VASECTOMY

The vas deferens (vas) is the tube that carries sperm from the testicle in the scrotum, to the prostate and into the urethra. Vasectomy involves the division and removal of a segment of vas from each side, so interrupting the flow of sperm resulting in infertility. It is one of the most popular and reliable forms of permanent contraception available.

Vasectomy should not be confused with castration: vasectomy does not involve removal of the testicles and it affects neither the production of male sex hormones (mainly testosterone) nor their secretion into the bloodstream. Therefore sexual desire (libido) and the ability to have an erection and an orgasm with an ejaculation are not affected. Because the sperm itself makes up a very small proportion of an ejaculation, vasectomy does not significantly affect the volume, appearance, texture or taste of the ejaculate.

When the vasectomy is complete, sperm can no longer exit the body through the penis. They are broken down and absorbed by the body.

The Decision to Have a Vasectomy

Given that the sterility is permanent, vasectomy should be a joint decision by you and your partner / wife. Important considerations prior to vasectomy include:

• Children’s ages and desire for further children.
• Desire for fertility in the event of loss of your partner / wife or loss of a child.

The advantages of vasectomy over other forms of contraception are obvious: its reliability is >99% and the procedure is comparatively inexpensive, simple and safe, well tolerated under local anaesthetic, with a rapid recovery to normal function.

Surgical Methods

Vasectomy typically takes 30 to 60 minutes to perform. The operation is usually performed under local anaesthesia with the option of also taking some oral sedation beforehand.

We offer a ‘needle free’ local anaesthetic administration technique. Local anaesthetic is delivered into the scrotal skin and vas with a no-needle jet injector. This feels like a rubber band snapping against the skin and anaesthesia is faster in onset and less painful than with the use of a needle.

The surgery can also be performed under a general anaesthetic if preferred.

We perform a “no-scalpel” or “Li” technique. The surgeon feels for the vas under the skin of the scrotum and holds it in place with a small clamp. An instrument punctures the skin and stretches the opening. The surgeon pulls out the vas through the opening and cuts the tube, excising a small section of the vas and cauterizing both ends of the vas. Small ties are applied to seal the cut ends of the vas and a layer of tissue is sewn between the ends to minimize the risk of spontaneous reversal. The skin punctures heal and need no stitches.

Recovery after Surgery

You may return home after 1 hour post-procedure. Two days of rest with regular pain relief are advisable. Most patients return to normal activities after 2-5 days, postponing heavy lifting and strenuous exercise for 1-2 weeks.

Swelling and bruising are normal and can be minimized through wearing supportive underwear and applying ice packs (a bag of frozen peas wrapped in a tea towel is recommended).

Most men report that pain and discomfort in the first few days after surgery are minor. It is typically described as a dull ache in the testicles and usually fades during the first week. Paracetamol is usually sufficient to relieve pain.

Resumption of Sexual Activity, Sterility and Contraception

You can resume sexual intercourse when you are reasonably free of discomfort.

You will not be sterile immediately after vasectomy and should continue to use contraception until semen tests confirm that your semen no longer contains any live sperm.

Ejaculations after vasectomy remove the remaining sperm from the vas deferens. Most men have low sperm counts after 10 to 15 ejaculations. In some men sterility takes longer. The most important to exclude is the 1 in 1000 failure where the test would show large numbers of mobile sperm.  Two semen samples should be submitted, two days apart, abstaining from ejaculation for two days prior to giving the samples. We aim to get two consecutive completely negative tests.

People often pass through a near negative phase with small numbers of dead sperm (non motile) on the way to the completely negative stage; in some this process is prolonged for months or years. If there are several (3) tests with a “few non-motile” (i.e. dead) sperm that is as good as a completely negative test. Both carry the same pregnancy rate of around 1:10000 pregnancy rate (lifetime).

Vasectomy and Sexually Transmitted Disease

Vasectomy does not protect yourself or your partner against AIDS and other sexually transmitted diseases. In any sexual encounter where there is a risk of contracting or transmitting disease, men should continue to use condoms (even after vasectomy) as a means of protection against infection.

Possible Complications of Vasectomy

Infection of the incision can cause localized swelling and pain that may require treatment with antibiotics.

Blood can accumulate in the skin of the scrotum and cause swelling and bruising. The body will absorb small amounts. Larger amounts may need to be drained by the surgeon.

Fluid can accumulate in the scrotum causing pain and swelling (hydrocele). The body will absorb small amounts of fluid.

Testicular discomfort is common early after surgery. This settles in 95% patients, but in 5% remains persistent and bothersome, requiring analgesics, anti-inflammatories or further surgery. This may relate to recurrent epididymitis or sperm granuloma

Vasectomy Failure resulting in pregnancy occurs in <1%: Primary failure means sperm is never cleared from the semen. This may result from a double vas or surgical failure and is the more common form of failure. It is essential to use alternative forms of contraception until the semen is confirmed free of sperm on 2 samples.

Secondary failure means the semen became sperm-free, but pregnancy ensued from later vas re-canalisation. This is rare, but well recognised. In addition, there are a handful of cases worldwide where pregnancy has occurred despite the semen remaining entirely sperm-free and in these patients, the mechanism of fertility remains unknown.

Vasectomy and the Prostate Gland: It is now clear that vasectomy does not cause prostate cancer and that there is no greater risk of this disease following vasectomy.

Immune Reactions to Sperm: Sperm do not usually come into contact with the body’s immune cells, so they do not usually cause an immune response. Vasectomy disrupts the barrier that separates the immune cells from sperm cells and a man may develop sperm antibodies after a vasectomy. Sperm antibodies can inactivate sperm thus reducing the chance of pregnancy after a vasectomy reversal.

Vasectomy and Heart Disease: Recent studies have found no evidence that men are more likely to develop heart disease after a vasectomy.

Vasectomy Reversal

Vasectomy reversal is a surgical procedure in which the cut ends of the vas are rejoined so that the flow of sperm to the prostate is restored.

Men may undergo a vasectomy reversal because they wish to regain their fertility. This is often in the context of a re-marriage or the death of a child.

Vasectomy reversal is a considerably more complex operation than vasectomy. The procedure is performed under a general anaesthetic using an operating microscope and usually takes several hours.

Vasectomy is difficult to reverse reliably due to damage and scarring which occur in the vas and epididymis after a vasectomy. The longer the duration of time between vasectomy and reversal the smaller the chance of a successful reversal. Overall, there is an approximately 50% chance of conceiving again after vasectomy reversal.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.