Vasectomy is a safe and simple surgical procedure that prevents a man from getting a woman pregnant and is the most effective form of male birth control. There are rarely any side effects from the procedure once it has healed, and a man can enjoy sexual relations as before without the risk of pregnancy. More than 500,000 procedures are successfully performed each year in the United States, and the failure rate is very low – about 1 in 2,000.
The procedure involves blocking the tube through which sperm normally pass from each testicle into the place where semen is formed. First the scrotum is anesthetized, and then one or two small openings are made. Your surgeon then carefully clips and ties off each vas deferens. The openings in the scrotum are then closed with stitches.
A vasectomy is usually done under local anesthesia, which means you'll be awake and have medicine to numb the surgery area. Surgery usually takes about 20 to 30 minutes. To perform a vasectomy, your doctor will:
- Numb the surgery area by injecting a local anesthetic into the skin of your scrotum with a small needle.
- Make a small cut (incision) in the upper part of your scrotum once the surgery area is numb. Or, with the "no-scalpel" technique, a small puncture is made in the scrotum instead of an incision.
- Locate the tube that carries semen from your testicle (vas deferens) on either the right or left side.
- Withdraw part of the vas deferens through the incision or puncture.
- Cut the vas deferens where it has been pulled out of the scrotum.
- Seal the vas deferens by tying it, sealing it with heat (cauterizing) or using surgical clips. Then your doctor will return the ends of the vas deferens to the scrotum.
- Stitch up the incision at the surgery area. Stitches aren't necessary if your doctor has used the no-scalpel technique.
- Repeat the procedure on the other side.
No-Scalpel Vasectomy. Rather than requiring an incision in the scrotum, this procedure involves small puncture holes that do not need stitches. Surgery typically takes around 30 minutes, after which almost all men can go home. Recovery in most cases takes under a week. Vasectomy is an outpatient surgery with a low risk of complications or side effects. The technique has become widespread because the smaller puncture limits bleeding and hematomas, while reducing the risk of infection, and usually has a faster healing time.
Open-Ended Vasectomy: During this procedure the testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. This technique may avoid testicular pain as a result of increased back-pressure, while some research suggests that it may also reduce the long-term risk of post-vasectomy pain syndrome.
A vasectomy is almost 100 percent effective, although in rare cases it does not work. It is considered a permanent procedure, even though vasectomy reversals are not only possible but have become very common procedures. A man can have sex again within a few days after a vasectomy, but until his semen is completely free of sperm he may still be fertile. Therefore it is important to have your semen tested to ensure the absence of all sperm before having unprotected sex. Before having unprotected sex, you'll need to wait up to eight weeks or longer and ejaculate 20 times or more to clear any sperm from your semen.
Like any form of surgery there is the risk of infection, pain and bleeding. In almost all cases these can be treated or resolve themselves in a very short time period.
Side effects immediately after a vasectomy include:
- Bruising of your scrotum.
- Bleeding or a blood clot inside the scrotum.
- Blood in your semen.
- Infection at the surgery site.
Delayed complications can include:
- Fluid buildup in the testicle, which can cause a dull ache that gets worse with ejaculation.
- Inflammation caused by leaking sperm.
- Pregnancy, in the event that your vasectomy fails (rare).
- Chronic pain (rare)
- Your sex drive will not be affected, nor will any other masculine traits.
- There is minimal risk that any of your sexual organs will be injured during the procedure.
- There is no proven link between vasectomy and prostate or testicular cancer.
- A vasectomy will not increase your risk of heart disease.
- You may feel minor pain and pulling or tugging during surgery, but severe pain is rare.
- After surgery you may have some pain in the surgery area, but for most men it's minor and goes away after a few days.
- If you change your mind about having a child, it may be possible to reverse your vasectomy.
- Insurance companies vary on their coverage of vasectomies, so check your policy ahead of time. Some doctors and insurance companies require a waiting period between your first meeting with the doctor and surgery.
Your doctor will give you instructions on how to prepare. You may need to:
- Stop taking aspirin or other blood-thinners for several days before your surgery. These include warfarin, heparin, aspirin, and other over-the-counter pain medications such as ibuprofen.
- Wash your genital area thoroughly the day of your surgery. Your doctor may ask you to shave the surgery area.
- Take medication to relax you 30 minutes to an hour before surgery if your doctor has prescribed it.
- Arrange for a ride home to avoid movement and pressure on the surgery area caused by driving.
After your procedure you should expect some slight bruising, swelling and pain, but these usually last only a few days. Your doctor will give you instructions for recovery. These might include:
- Support your scrotum with a bandage and tight fitting underwear for at least 48 hours after your vasectomy.
- Limit activity after surgery. You'll need to rest for 24 hours after surgery, but you can probably do light activity after two or three days. You will need to avoid sports, lifting and heavy work for a week or so. Overdoing it could cause pain or bleeding inside the scrotum.
- Use an ice pack periodically to help with swelling and pain for one to three days after surgery.
- Avoid blood-thinning medications for three to seven days after surgery. These medications can increase your risk of bleeding.
- Refrain from bathing or swimming for a few days following surgery.
- Avoid any sexual activity for a week or so. If you do ejaculate, you may feel pain or notice blood in your semen. Do not have sexual intercourse until your doctor says it's okay, unless you use another form of birth control. It takes several weeks or longer before sperm are no longer present in your semen.
Infection: If you experience any signs of infection after your procedure, such as pus or blood oozing from the surgery site, fever, or worsening pain or swelling, call your doctor immediately or visit the emergency room if they are unavailable.