe stronger pain medication (for example, Percocet).

How effective is vasectomy?

Although we really do not know the failure rate because of long-term follow-up issues, the best estimates are in the range of one failure in every one hundred to three hundred operations. These failures result from what is called recanalization of the vas deferens, which means that somehow a passageway opens in the tube that was tied off during the operation. In that case, the ejaculate will contain sperm.

The most common cause of “failure” is that people rely on the vasectomy too soon. Vasectomies are not effective immediately, because sperm in the duct downstream from where the vas was cut have to be ejaculated. Usually the urologist will suggest that the patient come back for a sperm count six or eight weeks after the procedure. A laboratory technician will examine a sample of the ejaculate under a microscope to make sure that all the sperm are gone.

To be absolutely certain that no sperm are still present, some doctors prefer two consecutive negative sperm analyses. The first one is done six weeks after the procedure and the second one two weeks later, a total of eight weeks after the operation. Until two sperm counts have shown that there are no viable sperm in the ejaculate, it is advisable to use backup birth control.

Abby, who has a family history of high blood pressure, had two children before she was 23. During her first pregnancy, she gained more than forty pounds and did not lose much of the weight afterward. During her second pregnancy, she gained even more weight and her blood pressure got significantly worse.

Therefore she and her husband decide not to risk a third pregnancy. He has a vasectomy, which seems reasonable considering Abby’s medical history. Unfortunately, despite our best educational efforts, Abby and her husband do not understand the need to use other birth control methods until his sperm count drops. They decide to celebrate his vasectomy and have sex the next day. She becomes pregnant once again. Her blood pressure is even higher this time.

Can men have erections after vasectomy?

Yes, all the male hormones that account for sex drive and performance and for other masculine physical and behavioral traits remain fully in force after a vasectomy. The only difference is that because the duct to the outside world is blocked, the sperm do not get out of the body. The scar is small and not easily visible, so it is really not evident that the procedure has been done.

The ejaculate itself remains the same to the naked eye. Although a lab technician can see through a microscope that no sperm are present, neither the man nor his partner can notice a difference.

Are vasectomies harmful to men’s health later on?

There are two myths, both unfounded, that men who have had vasectomies have greater risk of heart attack and of rheumatoid arthritis. No data support these notions. Some studies on macaque monkeys have shown that those with vasectomies had higher rates of atherosclerotic heart disease (in which fat and cholesterol build up inside the arteries) than a similar group without vasectomies, but no studies of humans have yielded similar results.

Other well-designed studies show that there is no documentable relationship between vasectomies and rheumatoid arthritis or prostate cancer. Certainly men who go to their urologists in order to have vasectomies can be diagnosed with other conditions, but only because the physical exam reveals those other problems.

Are vasectomies reversible?

A man who has a vasectomy should treat it as permanent. For this reason a few men donate sperm to a sperm bank before the procedure is done. There is a surgical procedure for reversing a vasectomy, but it is more expensive and more difficult than the vasectomy itself. It requires a general anesthetic and two or three hours of surgery. The success rate depends to some extent on timing of the reversal. If the vasectomy is reversed within five years, about 80 percent of men do have sperm in the ejaculate, with pregnancy rates approaching 50 percent. However, successful reversals have been reported as late as twenty years after the vasectomy.

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