Vasectomy

Overview | How it works | The procedure | Complications | Risks | Effectiveness | Alternatives

What are your birth control options?
You and your partner are absolutely sure that you do not want to have any more children. Sterilization is an available option, offering an almost completely safe and reliable form of permanent birth control. Because it is safer and less complicated, most physicians recommend male rather than female sterilization to couples.

The vasectomy is a simple office procedure in which a segment of the tubes carrying the sperm from the testicles is removed, and the ends are sealed off. The procedure takes about ten minutes and is performed under a local anesthetic. Check to see if you can have a scalpeless vasectomy, which uses a technique in which an incision is not made. Most men readily admit that the procedure is less painful than a visit to the dentist's office. Additionally, the only medication necessary afterward for the discomfort is a mild anti-inflammatory such as Advil or Tylenol. In order to minimize the discomfort and complications, it is important to stay off your feet for one to two days after the procedure. Most instances of complications from vasectomies occur because of too much activity following the procedure.

Family Planning: When Your Reproductive Years Are Behind You
Family size is the most difficult decision most couples ever have to make. There are so many aspects to consider: the joy children bring to the household, the cost of supporting them, your or your spouse's career plans, the medical risks of pregnancy and temporary birth control methods, and, of course, what your faith tells you.

Temporary birth control methods—condoms, the diaphragm, the pill, etc.—let couples time their births and postpone taking more permanent measures. But, used long enough, every one of them might just fail. For that reason, many couples eventually choose a more-permanent approach—voluntary sterilization.

Only you, yours and your maker can decide about sterilization. But I can tell you most couples take time—between two and five years—to become sure enough to go ahead.

That's good. Though both common forms of sterilization can be surgically reversed, reversal is more complicated and expensive than sterilization, insurance companies usually won't pay for it and there's no guarantee of success. That's why I like to call sterilization "permanent."

Once you're confident that you're ready to put your reproductive years behind you, there are two options: vasectomy (male sterilization) or tubal ligation (female sterilization). Vasectomy makes you sterile by cutting the pipelines (the vas deferens) between the testicles and the penis. These small tubes are located just under the surface of the scrotal skin, and it takes less than 15 minutes in the doctor's office to snip them and seal the ends under a local anesthetic.

Tubal ligation involves cutting and tying a woman's fallopian tubes, which are well below muscles and other tissue in the abdomen. It requires a general anesthetic and a hospital visit.

A couple of statistics might make the differences even more clear:

  • Fatalities per 100,000: tubal ligation = 3.51; vasectomy = 0
  • Approximate cost: tubal ligation = $2,500; vasectomy = $750 - 850

Vasectomy is simpler, safer, cheaper and takes less time to recover from than tubal ligation. Their failure rates are just about the same: 1 in 2,000.

Still, most men naturally squirm at the thought of anyone tampering with that part of their bodies. If you hear horror stories about vasectomy, press for details. I assure you the tale will turn out to be at least third-hand and groundless. I've done more than 4,500 vasectomies and have never seen a serious complication. The most frequent comment is, "You mean it's over already?"

When a man has a vasectomy Friday afternoon and follows instructions—uses ice packs, elevates his feet and is inactive for the weekend (no matter how good he feels)—he's back to work on Monday barely feeling a thing.

It's worth discussing with your doctor what approach he uses and how many vasectomies he's done. Technique and experience can make a significant difference both in how quickly you're back on your feet and also in the likelihood of failure.

Is sex different after vasectomy? Not at all. Because the testicles supply less than 5 percent of the ejaculate, there's no noticeable difference in the semen. Erections and sex drive are unaffected—though freedom from worry of pregnancy often enhances a couple's sex life.

What about long-term health effects? No repeated studies have ever documented a hazard to men who have had vasectomies. And recently, researchers at Harvard University reported in the New England Journal of Medicine results from the largest study ever of vasectomized men. They were unable to associate vasectomy with any health problem in 14,607 vasectomized men.

Don't choose vasectomy lightly. But if you and your spouse decide you're ready for permanent birth control, get the facts and consider it carefully. (Write the Association for Voluntary Surgical Contraception, 79 Madison Avenue, New York, NY 10016, 212-561-8090, for more information. Please include a business-size self-addressed, stamped envelope.)

When you understand the choices, I think you'll agree guys, it's the least we can do for our women.
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Overview
The vast majority of men who have a vasectomy are delighted by the results. But roughly two of every 100 end up regretting the decision. Almost without exception, it wasn't the vasectomy's fault. Those two simply weren't ready to accept permanent birth control. Usually, they're men who have entered a new relationship and have changed their mind about fatherhood. (Although vasectomy can sometimes be reversed, it should be considered permanent.)

Some of the positive signs that you may be ready to have vasectomy include:

  • You're in a stable, long-term marriage of 10 or more years, and both of you agree that you do not want more children.
  • You don't want to or can't use temporary methods of birth control.
  • You or your partner has an inheritable disorder that you don't want to risk passing along to a child.
  • Pregnancy poses a serious health risk to your partner.

On the other hand, some of the warning signs that vasectomy may not be a good choice include:

  • You are young.
  • You have few or no children.
  • Your relationship with your spouse is shaky.
  • Either you or your partner is less than certain about the choice.
  • You're worried about how it will affect your sexuality.
  • You think there's a chance you might want more children if your situation changes (for example, a new spouse, death of a child, or improvement in finances).
  • You think vasectomy reversal is a good option if your situation changes.
  • You're considering "banking" sperm just in case.
  • Your situation requires protection against sexually transmitted diseases. (Vasectomy offers no protection against STDs.)
  • You don't understand how vasectomy works, how it's done, what the side effects can be and what the alternatives are.

How vasectomy works
Sperm are produced in a man's testes, and they mature in an area attached to the testes called the epididymis. It takes about 90 days from the time that the sperm are made for them to travel gradually up two tubes called the vas deferentia and become available for ejaculation. Prior to ejaculation, they're mixed with fluids from the seminal vesicles and the prostate to form semen. Vasectomy interrupts this process by closing off the vas deferentia, preventing the sperm from joining the other fluids. There is no noticeable change in the man's semen, because the sperm's contribution to volume is less than 5 percent.

Vasectomy has no physical effect on a man's virility, because it doesn't change the testes' production of the male hormone, testosterone. His sex drive, potency, male characteristics, and sexual pleasure should be unchanged. (About 30 percent of men report improved sexuality after a vasectomy, most likely because the worry of pregnancy is eliminated.) After a vasectomy, sperm continue to be produced but at a decreased rate. Those that are produced die and are absorbed by the body—just as they would be in an unvasectomized man who did not ejaculate.
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How a vasectomy is done
Vasectomy is a minor surgical procedure done in the doctor's office that removes a small section of each vas deferens and seals off the ends. Prior to the late 1980s, most vasectomies were done using a small scalpel, took about 30 minutes, and required a couple of days for full recovery. Around 1988, though, a Chinese technique was introduced to the United States. The no-scalpel vasectomy simplifies the procedure, reducing the total time to between 8 and 10 minutes. No incision is made, so no stitches are required. There is less discomfort during and after the procedure, complications such as bleeding are reduced, and recovery is quicker.

No scalpel vasectomy is done with a special tool that creates minimum disturbance. The prick of the needle for the local anesthetic is about the extent of what most men feel. Nearly 8,000 vasectomies have been performed by Dr. Goldberg and the most common comment we hear is, "It's over? That's it?" Most men don't even need Tylenol afterward, let alone a prescription pain killer. Likewise, the pain isn't too great when the bill comes. Vasectomy typically costs $800.

If possible, you should have someone come along to drive you home, but we've had men drive a couple of hours both ways to have a vasectomy here. Spending a couple of days afterward resting and applying an ice pack to your scrotum will greatly speed your recovery and reduce the risk of complications.
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Complications from vasectomy
Only about 10 percent of men experience any sort of complication from a vasectomy, and these are usually minor. There has never been a death with a vasectomy. Of course, as is the case with any surgical procedure, there's always a small risk for bleeding, infection, or allergic reaction to the anesthetic, causing a rash. Complications specific to vasectomy include the possibility of a sperm granuloma, testicular pain, and epididymitis. Also, in very rare instances, a man can lose a testicle.

A sperm granuloma occurs if sperm leak from the vasectomy site or a rupture in the epididymis and provoke an inflammatory reaction. About a half-inch in diameter, they require further attention in only about two percent of men. About one percent of men experience aching testicles from congestion in the epididymis. This usually disappears within six months. Epididymitis is an inflammation at the vasectomy site, usually taking place within the first year. Heat and anti-inflammatory medicine usually clear it up in about a week.

By far the most common complication we see is swelling of the scrotum in guys who refuse to take it easy for a couple of days after a vasectomy. Unfortunately, once the swelling starts, it may take two weeks for it to reduce completely, so prevention is the best approach.
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What are the risks of vasectomy?
A study has shown that men who have had a vasectomy have an increased incidence of prostate cancer after 20 years. Since that report, other studies have noted that there is no increased incidence of prostate cancer. The Male Health Center is monitoring current developments regarding this possibility and will be happy to discuss the risk factors in more detail at the time of your consultation.

For at least the first six weeks after the procedure, you will be advised to use another form of birth control. Afterward, the man's semen is checked to ensure no sperm are present. Total charge for a vasectomy is typically less than $900.
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Long-term risks of vasectomy
Vasectomy is one of the most studied of all medical procedures, yet rumors of long-term risks have persisted almost since the beginning of its use in the U.S. in the 1960s. To date, the body of medical evidence indicates that it is quite safe. Both the National Institutes of Health and the World Health Organization have given it a clean bill.

Although risks such as heart disease and arthritis were pretty much debunked by the 1980s, vasectomy's effect on the risk of prostate cancer continues to be studied. Although some studies have suggested a relation between the two, others have not. A panel of experts was convened by the National Institutes of Health to study the available research, and it concluded that the evidence for a link between vasectomy and prostate cancer was inconsistent and insufficient. No changes were recommended, including no increased screening for prostate cancer among men who have had vasectomies.
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How effective is it?
The overall failure rate for vasectomy rate is 0.15 percent, but that doesn't give an accurate picture of its real effectiveness. Most vasectomy failures happen during the first couple of months after the procedure, when live sperm may still present in a man's semen. Couples must continue to use another method of birth control until the man has ejaculated about 20 times (clearing the sperm) over as long as six months and tests (we require two) have shown that no live sperm remain. Some men skip the tests and end up regretting it. About one of every 4,000 vasectomies fails because the vas deferentia manage to reconnect—a failure rate of 0.025 percent.
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What are the alternatives?
Up to 40 percent of couples considering permanent birth control have experienced a failure with a temporary method—such as condoms, a diaphragm, spermicides, IUDs, hormonal implants, and the pill—so the obvious alternative to vasectomy is tubal ligation for the woman. By comparison, tubal ligation is a more involved surgical procedure, costing about $1,500 to $2,500, with a greater rate of complication. To put it in perspective, the fatality rate for tubal is 3.51 per 100,000—compared with zero for vasectomy.

Despite the obvious advantages of vasectomy, more tubal ligations (about 600,000) than vasectomies (about 500,000) are performed each year. Why? Most likely because women have traditionally taken the responsibility for birth control. Vasectomy offers men the opportunity to begin to set the record straight.
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What about female sterilization?
Tubal ligation is a procedure in which a woman's fallopian tubes are severed or sealed off, which prevents the egg from being fertilized by sperm. Unlike vasectomy, which is a simple outpatient procedure, tubal ligation typically is more complex and can require a hospital stay. Sometimes tubal ligation can be performed at an ambulatory surgery center.

In the most common tubal ligation procedure, the woman's fallopian tubes are sealed off with tiny metal rings or clips. It is necessary that two incisions be made just below the navel. The costs for tubal ligation, including surgeon's fees, operating room facility, and anesthesiologist's charges, range anywhere from $1,500 to $2,500. The procedure requires a general or regional anesthetic. A recent study showed that there was an 18 percent incidence of reconnection after tubal ligation.
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What if you change your mind?
We can plan, but we can't predict the future. So a few man who have had a vasectomy—about one in 100 — will attempt to reverse it. Fortunately, microsurgical techniques developed in recent years have greatly improved the likelihood of success. Two types of surgical procedures are used to reverse vasectomy. In men who still have sperm present in their vas deferentia, vasovasostomy reconnects the vas. When no sperm are found (about one-third of all cases), the far ends of the vas deferentia can be directly connected to the epididymis, using a technique called vasoepididymostomy.

Neither method of reconnection is easy, certain of success, or cheap. Although both can often be done at an ambulatory surgery center, with the man going home the same day, vasovasostomy takes two to three hours, and vasoepididymostomy can take five. The cost will be somewhere between $5,000 and $15,000. Overall, the rates of pregnancy are about 50 percent and 20 percent respectively, but the chances also depend on how recently the man had the vasectomy. For vasovasostomy, the chances of pregnancy are as high as three-quarters for the first three years, declining to about half for years three through eight, and as low as one-third after the fifteenth year. Vasectomy reversal actually turns up sperm in semen considerably more often than the pregnancy numbers suggest. But sperm don't guarantee pregnancy, and pregnancy is the goal.

If reconnection fails, there is yet another option for couples who want children. In a new procedure, sperm are aspirated directly from a man's testicle and injected into an egg removed from the woman. Once fertilization takes place, the egg can be implanted in the woman, where normal gestation can take place. Needless to say, this is more complicated and expensive than reconnection, and the odds of success are lower.

As you can see, a man who wants to reverse his vasectomy has pretty good odds of success. But it's still not something to count on when considering a vasectomy as a birth control option.
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