Department of Urology

Minimally Invasive Vasectomy

Overview

Vasectomy is a minor surgical procedure for male sterilization. The purpose of vasectomy is to prevent sperm from entering the seminal fluid by blocking the vas deferentia.  As a result, the female egg cannot be fertilized after intercourse.

Vasectomy should be considered a permanent birth control procedure, although this surgery can be reversed in most cases.

Vasectomy is one of the safest and most effective forms of permanent contraception, provided that the patient is aware of and understands the potential risks associated with the procedure.

Description

Vasectomy is performed under local anesthesia in a hospital or doctor’s office. The surgery takes approximately 20-30 minutes to perform. A small incision or puncture is made in the scrotum and the sperm duct, or vas deferens, on each side is cut, and the ends sealed with cautery, sutures or metal clips and returned to the scrotum. The skin cut is closed with dissolvable sutures or, alternatively, with the “no-scalpel” technique, no skin sutures may be needed.

Preoperative Considerations

Benefits of Vasectomy

Vasectomy is a simple, quick and safe method to prevent unwanted pregnancy. The recovery period is short, and patients can return to work and their regular lifestyle fairly quickly.

Sexual activity, penile sensitivity and male hormone production are not affected by vasectomy, and there is no appreciable decrease in the semen volume. After a vasectomy, the testicles continue to produce sperm which then disintegrate and, like other dead cells within the body, are reabsorbed. Some patients find that freedom from the fear of producing an unwanted child results in an improvement in the mutual enjoyment of sexual relations, sometimes making it more spontaneous and frequent.

Alternative Methods for Contraception

A vasectomy may not be the best contraceptive choice for everyone.  Although vasectomy is reversible, it should be considered a relatively permanent form of contraception.

Other methods of birth control available are:

Cervical Diaphragm
Condoms
Contraceptive Creams or Jellies
Contraceptive Foam
Implantable Contraceptives
Intrauterine Device (IUD)
Oral Contraceptives
Rhythm Method
Tubal Ligation                            .

Cryopreservation of Sperm Before Vasectomy

Cryopreservation or sperm banking is available as an option for those men considering vasectomy or permanent sterilization. Although not recommended for all couples, some couples may elect to pursue this option. Please inform Dr. Walsh or a member of his team if you wish to bank sperm prior to your vasectomy.

Vasectomy and Long-Term Health Problems

Since vasectomy became popular as a means of permanent sterilization in the late 1950’s, isolated studies have raised concerns from time to time regarding general health hazards that might be associated with elective vasectomy including coronary artery disease, prostate cancer and frontal lobe dementia.  The interpretation of such studies has been controversial and panels of urologic experts have agreed that vasectomy remains a very safe procedure.

Postoperative Care

The procedure is associated with mild discomfort and most men are able to return to work in 1-2 days. A small amount of oozing blood (enough to stain the dressing) and swelling occur in the area of the incision and are not unusual. This should subside within 72 hours. Occasionally, the skin of the scrotum and base of the penis turn black and blue. This is not painful, lasts only a few days, and goes away without treatment.  Rarely (<2%), a small blood vessel may escape into the scrotum and continue to bleed and form a clot of blood.  A small clot will be reabsorbed by the body with time, but a large one is painful and usually requires reopening of the scrotum and drainage. Hospitalization and a general anesthetic may be required for this purpose.

For a period of 3 to 5 days following the vasectomy, sex should be eliminated. Strenuous exercise (for example climbing, riding motorcycles or bicycles, playing tennis or raquetball) should also be avoided for 3 to 5 days, and nothing heavier than a few pounds should be lifted. The reason for these restrictions is that these activities are sometimes associated with complications.

The surgical procedure is not always 100% effective in preventing pregnancy because, on rare occasions, the cut ends of the vas may rejoin. This occurs very infrequently, at a rate of approximately 1 in every 600 vasectomies.

Since sperm can survive from the point where the cords were cut for a period up to several months, it is very important that another form of contraceptive be used until sterility is assured. To determine when the ejaculate is devoid of motile sperm, a semen specimens must be brought in for microscopic examination beginning approximately 3 months after the procedure.  The specimen must demonstrate no swimming sperm before unprotected intercourse is allowed. Occasionally, it may take 6 months or longer after the procedure to flush out all the sperm.

Physicians

Thomas J. Walsh, MD, MS