Vasectomy is the most common surgical procedure used for male sterilization. In the United States, roughly one in five men over the age of 35 has had a vasectomy, and approximately 42 million men worldwide have undergone this operation. The decision to proceed with a vasectomy is a personal one, and we at The Urology Clinic want to make sure you have a clear understanding of the risks and benefits of the procedure, as well as the expected outcomes and follow-up procedures. Although vasectomy is a very reliable procedure, your cooperation with the follow-up schedule is essential. You must ensure that you have been cleared for unprotected intercourse prior to relying upon vasectomy to prevent pregnancy. In addition, vasectomy does not protect from sexually transmitted diseases.
The usual reason to undergo vasectomy is to create male sterility, that is, a situation where a man may no longer father children. This is accomplished by obstructing the flow of sperm from the testicles. Prior to vasectomy, the male uses a combination of several organs to produce semen. The seminal vesicles and prostate combine to produce roughly 98% of the ejaculate fluid. The remaining 2% is produced in the testicles and consists primarily of sperm, the male fertilizing element. The vas deferens is the conduit, or tube, through which the sperm travels from the testicles to join the ejaculatory ducts within the prostate. With the obstruction of the vas deferens, there is very little change in the amount of the ejaculation, and it bears no relationship to erection, the sensation of the sexual act, or the ability to ejaculate or climax.
In general, vasectomies are performed in the office at The Urology Clinic. Your physician may determine that the procedure needs to be done in our ambulatory surgery center, The Georgia Lithotripsy and Laser Center, or in the hospital. These decisions may be based upon the patient’s anatomy, anxiety, or the need for other surgical procedures.
After medications are given to ease anxiety, the scrotum is cleansed and prepped with an antiseptic solution and then covered with a sterile drape. If the scrotum was not shaven prior to surgery, this is completed prior to the skin preparation. Local anesthesia is injected into the skin over the vas deferens and into the cord itself, allowing excellent pain control. Although the patient will be aware of some pressure and movement, this “cord block” relieves operative and postoperative pain for several hours. The vas deferens is then isolated. We remove a small segment for pathologic confirmation, cauterize the vas lumen, and tie or place titanium clips on the ends. The incision or incisions are then closed with small dissolvable sutures.
After vasectomy, the testicles continue to produce sperm, but it is absorbed at roughly the same rate as it is produced. It is important to recognize that although no new sperm reach the ejaculate at this point, live sperm living beyond the site of vasectomy (in the vas or seminal vesicles) CAN allow a male to continue to father children for several months. In addition, rarely during the process of healing, new channels can form between the cut ends of the vas deferens, allowing new sperm to reach the ejaculated semen. This is found to happen at a rate of 4/1000 or 0.4%. For both of these reasons, it is absolutely essential to have the semen checked for residual sperm after several months to ensure complete clearance. You must continue to use other forms of contraception during this time. We request an office semen analysis in 6-8 weeks, at which time approximately 80% of men are free of sperm. If sperm are present, the man must still use other forms of contraception and bring in samples on a monthly basis until clear (usually within a few months). Rarely, motile or non-motile sperm can recur after an examination showing no sperm in the ejaculate. In addition, in up to 1% of cases, persistent non-motile (likely not living) sperm can be seen for 6-12 months or longer after vasectomy. Therefore, it is very important to keep to the follow-up schedule to verify an absence of sperm before relying on vasectomy for contraception.
Although a very safe and very common procedure, vasectomy is not without some risks and side effects. For the first several days after the procedure, you will likely have some heaviness and discomfort in the testicles, particularly with activity. This discomfort decreases week by week and usually by 2-3 weeks has completely resolved. There is commonly some swelling and bruising in the scrotum, and wearing a scrotal supporter or tight underwear for several days as instructed will decrease this.
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