MoonDragon's Womens Health Information
"For Informational Use Only"
For more detailed information contact your health care provider
about options that may be available for your specific situation.
The Vasectomy Choice Vasectomy Description Reasons For Procedure Risk Factors Vasectomy Surgical Procedures Expected Outcome Vasectomy Potential Complications Post-Procedure Care Medication Activity Recommendations & Restrictions Diet & Nutrition Recommendations Following Surgery Notify Your Health Care Provider Who Performed The Surgery Living With A Vasectomy A Change of Heart - Vasectomy Reversal Sperm Banking Before Surgery Alternative Birth Control Methods Non-Permanent Birth Control Methods For Men Birth Control Methods For Women
THE VASECTOMY CHOICE
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.
Consider your choices of birth control methods, including sterilization by vasectomy.
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.
Discussing choices with others that have had a vasectomy and 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.
You should discuss with your partner whether or not you want to have any more children before deciding on a vasectomy.
It is important to keep in mind that, if you should change your mind about wanting another child after you have had a vasectomy, you will have to undergo a major operation that is not guaranteed to restore your ability to father a child.
It is important to consult with your health care provider and your partner about the vasectomy procedure and whether or not it is the right choice for you and your situation.
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.
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.
Risks increase with emotional instability. Risks increase with recent illness, especially one with fever.
VASECTOMY SURGICAL PROCEDURES
HAVING A VASECTOMY
The vasectomy 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. The procedure takes about 20 to 30 minutes and can be done by a family practitioner, a urologist or a general surgeon.
PREPARING FOR SURGERY
Before coming in for surgery, you will need to shower, making sure to bathe your testicle-scrotum region 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 scrotum area before coming in to his/her office for the surgery. You may have your wife or partner assist you with this to make sure it is done thoroughly without any missed spots or areas and without cuts and nicks (I had the pleasure of doing this with my husband in preparation for his surgery... MoonDragon Midwife). After shaving and washing the testicular-scrotum area with antibacterial solution, you will be draped with surgical sheets.
You may be given an oral or intravenous (IV) medicine to reduce anxiety and make you sleepy. If you do take this medicine, you may not remember much about the procedure.
Each vas deferens is located by touch. A local anesthetic by injection is administered and injected into the area. 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. The vas deference tube is pulled slightly through the openings where they are tied in two places and cut between the ties (stitches or clips may be used or electrocautery may be used to close and seal the ends with heat resulting in scar tissue from the surgery that helps to block the tubes). A section of the tube is removed and sent to the pathology laboratory for inspection. 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 or dissolve in about 7 days and do not need to be removed. The incision may be closed using a small bandage.
NO-SCALPEL VASECTOMY METHOD
Another method utilized for vasectomy is called "no-scalpel technique". It requires 2 specialized instruments and avoids the usual surgical incision. The technique uses a small clamp with pointed ends instead of a scalpel to to cut the skin. The clamp is poked through the skin of the scrotum and then opened. the benefits of this procedure include less bleeding, a smaller hole in the skin, 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. No-scalpel vasectomy is as effective as traditional vasectomy.
NO-SCALPEL VASECTOMY (NSV) PROCEDURE
The No Scalpel Ring Clamp isolates and secures the vas deferens without penetrating the skin.
The No Scalpel Dissecting Forceps pierces the scrotal sac to expose the vas deferens.
The vas deferens is lifted out of the scrotum with the No Scalpel Dissecting Forceps and occluded.
Engender Health: No-Scalpul Vasectomy: Illustrated Guide (PDF) YouTube: No Scalpel Vasectomy Video
VASCLIP IMPLANT PROCEDURE
In the Vasclip implant procedure, the vas deferens is locked closed with a device called a Vasclip. The vas deferencs is not cut, sutured, or cauterized (sealed by burning), which possibly reduces the potential for pain and complications. Some studies show that clipping is not as effective as other methods of sealing off the vas deferens.
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 will not experience pain since the anesthetic is still working and probably will not 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 arrange to have someone take you home following the surgery. You will not be allowed to drive yourself.
Note: Many insurance policies will pay for or reimburse you for a vasectomy. Make sure you check your insurance policy.
VASECTOMY 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.
VASECTOMY POTENTIAL COMPLICATIONS
The risk of complications after a vasectomy is very low.
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, 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 at the site of the incision very rarely occurs a short time after surgery. In rare instances, an infection develops inside the scrotum. 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 to 5 percent 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 from a vas deferens into the tissue around it, forming a small lump. This condition is usually not painful, but it can be treated with rest and pain medications. Although the lump usually dissolves by itself, occasionally surgery is may be needed to remove the granuloma.
- Congestion epididymitis is inflammation of the tubes that move the sperm from the testicles. It is 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. This occurs in rare cases (called recanalization) and results in the man 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 percent of cases (often as a result of unprotected intercourse too soon after the procedure).
VASECTOMY POST PROCEDURE CARE
WHEN YOU GET HOME - THE FIRST 24 TO 48 HOURS
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 or snug underwear for 24 hours (or longer). This will help ease discomfort and protect the area, 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. Lie on our back as much as possible for the rest of the day. This will reduce the chances of swelling. You may have some swelling and minor pain in your scrotum for several days after the surgery.
Apply ice bags or cold packs 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).
FURTHER INSTRUCTIONS AFTER SURGERY
Your health care provider may want to see you in 2 or 3 days to check your progress.
Avoid any heavy lifting or vigorous exercise for 5 to 7 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 or as soon as you are comfortable. 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. You can still get your partner pregnant until then. 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 after 10 to 20 ejaculations over a shortr period of time). 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. Your first test will usually be about 6 to 8 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 one too many and result in an unwanted pregnancy. Once your sperm count is zero, no other birth control method is necessary. Most men go back to their health care provider's office to have their sperm count checked. But there is also a home test available.
A vasectomy is a permanent method of birth control. Only consider this method when you are sure that you do not want to have a child in the future. Vasectomy is a very effective (99.85%) birth control method. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy.
RISK OF FAILURE
Pregnancy may occur after vasectomy because of:
- Failure to use another birth control method until the sperm count is confirmed to be zero. It usually takes 10 to 20 ejaculations to completely clear sperm from the semen.
- Spontaneous reconnection of a vas deferens or an opening in one end that allows sperm to mix with the semen again. This is very rare.
ADVANTAGES: Vasectomy is a permanent method of birth control. Once your semen does not contain sperm, you do not need to worry about using other birth control methods. Vasectomy is a safer, cheaper procedure that causes fewer complications than tubal ligation in women. Although vasectomy is expensive, it is a one-time cost and is often covered by medical insurance. The cost of other methods, such as birth control pills or condoms and spermicide, is likely to be greater over time.
DISADVANTAGES: A vasectomy does not protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV). Condoms are the most effective method for preventing STDs. To protect yourself and your partner from STDs, use a condom every time you have sex.
OTHER CONSIDERATIONS: If you are considering a vasectomy, be absolutely certain that you will never want to father a child. A vasectomy is not usually recommended for men who are considering banking sperm in case they decide later to have children. Discuss other options with your partner and your health professional. Surgery to reconnect the vas deferens (vasectomy reversal) is available. But the reversal procedure is difficult. Sometimes a health care provider can remove sperm from the testicle in men who have had a vasectomy or a reversal that did not work. The sperm can then be used for in vitro fertilization. Both vasectomy reversal and sperm retrieval can be expensive, may not be covered by insurance, and may not always work.
Some older studies showed a risk of prostate cancer in men who have had vasectomies. But many years of research have found no clear evidence that vasectomy is linked to prostate cancer.
Some health care practitioners or health insurance plans may require a waiting period from the time you request a vasectomy and the time the procedure is done. This time allows you to be certain about your decision.
Researchers are studying other male birth control methods, such as reversible vasectomy or hormonal methods. Reversible vasectomy involves plugging the vas deferens and then removing the plug when birth control is no longer wanted. Hormonal methods include pills or injections that the man would use to prevent sperm production. So far, no new method has been shown to be effective enough, with low side effects, to be marketed for men.
MEDICATION FOLLOWING SURGERY
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 RECOMMENDATIONS & RESTRICTIONS
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. Do not 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 & NUTRITION RECOMMENDATIONS
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: Adult Regular Diet
MoonDragon's Nutrition Information, Guidelines, Dietary Recommendations
NOTIFY YOUR HEALTH CARE PROVIDER WHO PERFORMED THE SURGERY
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.
NOTE: If you are not in a monogamous relationship with a partner (if you have more than one person you are having sexual relationships with) you should still use condoms as a means of preventing sexually transmitted disease infections.
A CHANGE OF HEART - VASECTOMY REVERSAL
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.
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 percent effective, and the effectiveness of any non-permanent method depends largely on your using that method correctly.
NON-PERMANENT BIRTH CONTROL METHODS FOR MEN
As a man, you can assume responsibility for birth control with these methods:
The condom is a thin, rubber (usually latex), 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 percent or so. For more information about condoms, see these webpages:
MoonDragon's Contraception Information: Male Condoms
MoonDragon's Disorders Information: Using Condoms To Prevent STDs
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.
MoonDragon's Contraception Information: Withdrawal Method
NATURAL FAMILY PLANNING
This method, often called the "rhythm method", requires participation by you and your partner together, and is about 75 to 85 percent 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 will need to learn about this method from your midwife, your health care provider, or a family planning clinic.
MoonDragon's Contraception Information: Natural Family Planning (NFP)
BIRTH CONTROLMETHODS 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 percent effective for most women. There can be many side effects, some may be significant. A prescription is required.
MoonDragon's Contraception Information: Oral Contraception (The Pill)
Other hormone-based contraception besides oral contraception are available. Many of these have the same risks and contraindications as the oral method.
MoonDragon's Contraception Information: Hormone Injections
MoonDragon's Contraception Information: Hormone Implants
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 percent. Some have contraceptive hormones implanted in the device to be released over a fixed period of time. A prescription is required.
MoonDragon's Contraception Information: Intrauterine Device (IUD)
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.
MoonDragon's Contraception Information: Cervical Cap
MoonDragon's Contraception Information: Diaphragm
MoonDragon's Contraception Information: Female Condom
MoonDragon's Contraception Information: Contraceptive Sponge
For more detailed information about contraceptive methods see:
MoonDragon's Contraception Index
MoonDragon's Contraception Information: Methods Compared
MoonDragon's Contraception Information: Contraceptive Chart
MoonDragon's Contraception Information: Links
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