Vasectomy

Moshe Wald, MD
Department of Urology
University of Iowa Hospitals and Clinics
Creation Date: August 2001
Last Revision Date: January 2008
Peer Review Status: Internally Peer Reviewed

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Vasectomy is the most common form of male contraception utilized in the United States. It is a relatively simple procedure that typically leads to permanent sterilization. It is important to realize that, although reversible, vasectomy should only be performed when all of the man's childbearing is finished. However, in select cases, some men may feel more comfortable if semen is frozen and banked prior to sterilization. This frozen semen remains viable for many years. Vasectomy will only affect the sperm in your ejaculate; the amount that you ejaculate will remain the same. It will not change your sex drive or cause impotence. You will continue to produce sperm, but your body will reabsorb it as it sits in the vas deferens and epididymis. Although there have been studies to suggest that vasectomy may be associated with various other health problems, such as testis or prostate cancer, there is currently no scientific evidence to support these claims. On the contrary, most evidence has shown that vasectomy does not predispose a man to any health problems.

The procedure itself is typically performed as an outpatient under local anesthesia. Intravenous sedation may be utilized at the patient's request. Your scrotum will be shaved and then washed with sterile soap. Separate small incisions are made in each side of the scrotum to minimize the risk of cutting the same vas deferens twice. Once isolated, the vas deferens is then clipped or ligated and divided, with a small piece of the vas deferens being removed between the clips or ligatures. The ends of the severed vas deferens are cauterized. The ends are then separated within the scrotum by tissue, thus decreasing the chance of recanalization (see below). The skin incisions are closed with a stitch which will dissolve within two to three weeks. A gauze dressing and scrotal support will be placed. The procedure takes approximately 30-40 minutes, and you will go home shortly thereafter.

The first two postoperative days should be spent resting. Typically, ice packs and scrotal support are utilized for the first 36-48 hours. Following that, ice may be used as needed, although we recommend continued scrotal support for the next week. You may shower the next day, and return to regular activity two to three days after the procedure, as you see fit. The gauze dressing may be removed one week following surgery. A wound check will be scheduled approximately 10 days after the procedure. We will then see you back to examine your semen in two to three months.

You are not considered sterile until you have returned TWO samples, at least one week apart, that demonstrate NO SPERM. This typically will take approximately three months, but could take longer. Until that time, some alternative method of birth control must be used. You will be given a container in which to drop off your sample. It is important that the sample be relatively fresh (no more than two hours old), as samples that are older may erroneously show dead sperm, when in fact, there may be live sperm present. You will be notified of the results. You will not be charged for your follow up visits, including the semen analyses.

Risks of the procedure include bleeding, infection, pain, and failure. These are all rare. The risk of pregnancy due to recanalization of the vas deferens, where the ends come back together and sperm reappears in the ejaculate, is estimated at 1 in 4500. There is no way to absolutely prevent this, although the surgical technique utilized does make this less likely. Another rare occurrence is scrotal pain, which is typically pronounced following ejaculation. This is due to distention of the tubing system, and typically resolves over time. However, in a very small number of patients, this does not resolve, and surgical intervention may be needed. Such interventions may involve repeating the vasectomy, leaving the ends open.

Vasectomy is a safe, effective form of permanent sterilization. However, follow up must be adhered to, as failure to return or wait for complete absence of sperm may result in an unwanted pregnancy.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.