About 500,000 men have vasectomies in the US each year. It involves the surgical cutting of the vas deferens, which are thin tubes in the scrotum that carry sperm from the testicle to urethra. By cutting the vas deferens the sperm cannot escape into the ejaculate. A vasectomy should be considered permanent. Even though it is technically possible to reattach the vas, this is not always successful.
A vasectomy is usually performed in the office. You will need to stop all blood thinners 5 days prior to your procedure. These include but are not limited to: Aspirin, Aspirin containing products, Vitamin E, Fish Oil, herbal remedies, Plavix, Xarelto, Pradaxa, Effient, Eliquis, Lovenox, Arixtra, Savaysa, ibuprofen, naproxen, and arthritis medications. If you are on Coumadin, please speak to your doctor for special instructions. If you are unsure of a certain medication being taken before the procedure, please contact your doctor. Your doctor may give you an IV or oral medicine to help you relax. Please wash your scrotum with an antibacterial soap the day of your procedure. Your doctor will use a local anesthetic to numb the area. It is normal to feel some pressure and tugging sensation during the procedure. After your vasectomy you should plan to rest for the remainder of the day and undertake no strenuous activity or heavy lifting for 48 hours. You can resume sexual activity in several days when the soreness and swelling has gone away. You will have a prescription for pain medicine. Ice packs for the next 48 hours should be used and are effective for pain. Scrotal support, either an athletic supporter or tight briefs, also help to minimize swelling and improve comfort. You may shower 24 hours after your vasectomy. You may notice some oozing of blood or fluid from the wounds. If this occurs, pinch the skin edges together with a gauze pad for five minutes. You may also notice some bruising and mild swelling. This is normal, but if you notice swelling such that your scrotum is tight or it extends up into your groin, then call your doctor. Apply any antibiotic ointment to the wound for the next several days.
There are still sperm in the vas deferens after a vasectomy. You must continue to use some form of birth control until you have had 2 semen analyses showing no sperm. We advise patients to have no ejaculations 7 days after the procedure. After you have had 15-20 ejaculations, you should submit for your first semen analysis. This usually occurs 10 weeks after your vasectomy. Two weeks later at the 12 week mark, you should submit for your second and final test. Our office uses a third party company, SpermCheck®, to supply our patients with home sperm test kits. Once you enroll with SpermCheck®, they will contact you with information to purchase the kits and will provide instructions for their Vasectomy Home Sperm Test Kit. Please note that there is a separate charge you will be responsible for to purchase the test kits direct from SpermCheck®, and they are not billable to health insurance. The current price is $49.99 and includes the required two kits. It is absolutely necessary to use another form of birth control until you receive clearance instructions from our office.
Even though a vasectomy is a common and safe procedure, there are some risks and complications possible. Bleeding is the most common problem and this is called a scrotal hematoma. If this is small, then it may resolve on its own. Sometimes, this may be large enough to require surgery with a general or spinal anesthetic. This surgery would be done to open the scrotum and let the blood out and control bleeding. Rarely this may involve loss of a testicle.
Another risk is that the procedure may fail. This may happen immediately after the procedure or later. If sperm continues to appear in your semen samples, then the vasectomy has failed. If it happens after you have had semen samples showing no sperm, it is because the vas have grown together. This is called recanalization and can happen many years later. It is rare and happens about 1 in 2000 vasectomies.
Some people report prolonged pain in one or both testicles after vasectomy. It is unclear if this is due to the vasectomy, but you need to be aware that you may have pain that lasts as a result of your vasectomy. You may also notice a lump in your scrotum at the site of the vasectomy. This is a natural response by your body and is called a sperm granuloma. It is not dangerous and may go away on its own.
A vasectomy will have no effect on your sexual performance. The volume of your ejaculate will be the same and similar in appearance. Some people feel that their sex life is improved after vasectomy since the fear of unwanted pregnancy is gone. There are no long-term effects on your health that are currently known. There was some report that vasectomy was linked to prostate cancer but this has been disproved.