Get answers to your female Fertility and Infertility questions.
Male sterilization; Vasovasostomy; Vasoepididymostomy
Vasectomy is a minor operation that takes about 15 - 30 minutes and is usually performed with local anesthesia in a doctor's office or a family planning clinic. Most insurance policies will cover vasectomies performed as a minor outpatient procedure, but will not cover vasectomies performed as major surgery in an operating room. If a Vasclip procedure is performed, there may be an additional cost for this device.
A conventional vasectomy procedure is performed as follows:
A method of vasectomy called no-scalpel vasectomy (NSV) that does not require the use of a scalpel was developed in China in 1974. NSV is now used in at a third of all vasectomies.
The technique takes about 10 minutes and is performed in a doctor's office or a family planning clinic. The no-scalpel vasectomy differs from a conventional vasectomy in the method of accessing the vasa deferentia:
When performed correctly, NSV works just as well as conventional vasectomy, takes less time, and causes less bleeding, infection, and pain. Current research indicates that NSV is the safest type of vasectomy procedure. NSV is difficult to perform, however, and most surgeons must do about 15 - 20 procedures in order to be proficient. NSV is becoming a popular alternative to standard vasectomy, but it is important to select a doctor who is experienced with this procedure.
A simpler method of NSV, called percutaneous vasectomy, is now also being used. Recent research suggests that it works as well as standard NSV and is easier to perform. Percutaneous vasectomy uses the same instruments as no-scalpel vasectomy, but with a different surgical technique. The hemostat is used to first puncture the skin (instead of spearing the vas and lifting it out). The ringed clamp is then passed through the incision and used to enclose the section of the vas that is then pulled out for closure. This avoids the need for the difficult wrist maneuver in NSV.
Vasclip. The Vasclip is a recent alternative to conventional vasectomy. The procedure does not involve cutting the vas deferens. Instead, a very small rice-sized plastic clip is locked around the vas deferens to stop the flow of sperm. Some studies have reported fewer post-surgical complications than with standard vasectomy, including infection and swelling. However, studies have also reported that the Vasclip is less effective than no-scalpel vasectomy for reducing sperm count. To date, there is insufficient evidence that the Vasclip is better than standard vasectomy. Some insurance companies consider this procedure to be investigational and will not pay for it.
Vasectomy is a low-risk procedure, and complications, which occur in about 10% of patients, are usually easy to control. There are generally fewer complications with no-scalpel vasectomy. Pain or soreness typically lingers for a few days after the procedure, but this is normal and usually does not require a return visit to the doctor. No deaths resulting from vasectomy have ever been reported in the United States.
Nearly all men recover completely in a few days. The following are some guidelines after the operation to help recovery:
Although rare, more serious complications may include soon after surgery. They include:
Bleeding. Frequently, blood may seep under the skin, so that the scrotum and penis appear to be bruised. If there is no dangerous swelling, this painless problem usually disappears without treatment within 1 - 2 weeks. If the patient bleeds excessively in the days after the operation and requires more than two or three gauze changes per day, he should call his doctor.
Hematoma. In a small percentage of cases, bleeding inside the scrotum can cause a painful swelling known as a hematoma. In these cases, the scrotum swells up shortly after vasectomy. The doctor should be called immediately.
Infection. Infection can occur after vasectomy. The incision site may become infected, causing redness and swelling around the incision. Antibiotics, antimicrobial creams or ointments, or both, along with hot baths several times a day will usually clear the infection in a few days. Severe infections are extremely rare.
After the vasectomy procedure, there are always some active sperm left in the semen for several months so the risk for pregnancy persists. The patient is considered sterile only when there are no live or moving (motile) sperm in his semen.
It takes, on average, around 3 months to clear the viable sperm from the reproductive system, but it may take some men as long as 6 months to become sterile. The doctor will perform a semen analysis at around 12 weeks after vasectomy to verify that no live sperm remain in the semen. It is essential that the patient and his partner continue to use other methods of birth control until his sperm count is zero.
About 25% of men who have vasectomies never bother to return for follow-up sperm testing (semen analysis). Without a follow-up test, men do not know whether the vasectomy was successful. Until test results verify that there are no sperm in the semen, men are at risk of fathering unwanted pregnancies.
Vasectomy Failure and Unexpected Pregnancy. Pregnancy rates after a vasectomy are very low, about 1 in 1,000. There are two main reasons for an unexpected pregnancy:
Recanalization and Sperm Granulomas. The primary reason for vasectomy failure is recanalization-- when the cut ends of the vas deferens spontaneously reconnect. Recanalization in some cases may be due to sperm granulomas. These are tiny balls of debris that form from sperm, scar tissue, and white blood cells at the incision site. Cells lining the inside of the vas deferens grow through the scar tissue and form a new channel through which the sperm can now move. In general, surgeons can reduce the risk for recanalization by leaving a gap between the two cut ends.
This natural vasectomy reversal can occur after any vasectomy surgical procedure, but it is uncommon, and occurs in very few cases. When recanalization does occur, sperm counts are almost always very low and pregnancies are still rare. Most cases of recanalization develop within several months after the operation. In very rare cases, sperm have reappeared a year or even longer after vasectomy.
Epididymitis. Epididymitis occurs when an inflammation at the site of the vasectomy causes swelling of the epididymis. This rare condition usually occurs within the first year and is treated with heat and anti-inflammatory medications. It usually clears up within a week.
Anti-sperm Antibodies. Sperm continue to be produced after vasectomy but are disposed of in the body. In some men the immune system mistakes these sperm as foreign proteins (antigens) and produces anti-sperm antibodies that are designed to target and interfere with sperm's motility (ability to move). Up to two thirds of vasectomized men develop such anti-sperm antibodies. Infections in the genital tract, such as orchitis or sexually transmitted diseases, increase the risk for anti-sperm antibodies. The anti-sperm response itself appears to be a problem only if a man wishes to reverse the vasectomy.
Chronic Pain. Some men develop testicular pain following vasectomy. If this pain lasts longer than 3 months, it is referred to as postvasectomy pain syndrome (PVPS). The causes of PVPS are unclear. It may be due to obstruction and resulting contraction of the epididymal duct, or inflammation and formation of fibrous tissue after rupture in the duct, which can cause nerve damage. Sperm granuloma has also been discussed as a possible cause, although their role remains controversial.
PNVS is first treated conservatively, with heat or cold therapy, rest, scrotal support, and nonsteroidal anti-inflammatory drugs (NSAIDs). Most patients are successfully treated with conservative therapies. If these methods do not work, other drug therapies, (including injections of local anesthetics or steroids), may be tried. Transcutaneous electrical nerve stimulation is another method that has been used with good results. If all options fail, surgical interventions, (including removal of the epididymis [epididymectomy], granuloma excision, or vasectomy reversal surgery), may be required.
Cancer Concerns. Because testosterone levels remain higher for a longer period in men who had vasectomy, there have been concerns raised as to whether vasectomy can increase the risk of developing prostate cancer. Men with a family history of prostate cancer can discuss the risks and benefits of vasectomy with their doctors, although the weight of evidence to date indicates there is no link between vasectomy and prostate cancer. There have also been some concerns that vasectomy could increase the risk of testicular cancer. Studies have not identified any significant associations between the two.
Cook LA, Pun A, van Vliet H, Gallo MF, Lopez LM. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004112.
Cook LA, Van Vliet H, Lopez LM, Pun A, Gallo MF. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003991.
Dassow P, Bennett JM. Vasectomy: an update. Am Fam Physician. 2006 Dec 15;74(12):2069-74.
Peterson HB. Sterilization. Obstet Gynecol. 2008 Jan;111(1):189-203.
Practice Committee of the American Society for Reproductive Medicine. Vasectomy reversal. Fertil Steril. 2006 Nov;86(5 Suppl):S268-71.
Tandon S, Sabanegh E Jr. Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU Int. 2008 Jul;102(2):166-9. Epub 2008 Jul 1.
© 2011 University of Maryland Medical Center (UMMC). All rights reserved.
UMMC is a member of the University of Maryland Medical System,
22 S. Greene Street, Baltimore, MD 21201. TDD: 1-800-735-2258 or 1.866.408.6885