Headed for a Vasectomy Consultation? Here's What You Need to Know
In the wake of the Supreme Court's June ruling in the Dobbs v. Jackson Women's Health Organization case, Cleveland Clinic, a large, nonprofit academic medical center, started getting 50 to 60 calls daily regarding a vasectomy consultation. That's a 300 percent increase over the number of calls the clinic received prior to the court decision that effectively overturned Roe v. Wade and returned abortion rights to the states.
Likewise, urologists in many other parts of the country saw increased interest in vasectomy as a means of preventing pregnancy.
"Anecdotally, I've noticed that as well in my practice," said Neel Parekh, M.D., a clinical assistant professor of urology at Cleveland Clinic.
Also known as male sterilization, a vasectomy is a surgical procedure that involves cutting the vas deferens, the tube that carries sperm from the testicles.
The increase in vasectomy interest didn't necessarily spike everywhere, though. Darshan Patel, M.D., an assistant professor of urology at the University of California San Diego Health, said he has noticed only about a 10 percent increase in vasectomy inquiries.
"That's probably a function of us being in California and not really being affected by what's been happening at a more national level," Patel said, referring to California being among 16 states that have state laws protecting the right to an abortion. "I've talked to other providers in other areas of the country that have noticed quite a significant increase."
The vasectomy consultation
During the conversation preceding the vasectomy, Patel asks men if they are certain they're done having children or, if they don't have kids, that a family is not part of their future plans.
"We consider vasectomy, for the most part, to be a permanent form of sterilization," Patel explained. "Certainly, it can be reversible under certain circumstances, but generally, that's not guaranteed."
Urologists take a urological history of the man requesting a vasectomy. They ask about any prior scrotal surgeries and hernias, as well as issues with urination, erections, sex drive and sexually transmitted infections (STIs).
Parekh said he examines the man's testicles to ensure there are no abnormalities, masses or tumors. He feels the vasa deferentia as well to make sure they're both there—one for each testicle—so there are no surprises during the procedure.
He also reviews the medications the patient is taking. Blood thinners, for example, may increase the risk of bruising and bleeding.
What does the procedure entail?
Patel and Parekh both said nearly all of their vasectomies are performed in the office since it is a relatively simple procedure and takes only about 15 minutes. The urologist puts a local anesthetic on the scrotum, and the patient remains awake.
"It's kind of like going to the dentist where you may feel us manipulating down there, but you shouldn't feel anything sharp," Patel explained. "We can always give more numbing medicine."
Patel said he tries to put patients at ease, because many men are understandably nervous about their scrotum being the focus of an operation. He doesn't typically administer any oral medications, but if a patient requests it, he may prescribe an antianxiety drug such as Xanax.
"I think patients do just fine awake without all the side effects and drowsiness of the sedatives," he said, adding they're able to drive themselves home following the procedure.
'It's kind of like going to the dentist where you may feel us manipulating down there, but you shouldn't feel anything sharp.'
The most common vasectomy method is the no-scalpel technique.
"That's essentially just describing how we puncture the skin with a sharp instrument to gain access to the vas deferens," Parekh said. "Instead of using a scalpel or knife to cut into the skin, we use a sharp instrument to spread the skin."
A small poke-hole incision is made right in the middle of the scrotum along the natural line that divides the two sections. This allows access to both sides, each of which has a vas deferens.
"There are two tubes that come from each of the testicles, so they need to do the same process on each side," Patel explained. "Basically, isolate that tube, bring it up through the skin, try to peel away blood vessels and nerve tissue that's around the vas deferens."
Then the vasa deferentia are cut, tied or seared, and put back in place. Finally, the urologist places a small, absorbable suture to bring the skin together. This suture usually falls off by itself within a week or so.
Side effects and impact on sexual function
Recovery from a vasectomy usually takes only a few days. Parekh recommends rest and refraining from strenuous activity to his patients. They can take ibuprofen or Tylenol for pain and ice the area—20 minutes on and 20 minutes off—if needed.
It's important to note that a vasectomy does not provide immediate protection against pregnancy. After the vasectomy, patients need to wait at least a few months and ejaculate 20 or more times to clear any remaining sperm from the semen before they have sex without contraception.
Many men want to know if a vasectomy impacts sexual function, including ejaculate volume, sex drive and the ability to achieve an erection.
"Overall, sexual function should be pretty much the same after you're healed up after the vasectomy," Patel said. "In terms of erectile function, it's kind of a different mechanism, different plumbing. We're basically just creating a roadblock in terms of the sperm's ability to join up with the rest of the ejaculate. It shouldn't affect anything in terms of erectile function and the ability to have rigid erections."
Patel said many men associate vasectomy with surgical castration, assuming they're no longer going to be making testosterone. That's not the case at all with a vasectomy. A vasectomy simply prevents sperm from joining the rest of the ejaculate; therefore, it does not affect testosterone production.
As for ejaculate volume, sperm make up only about 2 percent of the ejaculate. The vast majority of semen comes from the prostate gland and the seminal vesicles. A vasectomy does not affect a man's ability to urinate, either.
The risk for side effects and complications is low. There's less than a 1 percent risk of infection and significant bleeding, according to Parekh. Even more rare is post-vasectomy pain syndrome, a dull ache in the testicle that lasts more than three months. This affects about 1 in 1,000 patients, he said.
What to know about vasectomy reversal
Approximately 7 percent to 10 percent of men who undergo a vasectomy have a change of heart, possibly due to life changes, such as a new partner, or a desire for another child. Of that group, less than 1 percent undergo a vasectomy reversal, Patel said.
One reason men may decide against a vasectomy reversal is monetary. Insurance does not cover the procedure, and it can cost $5,000 to $15,000 out of pocket, according to the Urology Care Foundation.
Vasectomy reversal, which involves sewing each vas deferens back together, is a much more involved surgery than a vasectomy. Vasectomy reversals are done under anesthesia and generally last a couple of hours.
"We reconnect the two tubes using very fine sutures that are finer than the finest piece of hair, essentially to bring those two ends back together," Patel explained.
Vasectomy reversals have a high success rate, depending on how many years have passed since the vasectomy. Based on pregnancy rates, 30 percent to more than 90 percent of patients who undergo a reversal are able to get sperm back in the ejaculate, although this may take anywhere from three months to six months after the procedure.
Choosing to have a vasectomy is a major decision that should not be taken lightly. If you are considering the procedure, first schedule a vasectomy consultation with a urologist.