Dr. Michael C. Lee, a Harvard Vanguard urologist who practices at our Kenmore and Chestnut Hill/West Roxbury locations, answers common questions men and couples ask him about having a vasectomy.
What is a vasectomy?
Vasectomy is a simple, safe surgical procedure for male sterilization and/or a method of permanent birth control. The procedure, which only takes about 15 minutes, is done in the office with local anesthesia and involves cutting and tying off each of the vas deferens, the two tubes which supply sperm into the seminal stream (ejaculate). By preventing sperm to enter the ejaculate, fertilization of an egg cannot occur.
Worldwide, approximately 50 million men have had a vasectomy – in the U.S., about 500,000 men each year have the procedure done. Compared to methods for permanent female sterilization, it is simpler, more effective, has fewer complications and is much less expensive.
Myths about Vasectomy
Contrary to some belief, having a vasectomy has no impact on your sexual function. Nerves that aid in erections are far away from the area of the procedure. Essentially, everything remains the same except that the semen will no longer contain sperm. And many men even report that being free of worry about conception helps promote libido and sexual drive.
Some studies report that testosterone actually increases to a very subtle degree after a vasectomy, although we don’t know why. It does not increase levels enough to be clinically significant, but we certainly do know that having a vasectomy does not decrease testosterone levels.
Another myth is that a vasectomy may increase risk of prostate cancer risk because of the testosterone. There haven’t been clear studies to suggest that there is an increased risk of cancer as a result of vasectomy.
Percutaneous No-Scalpel Vasectomy Method
Formally introduced in China in the 1980s, the percutaneous no-scalpel vasectomy method uses a smaller incision than a traditional vasectomy, and patients typically experience less discomfort, fewer complications and a quicker recovery. With this technique, we only do two small punctures that are so small that we don’t even close them with a suture; they basically heal from the inside out so no stitches or sutures are needed.
Recovery, Complications and Risks
Very commonly, mild pain, bruising and swelling occur after the procedure. Take acetaminophen (e.g., Tylenol®) every four hours to lessen these discomforts. Ice of some kind (while you can use ice packs, I recommend using bags of frozen vegetables like peas or corn) placed over the scrotal supporter and dressing may provide relief as well. If you are diligent and use ice for the first 36 hours, it helps to decrease the amount of bruising and swelling.
The most common complications are inflammation, bleeding and possible infection, although these only happen about 10% of the time and are usually short-lived. Because the percutaneous no-scalpel vasectomy method only requires a small incision to be made, bleeding and infection are less likely than the traditional method.
Other possible risks include:
- Sperm granuloma: About 10% of the time at the vasectomy site, there can be a sperm granuloma, which is a bit of sperm leakage that can form into a small ball and causes inflammation. It could last a few months but usually resolves on its own with the proper, supportive care.
- Chronic Testicular Pain: this occurs in less than 1% of vasectomies and happens because sperm are still being produced after a vasectomy. These sperm cells can build up in and cause stretching and inflammation of the epididymis (a duct behind the testes). This condition usually subsides on its own without treatment, although some men require anti-inflammatory medications. In rare cases, some men may develop chronic pain which might require that we intervene surgically to relieve the obstruction. Surgical options may be as dramatic as reconnecting the ends of the vas deferens (a vasectomy reversal), just opening one end, or removing the epididymis.
Can I discontinue other birth control methods right away?
No. The reason: the lifetime of a sperm is about 90 days, so, theoretically, on the day of the vasectomy, sperm could be released from the testicle and traverse the vas deferens, and be on the “wrong side” of that tube when the procedure is done. Then, when ejaculation occurs, that one sperm could father another child.
To test for this, we typically do a semen analysis at 2 months after 15 ejaculations, then again at 3 months to make sure that live sperm are not present. In this practice, we check the specimen carefully and then send a letter that officially states the man is sterile. About 25% of the men don’t follow up and they are not deemed sterile due to lack of confirmatory testing.
Effectiveness of a Vasectomy
Although it happens less than 0.1% of the time, in rare cases sperm can find their way across the two blocked and separated ends of the vas deferens; this is called recanalization. It generally occurs within the first few months following vasectomy. If sperm are still found in semen samples after 6 or more months, it is a failure and it may be necessary to repeat the vasectomy procedure.
Vasectomy Reversals
Vasectomy reversals can be done. This is an outpatient surgery done under a microscope to reconnect the ends of the vas deferens. But there is no guarantee that it will be successful – in fact, there’s only about a 50% chance of conceiving a child naturally after a reversal.
For this reason, I try to schedule the initial consultation and exam about a month before I schedule the actual procedure. In this way, I can thoroughly explain the procedure itself, what to expect and what you should do to prepare, the possible albeit small risk of complications, as well as the chances of reversing it. In this way, both the man and his partner can discuss it thoroughly and allow themselves some time to decide whether a vasectomy is the right choice.
For more information or to schedule an appointment with Dr. Lee, please call his office at Chestnut Hill/West Roxbury at (617) 541-6350 or Kenmore at (617) 421-8749.
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