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Every year, more than 500,000 men in the United States are choosing sterilization by vasectomy as their method of birth control. Vasectomy is a simple, safe, and effective surgical procedure that blocks the flow of sperm by cutting the tube in the scrotum.
The only aspect of your life that is changed by having a vasectomy is your ability to father a child. However, because a vasectomy must be viewed as an irreversible procedure, it is a serious step to take and your decision should be a shared one with your partner.
Before deciding to have a vasectomy, make sure you and your partner understand all the facts. Above all, be clear and comfortable in your reasons for having a vasectomy, and bear in mind that sterilization should not be viewed as a solution for sexual or marital problems.
There are many questions you and your partner will need to think about. You must be certain that you do not wish to have any more children. You will also have to consider the possibility of divorce and remarriage; if you were to marry again, you might want to have children. You should not have any doubts about such issues if you are going to have a vasectomy.
It is important to keep in mind that, if you should change your mind about wanting another child after you've had a vasectomy, you'll have to undergo a major operation that is not guaranteed to restore your ability to father a child.
If you choose to have a vasectomy, your health care provider will ask you to sign a consent form beforehand which states that you are aware of the risks involved. Be certain all your questions have been answered before you sign the consent form. Your health care provider may want to discuss the procedure with both you and your partner before proceeding with the operation.
DESCRIPTION
A vasectomy involves cutting and tying the vas deferens (sperm channels inside the scrotum). The surgery stops the flow of sperm, and provides a safe, effective form of birth control without affecting sexual desire or ability. Personal counseling prior to the procedure is important to be sure the man obtaining the sterilization and his partner understand all aspects of a vasectomy.
So that you can better understand what a vasectomy is, you need to understand how your reproductive system works.
1. Tiny Sperm Cells and male hormones are produced by separate systems in the testes.
2. Sperm are stored in the epididymis where they mature.
3. The sperm are moved up the vas deferens within the spermatic cord.
4. Sperm can be stored along the upper part of the vas deferens for many weeks.
5. The seminal vesicles and the prostate secret sticky, white fluids which nourish and carry the sperm along.
6. When you have an orgasm, semen (98% fluid, 2% sperm) is ejaculated through the urethra.
THE EFFECTS OF A VASECTOMY
A vasectomy leaves your reproductive system essentially unchanged. The only difference is that sperm cells are blocked from traveling through the vas deferens. The testes still produce sperm cells, but they die and are absorbed by your body. Your male hormone level remains the same, and your secondary sexual characteristics - such as hair distributions and the pitch in your voice - are not affected. A vasectomy does not effect your ability to have an erection, nor does it interfere with urinating. In short, life seems just the same as before. The only difference being, you will not be able to reproduce and have more children.
REASONS FOR PROCEDURE
Voluntary sterilization.
Recurrent epididymitis when caused by chronic prostate infection.
RISK INCREASES WITH
Emotional instability.
Recent illness, especially one with fever.
DESCRIPTION OF PROCEDURE
HAVING A VASECTOMY
The procedure may be performed in the health care provider's office, outpatient surgical facility or hospital. You will be asked to sign a consent form beforehand which states that you understand that there can be certain risks involved and that the procedure cannot be guaranteed to make you sterile.
Preparing For Surgery
Before coming in for surgery, you'll need to shower, making sure to bathe your scrotum thoroughly. You should wear clean underwear to the health care provider's office or hospital.
What Happens During A Vasectomy
After you undress completely, the area around the incision will be washed and shaved (you may be asked by the surgical urologist to shave the area before coming in to his/her office for the surgery...I had the pleasure of doing this with my husband!). After shaving and washing with antibacterial solution, you will be draped with surgical sheets.
A local anesthetic by injection is administered. This will prevent you from feeling pain as your surgeon does the incisions.
One or two incisions, about 1/4 to 1/2 inch long are made on both sides of the scrotum. The vas deferens, which lies just below the skin, is identified, tied in two places and cut between the ties. A section of the tube is removed and sent to the pathology laboratory for inspection. The two ends are tied or clipped close, or they may be cauterized (sealed by heat). You may feel a sensation of pulling while the tube is being lifted out and cut.
The divided vas deferens is returned to the scrotum.
The edges of incised skin are reconstructed with fine sutures, which usually fall out in about 7 days or the incision may be closed using a small bandage.
Another method utilized for vasectomy is called "no-scalpel technique". It requires 2 specialized instruments and avoids the usual surgical incision. It requires no sutures to close the surgical site and may result in fewer complications. Some men may not be appropriate candidates for this procedure because of differences in scrotal anatomy.
After The Surgery
After the surgical operation, you will probably rest on the operating table for a few minutes. When you first get up, you might feel a bit wobbly, but you won't experience pain since the anesthetic is still working and probably won't wear off for an hour or two. Your health care provider can prescribe pain medication if you need one, but the discomfort is usually not severe. Any discomfort will be greatest during the first 24 hours. You will need to have someone take you home following the surgery.
Note: Many insurance policies will pay for or reimburse you for a vasectomy. Make sure you check your insurance policy.
EXPECTED OUTCOME
Expect sterility without complications. You may have up to 30 ejaculations before sperm completely disappear from semen. Allow 2 to 3 days for full recovery from surgery.
POSSIBLE COMPLICATIONS
Healing After Surgery
For a period after surgery you may have a dark discoloration around the genital area (some bruising), and there may be a small amount of bloody discharge from your incision. These are considered normal, and they may be accompanied by slight pain and a little swelling.
As with all surgery, even a minor operation like vasectomy carries with it the possibility of complications. Those that may occur soon after your vasectomy are the following:
- Internal bleeding and collection of blood in the scrotum may cause increasing pain, great swelling, or an enlarging mass. If you have these symptoms, which usually occur within 2 days after surgery, call your health care provider.
- Infection. Surgical wound infection in the incision very rarely occurs a short time after surgery. If you suspect or have symptoms of infection, call your health care provider.
- Sperm granuloma (benign lump in the surgical area). This occurs in 3-5% of all vasectomies and is a painful lump at the site where the vas deferens is tied off, and is caused by a leakage of sperm. Although the lump usually dissolves by itself, surgery is rarely necessary to remove it.
- Congestion caused by sperm left in the epididymis may cause some pain about 3 to 12 weeks after surgery. The congestion usually disappears without the need for treatment.
- Sperm antibodies in the blood are a normal response of the body to proteins formed from absorbed sperm. As of this time, these antibodies have not been found to be harmful.
- Spontaneous formation of a new vas deferens through the scar tissue left by the vasectomy very rarely occurs resulting in a small possibility of re-establishing fertility. This can usually be detected within the first few months after surgery by a semen test. Until your health care provider has done this test, you cannot be certain that you are sterile.
- Pregnancy may still occur in about 1% of cases (often as a result of unprotected intercourse too soon after the procedure).
TREATMENT
GENERAL MEASURES
When You Get Home
Arrange for a ride home. Once you are at home, there are several things you can do to aid your recovery and to help prevent complications.
- Wear an athletic support for 24 hours (or longer), but some men may find a supporter too tight and confining. If this is the case for you, you will probably find it more comfortable if you wear a pair of cotton, jockey-type undershorts that provide you with some support.
- Rest in bed for 24 hours, or at least try to stay off your feet as much as possible for the next 2 days. This will reduce the chances of swelling.
- Apply ice bags to both sides of the scrotum (outside of the athletic support) for 20 minutes per hour for the first 6 to 8 hours.
- Hard blunt ridges should form along the incisions. While healing, the ridges will recede gradually. Keep the incision area clean and dry.
- Use an electric heating pad, a heat lamp or a warm compress to relieve incisional pain (beginning 24 hours after surgery).
- Shower as usual (avoid hot baths or showers for 24 to 48 hours following surgery to protect your incision).
- Avoid any heavy lifting or vigorous exercise for 5 days after surgery. If your job is not a strenuous one, you can usually return to work on the third day after your surgery.
- Sexual activity can be resumed in about a week. However, it is absolutely essential that you use another form of birth control until your sterility is confirmed by the health care provider with a zero sperm count result. To make sure no sperm are left in your semen, you will be asked to collect a sample (usually at home and put in a clean pill bottle or small jar) and bring the semen sample to the health care provider's office for testing. Your health care provider will examine your semen under a microscope, and will tell you when there is no longer any evidence of sperm. Then - and only then - can you be considered sterile. You first test will usually be about 6 weeks after surgery and another test is given about 4 months after surgery. Remember, until you have been told that you can stop, continue using other methods of birth control! One sperm can be too many and result in an unwanted pregnancy.
- Your health care provider may want to see you in 2 or 3 days to check your progress.
MEDICATION
Prescription pain medication should generally only be required for 2 to 7 days following the procedure.
Non-prescription drugs, such as acetaminophen, may be used for minor pain. Avoid aspirin because of increased bleeding risk.
Antibiotics, if needed to fight infection.
ACTIVITY
Return to daily activities and work as soon as possible (usually 2 to 3 days after surgery.
Avoid strenuous activity for 5 to 7 days. Don't swim until the incision is healed.
Sexual relations may be resumed 1 week after surgery. Use birth control measures until laboratory studies confirm sterility (about 12 weeks).
DIET
No special diet. However, you should follow a healthy, balanced nutritional program for a healthy immune system and to assist in a rapid recovery from your surgery.
MoonDragon's Nutrition Information, Guidelines, Dietary Recommendations
NOTIFY YOUR HEALTH CARE PROVIDER
WHO PERFORMED THE SURGERY IF...
Pain, swelling, redness, drainage or bleeding increases in the surgical area.
Signs of infection develop: headache, muscle aches, dizziness or a general ill feeling and fever.
LIVING WITH A VASECTOMY
A vasectomy will not affect your manliness in any way because it has no effect on the male hormones produced by the testes. Nor will it alter your sexual functioning. You will still have the ability to have an erection and an orgasm, and the amount of semen ejaculated will not decrease noticeably.
Sexual relations will have the same sensations and excitability as before. If you had a good relationship before a vasectomy, it will be the same afterwards. Your mutual enjoyment may actually improve because you will no longer be afraid of unwanted pregnancy, and sex may be more spontaneous because birth control is no longer necessary.
A CHANGE OF HEART
Sometimes an unforeseen event in your life may cause you to seek to have a reversal of your vasectomy. Although vasectomy must be considered irreversible, there is a surgical procedure called a vasovasostomy that may work to restore your fertility. In a vasovasostomy, the cut vas deferens are reconnected to reestablish the flow of sperm. It is a major operation that is quite expensive and it is usually not reimbursable by health insurances. Most important, though, a vasovasostomy cannot guarantee to restore your ability to father a child.
SPERM BANKS
Another possibility that might enable you to have children after your vasectomy is a sperm bank. Before your vasectomy, your sperm is collected, then frozen and stored until you want to have a child. Sperm banks are available only in certain areas of the country, though, and success in achieving pregnancy with "frozen sperm" can be uncertain.
ALTERNATIVE METHODS OF BIRTH CONTROL
After reviewing the benefits and risks of vasectomy, you may want to consider alternative methods of birth control. Before deciding on a vasectomy, you should be familiar with these methods. Discuss them with your partner so that you both understand the choices.
Remember no form of birth control is 100% effective, and the effectiveness of any nonpermanent method depends largely on your using that method correctly.
NON-PERMANENT METHODS FOR MEN
As a man, you can assume responsibility for birth control with these methods:
THE CONDOM
The condom is a thin, rubber sheath that fits over the penis. It is put on before sexual intercourse and also helps to protect against venereal disease. Its actual use effectiveness is about 90% or so. For more information about condoms, see these webpages:
WITHDRAWAL METHOD
Withdrawal of the penis from the vagina before the semen is ejaculated is probably the least effective form of birth control. Semen leakage sometimes occurs before ejaculation and it may be very difficult for a man that has little or no control over his orgasm, in which case he may not be able to remove the penis from the vagina in time to prevent some semen spillage into the vagina.
NATURAL FAMILY PLANNING
This method, often called the "rhythm method", requires participation by you and your partner together, and is about 75 to 85% effective for most couples who use it. You'll have to abstain from sex during her fertile period, which lasts from 5 to 15 days during each menstrual cycle. For this method to be successful, your partner must know when she will probably ovulate. You'll need to learn about this method from your midwife, your health care provider, or a family planning clinic.
BIRTH CONTROL FOR WOMEN
These are the birth control methods used by women. Your partner should consult her health care provider first to find out which method may be best for her.
ORAL CONTRACEPTION (THE PILL)
Birth control pills are a widely used method of contraception. Oral contraception is 90 to 95% effective for most women. There can be many side effects, some may be significant. A prescription is required.
Other hormone-based contraception besides oral contraception are available. Many of these have the same risks and contraindications as the oral method.
The IUD (INTRAUTERINE DEVICE)
The IUD is a small metal or plastic device that is placed in the uterus to prevent a fertilized egg from attaching to the uterine wall. There can be some risks and side effects. Its effectiveness is about 95%. A prescription is required.
BARRIER METHODS (DIAPHRAGM, CERVICAL CAP, FEMALE CONDOM, SPONGE)
All of these methods are barrier methods of contraception that covers the cervix and prevents sperm from entering the uterus. They are generally is used with a spermicidal foam, jelly, or cream and it's effectiveness varies depending on frequency and correct usage. A prescription may be needed for some methods and a fitting may be required by your midwife, clinic, or health care provider, depending upon the method chosen.
For more detailed information about contraceptive methods see:
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