Vasectomy

Description
Vasectomy is an operation done to make a man sterile (unable to father a child). The procedure provides a permanent, reliable method of birth control. During the vasectomy, the doctor cuts and blocks the vas deferens (the two tubes on either side of the scrotum, the sac of skin that holds the testicles, that carry sperm from the testes to the penis). About 500,000 of these operations are done in the United States each year, making it one of the most common surgical procedures in the country.

Indications
Vasectomy is an option for men who want permanent sterilization.

Patient preparation
Typically, the doctor will have an initial consultation with you and your partner to make sure you both fully understand the benefits, risks and permanence of this procedure. The doctor will ask questions about your medical history and do a physical exam. Before giving your informed consent, share any concerns you have with your doctor. The procedure is typically done at a second appointment, which gives you additional time to make sure that your final decision is based on careful consideration.
It's also helpful to arrange for your care and recovery ahead of time. While you recover, you'll need plenty of rest, and it may be helpful to have some assistance with some daily activities.


Procedure
A vasectomy is usually an outpatient procedure typically done in a surgery center or the doctor's office. Although it's a simple procedure, it's important to find a doctor who has plenty of experience with the surgery and does it often, preferably at least 50 times a year. Typically, vasectomies are done by a urologist (a doctor who specializes in the male genital tract and the urinary tract of both sexes). Some family physicians and general surgeons are also trained to do vasectomies, however. There are two kinds of vasectomies: traditional and no-scalpel.
Traditional vasectomy
Medication to encourage relaxation is often given about an hour before the procedure. Then, the scrotum is shaved, cleansed with an antibacterial solution and numbed with a local anesthetic. The local anesthetic will also be used to numb the deeper tissues around the vas deferens. Then, the doctor will use a scalpel to cut one or two small openings in the scrotum. One at a time, the vas deferens are pulled through the opening(s) and cut. Then, both ends are sealed (typically by cautery, suturing or stapling) and placed back into the scrotum. The small incision(s) may be stitched closed or left to heal on their own. Gauze dressings may be applied to the area and held in place with an athletic supporter. The wound should seal within 24 hours.

The entire procedure takes less than an hour. You'll be observed for a short time before going home.

No-scalpel vasectomy
Medication to encourage relaxation is often given about an hour before the procedure. With the no-scalpel vasectomy, the penis is held upward onto the abdomen using a rubber band and clip. Then, the scrotum is shaved, cleansed with a warm antibacterial solution and numbed with a local anesthetic. To begin the procedure, the doctor will locate the vas deferens on one side of the scrotum and place a ring clamp around it to keep it in place. Then, a tiny puncture hole will be made and carefully enlarged with a special instrument. The doctor will pull the vas deferens through this opening, cut out a small part from it, seal the end, and place it back into the scrotum. Then, the identical procedure is done on the vas deferens on the other side of the scrotum.

No stitches are needed to close the tiny openings. Gauze dressings may be applied to the area and held in place with an athletic supporter. The wound should seal within 24 hours. The procedure takes about half the time of a traditional vasectomy. You'll be observed for a short time before going home.


Postprocedure care
For 48 hours after the procedure, rest as much as possible, preferably lying down or sitting with your legs up and testicles slightly elevated. Apply ice or cool compresses to the scrotum off and on during the first 24 hours, and take acetaminophen for pain. For scrotal swelling and bruising, it's helpful to wear supportive underwear or a scrotal support piece during the first few weeks of healing.
Follow your doctor's recommendations for activity restrictions after the surgery. For at least a week after the vasectomy, avoid heavy lifting and vigorous activity. Most men are able to resume normal activities within two to three days, but your doctor may tell you to wait a few days to one week or more before resuming sexual intercourse.

Your doctor will request semen specimens after your surgery. Usually, at least two semen analysis tests will be requested, typically at six weeks and three months after the surgery. A minimal number of ejaculations will be recommended to fully clear the tubing of any remaining sperm. If sperm is detected after three months (a rare occurrence), periodic repeat semen analysis must be continued. It's important to remember that another type of contraception must be used until your semen is found to be sperm-free.


Benefits
Vasectomy is considered one of the safest, most dependable and permanent methods of birth control.
For the no-scalpel vasectomy, additional advantages include:

no incision
no stitches
faster procedure
faster recovery
less chance of infection or other complications

Risks
Vasectomy is considered a simple and minor operation. Potential risks may include:
minor discomfort if the local anesthetic does not fully numb the area
reactions to anesthesia
infection
bleeding
Leakage of sperm from the vas deferens after a vasectomy may cause an inflammatory reaction and form a nodule called a granuloma. A granuloma may cause mild pain, but typically goes away on its own. Rarely, a granuloma may continue to grow in size and must be treated surgically.

Some studies have suggested a possible relationship between vasectomy and prostate cancer, while others have found no relationship. In 1993, the National Institute of Child Health and Human Development (NICHD) concluded that if there's any relationship, it's relatively small. A new study partially funded by NICHD, however, has found no increased risk of prostate cancer in men who've had vasectomies.


Considerations
A vasectomy may not be recommended if you have a major bleeding disorder or a history of significant allergic reaction to local anesthetics. It's important to remember that a vasectomy does not protect against sexually transmitted diseases.
Months or years after the procedure, there's a minimal chance that sperm can reappear in the semen and result in pregnancy for your partner. This may occur if the vas deferens grows back or a congenital duplication of the vas deferens was not treated during the vasectomy.

A vasectomy has no effect on testosterone, the male hormone responsible for a man's sex drive. Also, there is no physical impact on the ability to have an erection or experience orgasm. A vasectomy can have an emotional impact on your personal beliefs about what it means to be a man, however. You may experience feelings of grief and loss surrounding the inability to biologically father future children. If you have concerns about vasectomy before or after the procedure, talk with a trusted family member, friend or health care professional.

Before any type of sterilization, carefully consider issues that may be hard to think about, such as divorce or the death of your partner or children. You're not legally required to have your spouse or partner's consent for the procedure, but thoroughly discussing the decision is strongly recommended.


Reversing a vasectomy
Vasectomy is considered a permanent form of birth control, although it's sometimes possible to reattach the vas deferens once they've been severed. Referred to as a vasovasostomy, the procedure requires hospitalization and regional, general or spinal anesthesia. Considered a complicated procedure, the effectiveness increases if the vasectomy was fairly recent. Sperm quality and the possible development of antisperm antibodies affect the return to fertility. Sperm counts may take a long time to return to normal.