Clinical Specialties : Male Urologic Health

Vasectomy

What is a vasectomy?

A vasectomy (pronounced “va-sec-toe-me”) is a contraceptive procedure in men in which the vas deferens, or sperm duct, is cut and the cut ends are sealed in order to prevent the transportation of sperm. Sperm is still produced, but does not leave the body. Vasectomy is usually done as a means of sterilization and is sometimes reversible.

How will a vasectomy affect my sex life?

Although the man continues to have sexual intercourse and climax as before, his semen does not contain sperm and he cannot father a child following a vasectomy. A vasectomy only blocks sperm and does not affect your sexual drive, your ability to have an erection, orgasm or ejaculation or your ability to have and enjoy sex. Sperm is only a small fraction of the total liquid in your semen. The amount of fluid, intensity – even color and texture – does not appear to change when sperm is absent. Male hormones continue in the bloodstream, and secondary characteristics (such as beard or voice) do not change. Some couples say their relationship is improved by not having to worry about contraceptive techniques or unplanned pregnancy.

What is a No-Scalpel Vasectomy (NSV)?

The No-Scalpel technique is one of two main methods surgeons use to perform a vasectomy. Many doctors favor the No-Scalpel method because – unlike the traditional vasectomy approach – a scalpel is not required and there are no incisions (only one or two small punctures in the skin). In addition, the NSV often results in less discomfort after the procedure with a reduced risk of bleeding or infection. Also, there is no perceptible scaring.

How long does the No-Scalpel procedure and recovery take?

The procedure itself usually takes about 15 minutes, sometimes less. However, including the office routine, paperwork and preparation, the total time in a doctor’s office may be about an hour. The procedure is likely to produce tenderness, discomfort and slight swelling in the first two or three days afterwards, with a return to nearly all usual activities typically within a week. (Follow your doctor’s instructions carefully, take your time and use the schedule that is right for you.)

Does it work immediately?

No, any vasectomy does not make you sterile right away, and you’ll want to continue using some other means to guard against pregnancy until your doctor tells you otherwise. Immediately after a vasectomy, active sperm remain in the semen for a period of time. It may take 15 to 20 ejaculations and several weeks before your semen is free of sperm. Your doctor will test the semen, perhaps several times over several weeks, and let you know when you can safely consider the vasectomy to be complete. This may be as long as two months.

What happens to the sperm?

This is a mystery to some people, but the answer is both normal and natural. The body absorbs unused sperm cells normally – whether or not you’ve had a vasectomy. After the procedure, the testicles will continue to produce sperm, but they will not leave the body in the semen. They dissolve and are simply and naturally absorbed by the body.

What is the cost of a No-Scalpel vasectomy?

The actual cost of the procedure ranges from $400 to $1,200 but this cost is covered under many health insurance programs. You will want to ask your insurance company or HMO if any or all of this cost is provided under the benefits of your coverage. (As a point of reference, this cost is significantly lower than the sterilization operation for women – tubal ligation.)

Are there risks or complications?

Yes, as with any surgical procedure, there could be complications and you should ask your doctor to go over these carefully with you. However, any type of vasectomy ranks among the safest procedures and the majority of complications, if any, are usually minor and easily treated. These include a chance of infection, bleeding or transient bruising, temporary swelling or fluid accumulation.

Following the procedure, some men experience pain, often as a dull ache, caused by a pressure on the miniature tubes of the epididymis. This is usually treated successfully with medication, but the removal of the epididymis is sometimes recommended.

Some studies have found that some men, who had a vasectomy 20 years earlier, have a slightly higher risk of prostate cancer than others who did not have a vasectomy. Most other studies did not support those results. The American Urological Association and the American Cancer Society recommend that men over the age of 50 should have a regular prostatic examination and a PSA blood test to help detect early prostate changes. This recommendation is the same for all men in this age range (50 to 70), including those who have had a vasectomy and those who have not had the procedure.
For a more recent study looking at a group of nearly 2000 men and concluding that there is no increased risk of prostate cancer after a vasectomy, you can see the abstract at The Journal of the American Medical Association.

Can a vasectomy be reversed?

You should consider any vasectomy to be permanent. There are delicate microsurgery operations that may be able to reverse the effects of a vasectomy, but there is no assurance that the flow of sperm can be restored or pregnancy will result in every case. The likelihood of success can vary greatly depending on individual circumstances, including how much time has passed since the vasectomy. If you are seriously considering a vasectomy, it’s best to assume that it will be a permanent change.

If you are interested in vasectomy or vasectomy reversal, please contact Dr. Charles Lynne (clynne@miami.edu) or Dr. Ranjith Ramasamy (ramasamy@miami.edu).