What Women Should Know About Vasectomies
Let's be honest. As a woman, you spend a considerable portion of your life thinking about birth control. From condoms to coils, the myriad birth control methods can be a bit of a minefield.
Then, if you are absolutely sure you don't want any kids or are done having them, there is permanent birth control. The procedure is a tubal ligation for women and a vasectomy for men.
Before choosing birth control, particularly permanent birth control, it's good to get all the facts to make an informed decision. If your partner is considering a vasectomy, here are some details you should know.
Vasectomy basics
A vasectomy is a form of male contraception, said Justin Dubin, M.D., a urology fellow specializing in male infertility and sexual medicine at Northwestern University. He explained that men have two testicles whose job is to create sperm, which then travel through a tube called the vas deferens.
The vas deferens is a long muscular tube that propels sperm through the male reproductive tract to the ejaculatory duct, said Richard Schoor, M.D., an assistant professor of urology at the NYU Grossman School of Medicine in New York City. This is where the sperm are mixed with seminal fluid and prostatic secretions, which is the mixture called semen.
"Semen is what gets ejaculated into the female reproductive tract," Schoor added. "A vasectomy involves simply cutting, aka transecting, the vas deferens so that the semen does not contain sperm."
Reasons to get a vasectomy
Dubin said men who get vasectomies are not typically interested in having children in the future. These can be men who do not want kids at all or who do not want additional children. He said another significant reason many men get a vasectomy, which is extremely safe and effective, is so their partner can stop taking female contraceptives, which can be a long-term burden.
Men 18 and older are eligible for the procedure, Schoor said, adding that in the United States, spousal approval is not required, nor is it legal for a physician to require a patient to consult a partner as a condition of having the procedure.
He did say the major prerequisite for a vasectomy is proper informed consent and the man's ability to understand the nature of the procedure.
"This procedure permanently prevents men who undergo it from naturally conceiving," Dubin stressed. "Therefore, men who get vasectomies must be 100 percent certain that they do not want any future children."
The truth about ED and sensation after a vasectomy
"One of the most common questions by men interested in getting a vasectomy is whether it will impact their sexual function, including their ejaculate volume, penile sensation, orgasms, erections and testosterone levels," Dubin said.
He said men also express concern about possible links between vasectomies and the risk of prostate cancer. No such links exist.
"There are no sexual side effects from the vasectomy," Schoor said, adding that erectile dysfunction (ED) does not result from a vasectomy. "There are no changes in sensation of orgasm, ejaculate volume, the force of ejaculate or the pleasurable sensation of sexual activity."
According to Dubin, the sperm that travel through a man's vas deferens make up a very small portion of the semen, so the volume stays the same. Testosterone levels remain unchanged, and there is no increased risk for prostate cancer.
"If you are discussing vasectomies as a couple, making sure that the male partner understands that there is no risk to their libido, sexual function or testosterone levels is key," Dubin said.
The best way to do this is to see a urologist who performs vasectomies to learn more about the procedure.
"Men need to know it is a safe procedure with few risks and side effects, especially none that impacts their sexual health," Dubin continued. "Once they know that, I think most men interested in sterility are open to getting one."
The vasectomy recovery period
"Vasectomies are not very invasive," Dubin said, explaining the procedure usually takes less than an hour and is often performed in the doctor's office while the man is awake. "The doctor either makes one or two small incisions in the man's scrotum, where they are then able to isolate the vas deferens on each side and disconnect them."
Schoor said men can resume sexual activity several days after a vasectomy, and return to office-type work within a day or so.
"Depending on their occupation, guys usually take one to two days off work or a long weekend to recover," Dubin said. "During the first 24 to 48 hours, men are encouraged to take it easy, sit on the couch, watch TV and ice themselves."
Men should abstain from activities such as heavy labor or sports for about seven to 10 days, Schoor said. They can return to all their usual activities about a week after having a vasectomy.
Dubin emphasized that the partners of men who get vasectomies need to take note of one fact: "The most important thing you need to know is that although your male partner had a vasectomy, he is not sterile after that recovery week."
When the vasa deferentia are cut, some sperm are stuck inside them and need to be cleared out, he explained.
"After a vasectomy, we usually have the men come back in two or three months to provide us with a post-vasectomy semen sample to confirm that they no longer have sperm in their ejaculate," Dubin said.
Only once a doctor has confirmed there is no sperm in the ejaculate and the patient is sterile can you and your partner safely proceed with unprotected sex without worrying about getting pregnant.
The success rate is high
When talking about the success rate of vasectomies, Dubin said you have to break it down into two categories:
- The success of the surgery
- Its ability to prevent an unwanted pregnancy
"The success rate of the surgery itself is very high," Dubin said. "Over 99 percent of men who undergo a vasectomy become sterile, meaning they don't have sperm in their ejaculate and cannot have any children from intercourse."
Now, let's address the second point. Once a man is confirmed sterile after vasectomy, what are the chances of having an unwanted pregnancy?
"The only way a pregnancy can occur after vasectomy is if the two cut ends of the vas deferens find each other again and reconnect," Dubin said.
Fortunately, Dubin said this is very rare; he put the chances of this happening at 1 in 2,000.
"To put this into perspective, the chances of achieving a pregnancy on oral birth control is 1 in 400, so vasectomies are much more effective than oral birth control," Dubin said.
Overall, vasectomies are a minimally invasive and effective form of permanent male birth control.
But—and this is the big takeaway from Dubin—even though your partner just had a vasectomy, to avoid pregnancy, you must use some form of contraception until it's confirmed they are sterile.
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