Is vasectomy right for you?

Vasectomy is a simple, safe and effective surgical procedure that makes a man sterile (unable to father a child). Because a vasectomy should be considered irreversible, it's a serious step to take. You and your partner should understand all the facts and share in the decision.

A permanent decision

Few decisions in life are permanent, but having a vasectomy is one of them. So, before you make this decision, you and your partner must be sure that you do not want any more children. Is there any circumstance that might make you change your mind?

For instance, if you divorced or became a widower and remarried, would you want more children? If you choose to have a vasectomy, you should have no doubts about these issues, as there are no guarantees it can be reversed with later surgery (vasectomy reversal).

Your reproductive system

To understand how a vasectomy works, you need to know how sperm is produced, stored and released by your reproductive system.

How a vasectomy works

When you have a vasectomy, the two vas deferens are cut to keep sperm from travelling from the testes to the penis. This is the only change in your reproductive system. The testes still produce sperm, but since they have nowhere to go, they die and are absorbed by your body.

Your prostate and seminal vesicles still produce fluids, so your semen does not look or feel any different. Your male hormone level remains the same, so your hair distribution, the pitch of your voice and your sexual drive do not change.

• The vas deferens are cut, preventing sperm from moving to the penis.
• The seminal vesicles and prostate secrete the same amount of fluid as before.
• Erection and ejaculation continue as before, but the semen contains no sperm.
• The testes still produce sperm and hormones.

Note: Because some sperm remain in the upper part of the reproductive system after a vasectomy, it takes several weeks and numerous ejaculations before the semen is completely free of sperm.

The vasectomy procedure

A vasectomy is an outpatient procedure that can be done in a doctor's rooms, clinic or hospital. Several days before your vasectomy can be performed, you'll be asked to read and sign a consent form that states you're aware of the possible risks and complications and understand that the procedure, though usually successful, is not guaranteed to make you sterile. Be sure that you have all your questions answered before signing this form.

Preparing for surgery

Avoid taking aspirin for three days before your procedure, and ask your doctor about any other medications you take. On the day of your surgery, shower and thoroughly clean your scrotum. Eat a light snack instead of a heavy meal before your surgery. Wear a clean pair of underpants to the doctor's rooms or hospital. If you're nervous about your surgery, the doctor may give you some medication to help you relax.

During surgery

You will be asked to undress and lie on the examination table. Sterile drapes are placed over you to help prevent infection. You are given injections of a local anaesthetic in your scrotum or lower groin. This prevents you from feeling pain. Once the anaesthetic takes effect, two small incisions are made in the skin of the scrotum with a scalpel or a pointed clamp (no-scalpel method).

Each of the vas deferens is lifted through the incision and cut, and a section may be removed. You may feel a pulling sensation during this process. The two cut ends are tied or clipped closed, or they may be sealed by heat (cauterised). The incisions are closed with one or more stitches.

After surgery

If you have been given medications to help you relax, you will need to have someone drive you home. The local anaesthetic begins to wear off after about two hours. Any discomfort you feel is usually mild. If you need it a pain medication can help.

Healing

Once you're home, you can do several things to aid your recovery:

• Stay off your feet as much as possible for the first two days to lessen the chance of swelling. An ice pack or bag of frozen peas can also help keep the swelling down.
• Wear snug cotton briefs or an athletic support.
• Ask your doctor how long to wait before having a shower (usually 24 hours).
• Wait until your doctor says it's okay to return to work.
• Avoid heavy lifting or exercise for at least five days after surgery.

Ask your doctor when you can begin having sex again. Remember, you must use another form of birth control until your doctor says you are completely sterile.

For about a week your scrotum may look bruised and slightly swollen. You may have a small amount of bloody discharge from the incision site. You may also fell a little pain. These symptoms are normal.

Possible risks and complications

Even with a minor operation like vasectomy, problems can occur. If you experience any of the following or any other symptoms you're concerned about call your doctor.

The following complications might occur during the first few days after your surgery:

• Internal bleeding in the scrotum sometimes occurs, usually within two days of surgery. Symptoms include increasing pain, excessive swelling, a large black-and-blue area, or a growing mass.
• Infection may occur. Some signs of infection are fever, chills, drainage from the incision site and a very painful incision site.

Other complications, though rare, may occur in the first few months after surgery. These are the most common:

• Sperm granuloma is a lump at the site where the vas deferens is tied off. It's caused by leaking sperm. The lump usually dissolves by itself, but surgery is needed to remove it.
• Congestion is a build-up of sperm in the epididymis. It may cause inflammation of the epididymis (epididymitis) and some aching about 3 to 12 weeks after surgery. It usually disappears without treatment.
• Sperm antibodies are a common response of the body to absorbed sperm. There's no evidence that these antibodies are harmful, but a large number of them may make it difficult to become fertile again, if you should ever change your mind.
• Testicular discomfort lasting several years after the procedure occurs rarely.
• Spontaneous return of fertility occurs very rarely. This can happen if the cut ends of the vas deferens reconnect (recanalisation). It's usually detected by a semen test after surgery, although it occasionally occurs after the semen test has been done.

Sex after a vasectomy

A vasectomy will not alter your sexual functioning. When you start having sex again, you'll still have erections and orgasms, and your sexual relations will feel the same as before. If you had a good relationship with your partner before vasectomy, it shouldn't change because of vasectomy.

Until you're sterile

It is absolutely essential that you continue to use some other form of birth control after your vasectomy until your doctor tells you that your sperm count is zero. To make sure no sperm are left in your semen you'll have a postoperative semen exam. This is commonly done about three months after surgery. You usually collect the semen at home in a small jar, and bring it to the lab. You are sterile only when these semen samples show no evidence of sperm.

After you're sterile

After your doctor tells you you're sterile, you no longer need another form of birth control. You are free to have sex without the fear of unwanted pregnancy. However, keep in mind that vasectomy does not protect you from sexually transmitted infections. If you're not in a mutually monogamous relationship, practice safe sex by using condoms.

Original material provided by StayWell/KRAMES, and kindly reviewed by Dr John Russell.