Vasectomy

Anatomy of the male reproductive system. Source: National Cancer Institute

A vasectomy is a permanent form of birth control, performed by surgically cutting the vas deferens, the tube that transmits sperm. It is done to create sterility in a man, in order to prevent pregnancy. When the vasectomy is complete, sperm can no longer exit the body through the penis. The sperm are broken down and absorbed by the body. The procedure is generally considered to be at least as effective as female sterilization and is simpler to perform, safer, less invasive, and less costly.

Male reproductive anatomy. The vas deferens (#1) is cut during a vasectomy. #2: Seminal vesicle. #3 & 4: Prostate. #5: Urethra. Source: Wikimedia Commons

Why Vasectomy Is Done

Vasectomy is a method of birth control. It prevents sperm from exiting the penis during sexual intercourse. This means that the man cannot make a female partner pregnant. Vasectomy does not, however, prevent sexually-transmitted diseases.

Types

Conventional surgery

Conventional surgical vasectomy is performed with a scalpel. This can be done through one incision in the middle of the scrotum, or through one incision on each side of the scrotum. This technique is also called an open vasectomy.

No-scalpel vasectomy

A no-scalpel vasectomy is a technique that uses a small clamp with pointed ends. The vas deferens is brought directly up to the skin and the skin is gently separated with an instrument instead of being cut with a scalpel. The vas deferens is separated from adjacent structures and a piece is usually removed. The edges of the cut vas deferens can be clipped, tied, or cauterized. The benefits of this procedure include less bleeding, a smaller hole in the skin, and fewer complications. No-scalpel vasectomy is as effective as traditional vasectomy.

Vasclip implant procedure

In the Vasclip implant procedure, the vas deferens is locked closed with a device called a Vasclip. The vas deferens is not cut, sutured, or cauterized (sealed by burning), which may reduces the potential for pain and complications. Some studies indicate that clipping is not as effective as other methods of sealing off the vas deferens.

Preparation

Showering and washing the genital area before the procedure is generally recommended. Shaving is not necessary. Aspirin and blood thinners should be held before the procedure, usually about two weeks. Patients should make arrangements for a ride home after the procedure.

How Vasectomy Is Done

A vasectomy is done by blocking the tube, called the vas deferens, through which sperm normally pass from each epididymis in the testicles on the way to the seminal vesicle, forming semen.

As mentioned in Types, there are several ways to perform a vasectomy, including with conventional surgery, the no-scalpel technique, or with a Vasclip device. Whichever method is chosen, the operation can be done with local anesthesia only, with sedation, or in the operating room.

The surgery usually takes no more than 30 minutes, after which time almost all men go home the same day. In most cases, recovery takes less than a week.

Benefits

The primary benefit of vasectomy is the prevention of pregnancy. When compared to surgical sterilization of a woman (tubal ligation), the benefits are that it is a simple outpatient procedure, is safer than a tubal ligation, is less expensive and often covered by insurance, and is highly effective.

Risks

Vasectomy is considered to be a safe, minor surgical procedure, but, like any form of surgery, there are some possible risks. These risks include infection, bleeding, and pain.

Complications

• Bleeding with formation of a hematoma (collection of blood)
• Chronic testicular pain
• Infection
• Failure of the vasectomy to prevent pregnancy (due to failure of the original operation or recanalization)
• Regret and a desire to reverse the vasectomy
• Formation of a sperm granuloma (a lump at the site where the vas deferens is cut)

Related problems

Some have raised concerns that vasectomy is associated with cancer or heart disease. A large population study in England looked at this. They reviewed the files of men who had vasectomy and compared to those who had not. They found no change in the numbers of men with prostate cancer, other cancers, or heart disease.^[1] Other studies have found similar results.

Precautions

Special measures may need to be taken in patients with certain conditions, including:

• Patients taking blood thinners
• Those with allergies to anesthetic agents such as lidocaine
• Those with an infection of the genital skin or urinary tract
• Those with anatomic abnormalities of the scrotum such as a hydrocele or varicocele

If a patient has a history of undescended testicles and had surgery to bring the testicle into the scrotum, special precautions are needed. The testicle receives its blood supply from the testicular artery and from vessels surrounding the vas deferens. In some cases, the testicle is brought into the scrotum by dividing the testicular artery. If this is done, the testicle then gets blood from the blood vessels surrounding the vas deferens. During a vasectomy, these are cut. If a patient does not have one of these two vessels, the testicle may atrophy (shrink) or die (infarct).

A vasectomy should be considered permanent, even though some men do successfully have vasectomy reversal. The success rate of the reversal procedure is low, and can never be relied on. Men who are most likely to regret having a vasectomy are those who find new partners, are younger, or have fewer children. Men and their partners should very carefully consider this decision before proceeding with sterilization.

Side Effects

The most common side effect is discomfort after the procedure. If there are no complications, side effects are not expected.

Effectiveness

Vasectomy is very effective. It has been estimated that only about 15 out of 10,000 couples get pregnant during the first year after a vasectomy. Although rare, pregnancy is possible even years after the procedure. One study by the CDC showed that 11 per 1000 procedures fail over a two-year period, that half of these occur within the first three months, and that all of these occurred within the first 72 weeks.^[2]

Although some men have been able to have their vasectomies reversed (undone), this process involves expensive, major surgery, and success cannot be guaranteed. Therefore a vasectomy is considered appropriate for those who desire a permanent form of birth control.

It is also important to remember that vasectomy does not protect against sexually transmitted diseases (STDs), such as HIV/AIDS. Men who have had a vasectomy should still practice safe sex to avoid STDs.

Follow-up

Although a man can have sex again within a few days of a vasectomy, he is not protected against getting a woman pregnant until all of his semen is free of sperm.

It is important to have the semen tested to make sure there are no sperm left before having unprotected sex.

Recovery

Most men only have pain for two or three days. Ice packs used after surgery can help. Jock straps also reduce pain by reducing the tension on the scrotum.

Statistics

The CDC reports that in 2002, 526,501 men underwent vasectomy in the United States.

In a CDC study asking partners of men who had vasectomies whether they regretted the decision, 6% of women reported regret over a five-year period.^[3]

Alternatives

Birth control can be achieved in a variety of ways. Options for the male partner include abstinence, using condoms, or undergoing vasectomy. Female partners can also use natural techniques, take medications, or undergo surgery to prevent pregnancy.

Controversy

Many religions prohibit vasectomy as a means of birth control.

Interesting Facts

• After a vasectomy, a man will still ejaculate. There will be no sperm in the semen, which appears the same and is released in the same amounts as before the operation.
• Vasectomy reversal is only effective 50-70% of the time. Vasectomy should only be done if a man desires permanent sterilization.
• Vasectomy does not affect a man's sex drive or testosterone levels.

History

How vasectomy was developed

Vasectomy was initially studied in dogs and rabbits in the 1880s. It was used to treat numerous conditions—including masturbation and enlargement of the prostate—for many years before it was recognized as a method of birth control. Vasectomy was frequently used as a sterilization measure in eugenics programs in the first half of the 20th century.^[4][5]

New and Emerging Technologies

This article describes a technique for blocking the vas deferens using ultrasound waves instead of surgery.

A remote-controlled device that can be inserted into the vas deferens with a needle has also been described.

Techniques to implant a plug into the vas deferens that could later be removed have also been reported. This article describes a polymer gel that would theoretically be implanted and later flushed out if childbearing was again desired.

References

1. ↑ Goldacre MJ, Wotton CJ, Seagroatt V, Yeates D. Cancer and cardiovascular disease after vasectomy: an epidemiological database study. Fertil Steril. 2005 Nov;84(5):1438-43. Abstract
2. ↑ Jamieson DJ, Costello C, Trussell J, Hillis SD, Marchbanks PA, Peterson HB. The risk of pregnancy after vasectomy. Obstet Gynecol. 2004;103:848–850. Abstract | Full Text
3. ↑ Jamieson DJ, Kaufman SC, Costello C, Hillis SD, Marchbanks PA, Peterson HB. A comparison of women’s regret following vasectomy versus tubal sterilization. Obstet Gynecol. 2002;99:1073–1079. Abstract | Full Text
4. ↑ Vasectomy Information: The History of Vasectomy.
5. ↑ Leavesley JH. Brief history of vasectomy. Fam Plann Inf Serv. 1980 Dec 5;1(5):2-3. Abstract

External Links

American Urological Association

CDC: Unintended Pregnancy Prevention

Planned Parenthood

Google Groups: Vasectomy Discussion Forum

The Parents Centre: Birth Control Forums

Daily Strength: Vasectomy Support Group

Videos and illustrations

Vasectomy Medical: No-Scalpel Vasectomy

Cornell University: No-Scalpel Vasectomy

Vasectomy Information: Vasectomy Illustration

Vasectomy Information: Vasectomy Pictures