Vasectomy

A vasectomy is a surgical procedure performed as a method of birth control. It involves cutting the vas deferens to close off the tubes that carry sperm from the testicles (there is one vas deferens per testicle). If a man has a successful vasectomy, he can no longer get a woman pregnant.¹

Sperm are made in the two testicles, which are inside the scrotum. Sperm is stored in a tube attached to each testicle called the epididymis. When a man ejaculates, the sperm travel from the epididymis, through the vas deferens, and then mix with seminal fluid to form semen. The semen then travels through the urethra and out the penis.

Before a vasectomy, semen contains sperm and seminal fluid. After a vasectomy, sperm are no longer in the semen.² The man's testicles will make less sperm over time, and his body will harmlessly absorb any sperm that are made.³

A vasectomy is usually performed in the office of urologist, a doctor who specializes in the male urinary tract and reproductive system. In some cases, the urologist may decide to do a vasectomy in an outpatient surgery center or a hospital. This could be because of patient anxiety or because other procedures will be done at the same time.¹

There are two ways to perform a vasectomy. In either case, the patient is awake during the procedure, but the urologist uses a local anesthetic to numb the scrotum.

With the conventional method, the doctor makes one or two small cuts in the scrotum to access the vas deferens. A small section of the vas deferens is cut out and then removed. The urologist may cauterize (seal with heat) the ends and then tie the ends with stitches. The doctor will then perform the same procedure on the other testicle, either through the same opening or through a second scrotal incision. For both testicles, when the vas deferens has been tied off, the doctor will use a few stitches or skin "glue" to close the opening(s) in the scrotum.

With the "no-scalpel" method, a small puncture hole is made on one side of the scrotum. The healthcare provider will find the vas deferens under the skin and pull it through the hole. The vas deferens is then cut and a small section is removed. The ends are either cauterized or tied off and then put back in place. The procedure is then performed on the other testicle. No stitches are needed with this method because the puncture holes are so small.^2,3

After a vasectomy, most men go home the same day and fully recover in less than a week.

Vasectomy is one of the most effective forms of birth control. In the first year after a man has a vasectomy, a few couples will still get pregnant. But the number is far lower than the rates of pregnancy among couples using condoms or oral contraceptive pills.¹

However, a vasectomy is not effective right away. Men still need to use other birth control until the remaining sperm are cleared out of the semen. This takes 15 to 20 ejaculations, or about 3 months. Even then, 1 of every 5 men will still have sperm in his semen and will need to wait longer for the sperm to clear.²

A healthcare provider will check a man's semen for sperm at least once after the surgery. Once the sperm count has dropped to zero, it is safe to assume that the vasectomy is now an effective form of birth control.^2,3 Until that time, men need to use another form of birth control to make sure their partner does not become pregnant.

Although vasectomy is safe and highly effective, men should be aware of problems that could occur after surgery and over time.¹

Surgical Risks

After surgery, most men have discomfort, bruising, and some swelling, all of which usually go away within 2 weeks. Problems that can occur after surgery and need to be checked by a healthcare provider include:

• Hematoma. Bleeding under the skin that can lead to painful swelling.
• Infection. Fever and scrotal redness and tenderness are signs of infection.²

Other Risks

The risk of other problems is small, but they do occur. These include:

• A lump in the scrotum, called a granuloma. This is formed from sperm that leak out of the vas deferens into the tissue.³
• This is called postvasectomy pain syndrome and occurs in some men.⁴
• Vasectomy failure. There is a small risk that the vasectomy will fail. This can lead to unintended pregnancy. Among 1,000 vasectomies, 11 will likely fail over 2 years; and half of these failures will occur within the first 3 months after surgery.⁵ The risk of failure depends on a number of factors. For example, some surgical techniques are more likely to fail than others.⁶ Additionally, there is a very small risk that the two ends of the vas deferens will grow back together. If this happens, sperm may be able to enter the semen and make pregnancy possible.⁷
• Risk of regret. Vasectomy may be a good choice for men and/or couples who are certain that they do not want more or any children. Most men who have vasectomy, as well as spouses of men who have vasectomy, do not regret the decision.⁵ Men who have vasectomy before age 30 are the group most likely to want a vasectomy reversal in the future.⁶

Vasectomy will not affect your sex life. It does not decrease your sex drive because it does not affect the production of the male hormone testosterone. It also does not affect your ability to get an erection or ejaculate semen. Because the sperm make up a very small amount of the semen, you will not notice a difference in the amount of semen you ejaculate.^1,2