Overview | How
it works | The procedure | Complications | Risks | Effectiveness | Alternatives
What are your birth
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.
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
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
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.
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
- 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
- You don't understand how vasectomy
works, how it's done, what the side effects can be and what the
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
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.
How a vasectomy
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.
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
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.
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.
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
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.
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.
What are the
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.
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
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.
What if you change
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
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