Dr. Paul Siami, Deaconess Clinic Urology
Once a couple has decided that their family is complete, or a man simply knows that he doesn’t want future children, vasectomy is an option to consider.
Vasectomy is highly effective and is covered by insurance. However, if a man were to change his mind later, the reversal procedure is expensive, and is NOT covered by insurance, so the decision to have a vasectomy needs to be made with a great deal of consideration.
Who is an appropriate candidate for vasectomy?
The short answer is: any man who does not wish to have future/any more children. I typically see men between the ages of 25 and 45, when they believe their family is complete.
Vasectomy is appropriate for men who want to step up to the plate and take care of birth control. Their wives have likely handled this (pill, IUD, other contraceptives) for a long time, and also birthed their children, so many men decide it’s their turn to take this responsibility. That’s when a man can really become his wife’s hero.
Also, having a vasectomy frees up any need for condoms in a monogamous relationship, and simply takes away the stress of worrying about an unintended pregnancy. I’ve had couples report that once that underlying concern of pregnancy is gone, their sex lives are better than ever.
What are the advantages of a vasectomy over female contraception and/or sterilization?
There are numerous benefits to consider.
There is simply nothing more effective in preventing conception (besides abstinence!) than vasectomy.
No pills/shots. Nothing to remember, no risk of hormonal side effects. Some women are at increased risk for certain complications from hormones, and shouldn’t be taking them.
No IUD, which has a small but existing risk for complications. Also has to be changed every few years, and can come out of position and be ineffective.
No messy spermicides, and no “interrupting the moment” to use a condom.
When it comes to sterilization, this is far less invasive than what women have to endure. Women’s least invasive options involve significant sedation. Men—you simply require a local anesthetic.
There are minimal long-term risks of complication.
How a Vasectomy Works
To help explain the vasectomy procedure, let’s start with an anatomy lesson.
Sperm is made in the two testicles located in the scrotum. From there, the sperm travels to the prostate through two specialized tubes called vas deferens. The sperm is then mixed with special secretions from the prostate and the two seminal vesicles, located near the outlet of the bladder.
Semen is formed when sperm from the testicles combines with special secretions from the prostate and the two seminal vesicles. Semen is stored in the seminal vesicles, located near the outlet of the bladder, and released at ejaculation.
The way vasectomy works is to prevent the sperm from joining the semen before the semen is ejaculated. This is done by removing a small section of the vas deferens, which is the tube in which the sperm travels from the testicles to its resting location in the seminal vesicles. After the procedure, sperm is still made in the testicles. However, the sperm dies there and is reabsorbed by the body.
Sperm that was already stored in the seminal vesicles can still be ejaculated with the semen. Until all stored semen is ejaculated, pregnancy is still possible. This may take up to 20 ejaculations. This is why it is important to use other contraception until you do the SpermCheck test, which will be done 3 months after the procedure.
What can you expect from your vasectomy procedure?
You will be pleased to know that it is done on an outpatient basis, here in my office at Deaconess Clinic, and you will be able to go home very shortly after.
You will be brought to the procedure room, and preparation will take place to make the area sterile. After cleaning and possibly shaving the scrotum, you will be draped with sterile towels. The scrotum will be exposed in the sterile area so I can begin the procedure.
I will start by using immediate AND long-acting numbing medication, (.50% marcaine & 1% lidocaine) to numb the scrotum. Once numbed, one or two tiny openings are made in the scrotum. Both vas deferens are exposed one at a time and a small section of each vas deferens is then removed. The ends are tied with a permanent suture and the cut ends are cauterized.
During this procedure you may feel some tugging and pressure in the scrotum up to the abdomen. This may be slightly uncomfortable but not painful. Remember you will receive plenty of numbing medication.
One or two sutures may be used to close the incision site; these will dissolve in a week or so. After the procedure is done you will go home with post-op instructions.
What can you expect after vasectomy?
For the first couple of hours after the procedure, using ice packs for 10 minutes on/10 minutes off can help reduce discomfort. However, the numbing medication given will last for 8 hours or more.
Limit lifting over 15 pounds or strenuous activity for 2-3 days. This includes no running, jogging or stair climbing. Most men go back to work in a couple of days. (Fridays are an excellent time to do this procedure. 1 day of work missed, at most.)
Be prepared to rest for a day or so after the procedure
Wear briefs (not boxers) to keep the scrotum from moving, this will help keep swelling down.
Are there any complications to vasectomy?
We will give you a SpermCheck kit to take home. This can be done in the privacy of your home, with immediate results. Mark your calendar for 3 months after the procedure to do this check, and then the second test, one month later. You will not receive a reminder, so mark your calendar. The kit includes instructions which we will go over at the time of your procedure. Until you’ve taken your test and have a negative result, use some type of contraception.
There are a few very uncommon complications that may occur after the procedure.
Epididymitis, which is pain and/or swelling of the epididymis (area where sperm matures and is stored); usually goes away with use of Motrin or Advil (ibuprofen).
Hematoma, which is bleeding inside the scrotum that may cause painful swelling shortly following a vasectomy (I’ve never had a patient develop one).
Infection. Infection of the incision site, or deeper tissue, occurs in less than 1 percent of all cases. (Again, I’ve never had a patient develop an infection.)
Recanalization – Happens in less than 1 in 2,000 cases. It is the spontaneous rejoining of the severed vas connection through the scar tissue. This can be detected by semen analysis at regular intervals.
Persistence of sperm right after the procedure may indicate too few ejaculations. It takes 20-25 ejaculations to clear sperm from the vas deferens. Postoperative semen analysis requires 2 samples (within 3 months) without motile sperm for the surgery to be considered a success.
Does a married man have to have his wife's written permission to have a vasectomy?
Sperm Granulomas - a small and usually painless lump at the site of a vasectomy and caused by sperm leakage from the cut end of the vas. This does not pose a danger and usually resolves over time.
No, this is not true. Any adult who wants to consent to vasectomy can have it done.
Posted: April 1, 2014 by