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Vasectomy is a safe, simple and effective birth control method.

One of the most common and popular means for contraception around the world is vasectomy - a brief, surgical procedure used for male sterilization. It is a popular means of birth control for couples that have decided that their family is complete. It is nearly 100% effective and is intended to be permanent.

A vasectomy is chosen by over 600,000 American men annually, and as many as 30 million men worldwide. The vasectomy procedure is uncomplicated, is commonly performed in a doctor's office and usually takes about 15 to 20 minutes.

Making a permanent decision.

When your family nest is full, or you have chosen not to father a child, vasectomy offers a permanent, safe, and worry-free choice in birth control. But is vasectomy for every man or every couple?

There are some general ground rules to consider first, as well as emotional and family concerns to discuss with your partner and physician. While the law may not require that you have the consent of your wife or partner, vasectomy or any contraceptive choice is best discussed and decided as a couple. It is not uncommon to require waiting periods for patients prior to vasectomy surgery so that you're confident in your decision.

A serious decision not to be made lightly or alone.

Couples should first explore all birth control methods available -- both the positive and negative aspects -- and discuss their feelings and thoughts about each, before sharing their concerns and choice with a doctor.

Vasectomy is a long-term, low-cost choice for contraception and should be considered permanent. It removes risk and uncertainty of unintended pregnancy, just as tubal ligation does, but without the additional cost, possible hospitalization and surgical time to the woman. And vasectomy does not pose the danger to men that other contraceptive methods may pose for women.

On the other hand, things change. You should be absolutely certain that you do not want to father a child later under any circumstances, even if there are significant changes in your future. While a vasectomy can sometimes be reversed, you should assume that it might not be possible to change your mind later.

Are there some men who should NOT have a vasectomy? Frankly, yes. You may regret having the procedure if you are too young at the time of your decision. Generally, there is no minimum age requirement except that you must be an adult. Common sense, however, suggests that "older is wiser."

Men under the age of 25... those who divorce young and remarry...or those who have the procedure immediately after the birth of a child, can come to regret the decision made too early in their lives. And regardless of the man's age, if the female partner is under the age of 25, couples may become dissatisfied with the decision.

Also, the decision to have a vasectomy should not be made based strictly on financial considerations. Your family income or circumstances may change and permit you to expand your family in subsequent years.

What about emotional considerations?

Experience suggests that you should not get a vasectomy to please someone else. The decision to father a child is yours -- and your partner's -- and no one else's.

If you have concerns about the stability of your current relationship, or your decision not to father a child in the future, a vasectomy may not be right for you at this time.

If you and your partner are experiencing sexual problems, fears, an unhappy relationship or just having difficulty communicating with each other about birth control options, it may not be a good time to decide about a vasectomy.

Vasectomy will not solve marital or sexual problems. But it can help you enjoy sexual relations more -- free from the fear of unwanted pregnancy. And it can the right choice if the female partner does not want or cannot take birth control pills or use other forms of contraception.

Who are the best candidates for vasectomy?

Because this is a personal decision, there are no absolute rules, and the best answer lies in being informed. However, here are some suggestions to consider as to who is a good candidate:

  • Men and their partners over the age of 25, who are seriously committed to not having more children now, or in the future.
  • Men for whom other forms of contraception are not safe alternatives for themselves or their spouse. Men who want to enjoy sex without the fear of unwanted pregnancy.
  • Men who do not feel 'forced' into this decision by others or financial circumstances.
  • Men who want to take the responsibility of contraception.
  • Men who are concerned about passing on a genetic disease or hereditary disability.
  • Before making a decision, discuss these and all related issues with your spouse, and seek the advice of your physician.

 

Vasectomy Anatomy & Terms

The Male Reproductive Anatomy - Here's a simple diagram that illustrates the primary elements of the male reproductive system.

 

 

A Brief Glossary

Some of the terms used throughout this site are briefly defined in the following list. Consult your doctor for a complete explanation or clarification.

Allergic Reaction - the itching and hives some men may experience as an allergic reaction to local or general anesthetic.

Antisperm Antibodies - Antibodies which form against one's own sperm once blood and sperm come in contact (usually during a vasectomy). These antibodies can bind onto the sperm and prevent them from fertilizing eggs, but they cause no health risks or symptoms otherwise.

Artificial Insemination - a procedure that involves the placement of relatively large numbers of healthy sperm either at the entrance of the cervix or into a women's uterus, bypassing the cervix, to have direct access to the fallopian tubes.

Assisted Reproduction Techniques (ART) - new forms of treatment for male and female infertility. Includes sperm retrieval, artificial insemination, in vitro fertilization and sperm microinjection (termed Intra-Cytoplasmic Sperm Injection).

Bladder - a muscular, elastic pouch that serves to store and expel urine.

Chronic Orchalgia - a rarely experienced dull ache in the testicles following vasectomy. This is generally believed to be caused if the epididymis becomes congested with dead sperm and fluid. It usually disappears within six months.

Congestion - a common name for chronic orchalgia.

Ejaculation - the discharge of seminal fluid at the moment of male sexual climax.

Ejaculation, retrograde - seminal discharge into the bladder rather than out the tip of the penis through the urethra.

Epididymis - tightly coiled, very small tubes covering the back and sides of the testis, where sperm are stored and mature after leaving the testis. From the epididymis, sperm migrate to the vas deferens.

Epididymitis - pain and/or swelling of the epididymis. The application of heat, the use of a scrotal supporter, and the use of anti-inflammatory medication and sometimes antibiotics usually clear this uncommon condition within a week.

Erectile Dysfunction - the inability for a sexually active male to obtain and sustain an erection for sexual purposes. Also called impotence.

Erection - state of male arousal in which the penis fills with blood, becomes turgid and hard.

Follicle Stimulating Hormone (FSH) - a pituitary (gland within the brain) hormone that stimulates the testes to make sperm.

Hematoma - bleeding inside the scrotum that may cause painful swelling shortly following a vasectomy. While seldom serious, it should be reported to a physician.

Hematospermia - the presence of blood in a man's ejaculation. Usually it is a benign condition due to a small ruptured blood vessel, and is usually of no consequences. Occasionally it may be related to an infection and can be treated with antibiotics.

Hydrocele - a collection of fluid around the testicle that causes a painless swelling, and is common to men in middle age.

Immune Reactions - following vasectomy, the immune system may recognize the absorbed sperm cells as foreign proteins and produce antibodies in response.

Impotence - also called erectile dysfunction; a condition of being unable to maintain an erection to ejaculate.

Infection - if blood collects under the skin following vasectomy, it can become infected, resulting in painful inflammation. Infection of the incision site, or deeper tissue, occurs in less than 5 percent of all cases. Such infections respond favorably to antibiotic treatment, antimicrobial creams and hot baths, usually within a week.

Infertility - partial or complete inability to cause or achieve pregnancy. The male factors are poor or no sperm count, poor sperm motility (movement) often seen with a varicocoele, and infection or obstruction of the vas deferens tube.

Inguinal Area - the abdominal region, common to hernia. Inadvertent blockage of the vas deferens may be the result of prior inguinal hernia surgery.

Insemination - semen successfully placed within the uterus, cervix or vagina.

Intracytoplasmic Sperm Injection (ICSI) - an in vitro fertilization procedure that requires the direct injection of a single sperm into an ovum to conceive.

In Vitro Fertilization (IVF) - a treatment for infertility in which a woman's egg and a suspension of sperm are incubated together in a culture dish (like a test tube), wherein fertilization occurs outside the female body. Once embryos are formed, they are placed back into the woman's uterus.

Libido - sexual desire.

Long-term Testicular Pain - postoperative testicular pain lasting longer than three months. Persistent testicular discomfort is rare. This uncommon complication may be the result of pinched nerves.

MESA - a general term usually referring to Microsurgical Epididymal Sperm Aspiration; see Sperm Aspiration.

Microsurgery - surgery using optical magnification provided by an operating microscope.

Microsurgical Fertilization - a procedure used to facilitate sperm penetration into the oocyte (the female egg); fertilization takes place under the microscope - also known as Intracytoplasmic Sperm Injection (see above).

Motility - movement of the sperm. Less motility means less chance of fertility.

Multiple Semen Analysis - the collection of at least two semen examples on separate days to examine consistency or discrepancies in the semen parameters of sperm count, sperm motility, sperm morphology (shape), semen volume, etc. A single semen analysis is not always representative of the "typical" semen from an individual male, as the semen parameters can fluctuate from specimen to specimen, from day to day, from season to season, and perhaps most importantly from lab to lab.

No-Scalpel Vasectomy (NSV) - a procedure which utilizes special instruments to puncture the scrotal skin and draw the vas out to allow it to be cut and tied. There is very little bleeding in this less invasive method of vasectomy, and in many cases, no stitches are necessary. Less pain and fewer complications are associated with No-Scalpel Vasectomy.

Oligospermia - abnormally low numbers of sperm in the semen.

Orchiectomy - surgical removal of one or both of the testicles.

Orchitis - painful inflammation or swelling of the testicle sometimes due to an infection.

Postoperative Pain - some degree of scrotal pain or ache is normal following a vasectomy. Painful discomfort normally disappears within a day or two, while a slight ache may remain slightly longer.

Premature Ejaculation (PE) - The inability to refrain from ejaculation prior to insertion of the penis into the vagina, or within only a few minutes of penetration such that the sexual encounter is unsatisfactory for the couple, and or deposition of sperm within the vagina in not able to be achieved reliably.

Priapism - persistent erection of the penis, usually accompanied by tenderness and pain.

Prostatalgia - pain in the prostate gland.

Prostate-Specific Antigen (PSA) - an antigen made by the prostate gland and found in the blood; an abnormal level may indicate cancer in the prostate gland.

Prostate-Specific Antigen (PSA) Blood Test - a blood test used to help detect prostate cancer by measuring a substance called prostate-specific antigen produced by the prostate. PSA is frequently elevated in prostate cancer and can be the first sign of this illness.

Prostate Gland - located below the bladder, the gland that contributes to seminal secretions and where the ejaculatory ducts, the vas deferens and the urethra join. Urine released from the bladder flows through this channel running through the center of this gland to enter the urethra of the penis.

Prostatitis - inflammation of the prostate gland, sometimes caused by infection.

Prostate and Testicular Cancer - there is no known increased risk of testicular cancer following vasectomy. However, artificially increased levels of testosterone over the long term are associated with an increased risk of prostate cancer. While there were earlier studies that suggested a possible relationship between vasectomy and prostate cancer, more recent studies do not support any causative relationship. Nevertheless, physicians agree that all men over the age of 50 should have regular prostate examinations and PSA blood testing.

Recanalization - spontaneous rejoining of the severed vas connection through the scar tissue. This can be detected by semen testing at regular intervals.

Scrotal Support - ("jock strap") a device, such as an athletic supporter, worn after vasectomy and reversal to decrease swelling and pain.

Scrotum - the sac that contains the testicles, epididymis and vas deferens.

Semen - the combination of sperm and glandular fluid released out of the urethra when a man ejaculates; normally a mixture of less than 1 percent sperm and 99 percent seminal fluid.

Seminal Vesicle - a gland that produces a component of seminal secretions, the fluid that is ejaculated by a man at sexual climax. The fluid transports and nourishes the sperm.

Sexually Transmitted Disease (STD) - infection that is most commonly spread through sexual intercourse and other intimate sexual and genital contact.

Sperm Aspiration - a general term usually referring to Microsurgical Epididymal Sperm Aspiration (MESA), a surgical procedure whereby live sperm are attempted to be extracted from the epididymis and preserved for in-vitro fertilization (IVF). MESA may be considered for men when the reproductive tract is blocked. Done under a microscope, the surgery is relatively safe,. Surgically retrieved sperm cannot be used for artificial insemination (intrauterine insemination), but must be used with ICSI (intra-cytoplasmic sperm injection) and IVF (in vitro fertility). Only ejaculated sperm will work with artificial insemination-either fresh or frozen/thawed.

Sperm Banking - the process of collecting (via ejaculation, electroejaculion, or surgically) and preserving sperm for possible future use. Typically, sperm samples are frozen in liquid nitrogen and can be stored for extended periods before thawing and used in assisted reproduction techniques such as artificial insemination or in vitro fertilization. Normally, there is a continuing cost for the storage service.

Sperm Disorders - problems with the production and maturation of sperm; a cause of male infertility. Sperm may be immature, abnormally shaped or unable to move properly.

Sperm Granulomas - a small and usually painless lump at the site of a vasctomy and caused by sperm leakage from the cut end of the vas. This does not pose a danger and usually resolves over time. Rarely, the immune system responds to sperm leakage with an inflammatory reaction. This reaction frequently resolves with the use of anti-inflammatory medication. The presence of a sperm granuloma can be a predictor of success for a vasectomy reversal.

Sterility - the physical inability to reproduce due to infertility.

Suture - the material (thread) used during vasectomy and vasectomy reversal surgery.

Testes - (testicles) located in the scrotum, the male reproductive glands that produce sperm and testosterone.

Testicles - see testes. Testicular Cancer - cancer that develops in a testicle.

Testosterone - the sex hormone produced by the male sex glands, which stimulates and controls the development of the reproductive organs, as well as male characteristics, including body and facial hair, low voice and muscle growth. Testosterone is very important for sperm production within the testicles.

Tubal Ligation - female sterilization surgery where the uterine tubes are cut and closed by ligation or various mechanical devices. A more extensive surgery than male sterilization (vasectomy) and done under general anesthetic.

Urethra - the passageway running from the bladder to the penis, which carries urine and semen outside the body.

Urology - a medical specialty for the diagnosis, treatment and surgical care of problems of the male and female urinary tract and the male reproductive system. Urology covers diagnosis and treatment for both adults and children. A urologist is a medical doctor with specialized surgical training in these areas.

Varicocoele - a dilation of the veins draining blood from the testicle back to the body. This increases blood and heat around the testicle, causing injury to the sperm. A varicocoele can be treated with surgery or interventional radiology (see Varicocele Embolization).

Varicocele Embolization - nonsurgical, outpatient interventional radiology procedure in which the varicocele is occluded or "closed off" with a balloon catheter or vessel-hardening (sclerosing) solution.

Varicocelectomy - surgical correction of a varicocele.

Vas Deferens - the two muscular tubes that carry sperm from the testicle and epididymis to the urethra of the prostate. Each tube is referred to as a Vas. Together, they are called Vasa.

Vas Remnant - the length of the vas deferens from the epididymis to the site of the vasectomy.

Vasectomy - a surgical procedure that produces infertility by blocking the transport of sperm through the vas deferens.

Vasoepididymostomy - a surgical procedure that reverses a vasectomy in the case where there is a second blockage due to scar tissue in the epiddymis, in addition to the scar tissue from the vasectomy procedure. In this procedure the vas deferens is reconnected to the epididymis so as to bypass both scars.

Vasovasostomy - conventional vasectomy reversal. A surgical procedure to restore fertility by reconnecting the ends of vas deferens that were severed when vasectomy was performed.

Here is what to expect.

Whether it is a traditional surgical or the less-invasive No-Scalpel vasectomy procedure, a successful vasectomy blocks the vas deferens, preventing sperm from becoming part of the seminal fluid that leaves the body at sexual climax. The vas deferens are the thin tubes in the scrotum that would normally carry sperm from the testicles to become part of the ejaculate. When the sperm channel is interrupted, the man becomes sterile and can no longer father a child.

A typical vasectomy is done in the doctor's office. Although your experience may vary somewhat, the following describes what you can expect...

GENERALLY: Some expectations and considerations.

What a vasectomy is:

  • It is a safe and simple male sterilization procedure.
  • It is highly effective (over 99 percent), but it is not guaranteed.
  • It is considered a permanent birth control option and procedure.

What vasectomy isn't:

  • It usually isn't painful - a local anesthetic takes care of that.
  • It isn't as invasive or as expensive as the sterilization procedure for women (tubal ligation).
  • It shouldn't be considered uniformly reversible.
  • It isn't immediately effective because sperm in the vas deferens may be viable for many weeks.

What vasectomy doesn't do:

It doesn't affect male hormone levels, since testosterone is released into the bloodstream, not through the vas.

  • Vasectomy shouldn't affect sexual function.
  • The semen appears the same, although the sperm is missing.
  • It doesn't protect against sexually transmitted diseases.
  • A vasectomy will not affect your manliness. The amount and appearance of semen will not change noticeably and sex will feel the same.

BEFORE: Preparing for your vasectomy.

There are some simple things that you can do to get ready for your office visit in advance of your appointment.

  • Do not take aspirin or other anti-inflammatory medication (e.g. Nuprin® Advil®, Motrin®) for 10 days before the procedure. Such medication can increase the risk of bleeding.
  • Your doctor will likely ask you to shave the front portion of the scrotum. Shower thoroughly and wear or bring clean, snug underwear or an athletic supporter on the day of your appointment.
  • It is better if you arrange in advance for someone to drive you home following the procedure. While you might feel able to drive, post operative discomfort could become distracting.
  • It is better if you arrange in advance for someone to drive you home following the procedure. While you might feel able to drive, post operative discomfort could become distracting.
  • While your time at the office may be about an hour, the vasectomy procedure itself only requires about 15 minutes in most cases.

DURING: The usual steps involved in the No-Scalpel, non-invasive vasectomy.

Your doctor may describe the routine to expect in his office and your experience may differ from these steps. Generally...

  • You may be asked to change into a gown and lie on the exam table.
  • The procedure site will be washed and shaved (if you weren't instructed earlier to shave).
  • Sterile drapes will be placed over you to guard against infection.

After a local anesthetic is administered, a small puncture is made in the scrotum. (The punctures in the skin may not require a scalpel.)

 

 

  • Either the right or left vas deferens is lifted through this opening. The vas is cut, and a section may or may not be removed. You may feel a pulling sensation during this process. The two ends of the vas are heat sealed (cauterized), tied or clipped, before being returned to the scrotum.
  • The opposite vas deferens is then lifted through the opening for the same procedure. The remaining opening can heal with closure by stitches or naturally without stitches.

AFTER: Care following the vasectomy.

Follow your doctor's instructions. It's a good idea to read written instructions in advance, review them with your partner and make preparations, if needed.

Any discomfort is usually mild and pain relievers should be used if necessary. The local anesthetic begins to wear off after an hour or so. Vasectomy recovery time after a No-Scalpel Vasectomy is usually less than after a traditional vasectomy.

To ensure a speedy, nearly painless vasectomy recovery time, look to your own physician for specific instructions. However, here are a few general guidelines following an uneventful vasectomy:

  • Go directly home and rest; elevate your feet. Plan to limit the time on your feet as much as possible for the first couple of days.
  • Your physician may prescribe an analgesic (pain pill) to control the pain after the local anesthetic wears off.
  • Apply an ice pack to the scrotum periodically during the first 24 hours after the procedure to ease swelling.
  • Wear snug cotton briefs or an athletic supporter to help apply pressure against the procedure area and for support of the scrotum during the first week.
  • Your semen will be collected (usually at home) and examined under a microscope after approximately six weeks and possibly later after surgery to assure that no sperm remain.

Contact your doctor if you experience fever and chills, increasing pain, drainage (sign of infection), a growing mass (sign of internal bleeding or infection) or other concerns.

All about vasectomy.The simplest and safest vasectomy method is the No-Scalpel Vasectomy (NSV), which, as the name suggests, requires no scalpel, no incisions (only two tiny punctures in the skin) and no sutures. It is performed with a local anesthetic to numb the area. The No-Scalpel Vasectomy is rapidly becoming the procedure of choice among patients and is also favored by many doctors.

Urologists perform most vasectomies, although up to 30 % are performed each year by family practitioners, depending on the location. Costs range from $500 to over $1,000 and is reimbursed by many health insurance programs.

In Summary:

  • A vasectomy is a safe and simple procedure.
  • It is one of the most common means for permanent contraception.
  • The procedure is over 99% effective and intended to be permanent.
  • The "No-Scalpel Vasectomy" method is popular with patients and doctors.
  • It is usually performed in the doctor's office in less than 30 minutes.
  • The cost is low and is often reimbursed by health insurance.

(Modified with permission from Vasectomy.com)