The Facts About a Vasectomy

A vasectomy is a minimally invasive, outpatient surgery designed to prevent a man's sperm from leaving his body, thus providing him and his partner with a permanent form of birth control. The procedure is safe and low-risk and is frequently performed under local anesthesia in an office or clinic.

In a majority of cases, there is no need for general anesthesia or time in the operating room. The entire procedure usually takes from 10 to 30 minutes, according to Mayo Clinic. It involves the doctor severing and cauterizing the tubes that carry sperm from the man's testicles to mix with the rest of his seminal fluid when he ejaculates. It causes no changes in his sexual functioning, nor does it visibly change his ejaculate—it simply means no sperm are present in it.

Vasectomies have been used since the late 19th century when they were first performed in order to sterilize "degenerates" to keep them from reproducing. Voluntary vasectomy as a form of male birth control started during the 1940s.

People opt for vasectomy because it is a reliable, safe and effective form of male birth control. While condoms fail about 1 in every 100 times, the failure rate for vasectomies is 1 in every 10,000 cases.

For men who have had all the children they desire, are settled with a partner and don't need to worry about sexually transmitted infection (STI) and disease (STD) prevention, vasectomy is the optimal choice for birth control. That's in terms of effectiveness, reliability and simplicity.

Just as with any medical procedure, vasectomies have pros and cons.

Pros

The most important factor in favor of vasectomy is the procedure is simple, safe and effective. Other pros include the following:

• It is usually an outpatient procedure.
• It has very little risk of complications.
• It's a better approach to birth control for your partner, as it's much safer, cheaper and lower risk than the female equivalent, tubal ligation.
• It's cost-effective.

Cons

Men should approach vasectomy with their eyes fully open. It is permanent after all, and it does have a few potential downsides, including:

• Some men change their minds and decide they do want to have kids. (Vasectomy reversal is possible, but more complicated than the original procedure and far less effective.)
• It doesn't protect against STIs and STDs.
• It takes time to be effective.
• Some patients experience discomfort and bruising.

The complications of vasectomy, as with any surgical procedure—no matter how safe and simple—include the risk of inflammation, swelling and infection, but these are quite rare with vasectomy. More common risks include the following.

Pain

Any procedure that takes place in such a sensitive area carries the possibility of affecting nearby nerves and causing some pain. For a few days after, it can feel tender down there—as if there's bruising or you got kicked.

Less common is something called post-vasectomy pain syndrome, which affects 1 percent to 2 percent of patients, according to Cleveland Clinic. You may have testicular pain, pain with ejaculation and psychological stress after the procedure.

Sperm granuloma

Sometimes sperm may leak out of the cauterized end of the vas deferens. This may cause a painful lump called sperm granuloma.

Over-the-counter pain relievers are usually sufficient to help with any symptoms until the granuloma is absorbed back into your body.

Scrotal congestion

Some men feel a sense of pressure in their testes for the first two to 12 weeks after a vasectomy since the sperm in the epididymis have nowhere to go. This discomfort is usually not acute and resolves on its own over time.

Chronic scrotal pain

There is a small risk of having ongoing scrotal pain following a vasectomy, but it is very rare.

There are two types of vasectomies: scalpel and no scalpel. Both procedures begin with the doctor giving the man local anesthesia to numb the scrotum. Then, via tiny openings made in the scrotal sac, the doctor locates and draws out both vas deferens, separating them from the rest of the tubes that are part of the spermatic cord.

Once a loop of the vas deferens is pulled outside the scrotum, the doctor will cut off a small portion of it and the ends will be sealed. The doctor can cauterize, clip or tie off the ends of the vas deferens, or use some combination of those. Then, the vas is returned to its place inside the scrotum.

The main difference between the two versions of the procedure is in the size of the hole the doctor makes in the scrotum. With scalpel surgery, they make a tiny incision on either side. During a no-scalpel procedure, they make a single puncture. Another difference is that some doctors who perform the no-scalpel version may only feel the need to use a numbing spray rather than an anesthetic injection.

The no-scalpel approach won't usually require any stitches.

During a vasectomy procedure, the doctor accesses a loop of the man's vas deferens, which is the tube that carries the sperm from the testicle. The procedure consists of making an incision in the tube and sealing off each end. This means the man continues to produce sperm, but it essentially runs into a brick wall when it tries to exit the testicle and join the rest of the seminal fluid when the man ejaculates.

The sperm eventually die and are simply reabsorbed into the body, much the way your body processes other types of cells that die.

The man's testicles and testosterone production are unchanged. The sperm the testicles produce simply don't get ejaculated. Importantly, the ejaculation process, the ejaculate and the sensation of sex are all unchanged—apart from there being no sperm present.

Since sperm make up only about 2 percent to 5 percent of the total volume of ejaculate, you really can't tell the difference with the naked eye.

After you have a vasectomy, you need to continue using other forms of contraception for some time. This is because the journey of sperm from being "born" to being fully mature and ready to exit the body in the man's ejaculate takes about 74 days.

According to American Urological Association (AUA) guidelines, it's appropriate to perform the first post-vasectomy semen analysis eight to 16 weeks after the procedure is done. Another test should be done six months after the procedure to confirm there are no viable sperm in the man's ejaculate.

Another important post-vasectomy note: The AUA recommends refraining from ejaculating for seven days in order to give the cauterized or tied-off ends of the vas deferens time to heal.

Recovery from a vasectomy may involve some bruising and tenderness, but it's usually minimal. You'll want to take a couple of days to lie low and not move around too much, and ice packs are your friend during this period.

You'll want to wear tight-fitting underwear or a jockstrap to help keep everything in place, and strenuous activity, such as heavy lifting or other physical activity, is off-limits for several days and possibly up to a week.

Some urologists say they get an increase in vasectomy procedures during the NCAA men's basketball tournament; guys can justify lying on the couch for the entire weekend watching games while they recover.

You can resume regular activity, with the exception of heavy lifting, within a few days, and most guys report a full recovery within about a week or so.

Yes, the procedure can be reversed. Some doctors specialize in vasectomy reversal, but it isn't as simple or reliable a procedure as the initial vasectomy. In a vasectomy reversal, the doctor removes scar tissue from the ends of the vas deferens and stitches them back together. Sometimes, if there isn't enough vas left on the testicle side, they may attach the other end of the vas deferens directly to the epididymis.

The success rate of vasectomy reversal is between 60 percent and 95 percent, according to Cleveland Clinic, and pregnancy is possible more than 50 percent of the time. However, the success rate declines significantly after 15 years.

The procedure is often expensive and insurance usually won't cover it. If you think you might change your mind after getting a vasectomy, you might consider banking sperm prior to getting it done.

A vasectomy will not protect against sexually transmitted conditions. It is strictly a procedure designed to prevent pregnancy; it has absolutely nothing to do with protection against disease or infection.

From an STI/STD perspective in your sex life, continue using condoms because even post-vasectomy, you are still vulnerable to infection.

What happens to a man when he gets a vasectomy?

The vas deferens, the tubes through which sperm goes from his testicles to join the rest of the seminal fluid when he ejaculates, are severed, so it is theoretically impossible for him to get someone pregnant. He still ejaculates like normal, and his sexual drive is unchanged. The only difference is there are no sperm present in his ejaculate.

Is a vasectomy reversible?

Vasectomy is reversible, but the procedure is much more difficult, unreliable and expensive than a vasectomy.

Is a vasectomy 100 percent effective?

No method of birth control is 100 percent effective, so vasectomy is not considered 100 percent effective either. However, the rate of failure is small; fewer than 1 in 10,000 vasectomies fail. Compare this to the failure rate of condoms, which is 1 in 100, and you can see that vasectomy is the most reliable form of male birth control.