Andrew Siegel MD 7/30/2022
When one door shuts, another opens
In a historic decision, the United States Supreme Court this past June 24th reversed Roe v. Wade, ending the constitutional right to abortion. Subsequently, there has been an upsurge in demand of men seeking vasectomies. Urologists — particularly in red states — have been inundated with consultations for male voluntary sterilization.
Overview
Every year, roughly one half a million men in the USA undergo vasectomy as a means of permanent birth control. It is a minimally invasive procedure that is the most effective means of contraception, excepting abstinence. During this procedure, each vas deferens (sperm transporting tube) is cut and sealed, preventing sperm from being present in the semen. It is a simple, safe, and time-honored means of achieving male fertility control.
Vasectomy vs. tubal ligation
The female version of a vasectomy is tubal ligation (blocking the fallopian tubes to prevent pregnancy). Vasectomy is a skin-deep procedure versus tubal ligation that requires entrance into the abdomen. A vasectomy can be performed under local anesthesia with or without intravenous sedation whereas tubal ligation requires general anesthesia. There exists a simple test for the effectiveness of vasectomy (semen analysis), but no such test for tubal ligation (aside from a costly and uncomfortable x-ray test). Vasectomy is safer and less expensive and is generally well covered by medical insurance.
Reproductive anatomy 101
The testicles are responsible for sperm production. After sperm cells are manufactured, they ascend into the epididymis, where sperm mature and where they are stored. From the epididymis arises the vas deferens that runs up the groin within the spermatic cord, then courses behind the bladder where its terminal end forms the ejaculatory duct. This duct empties into the urethra, the channel that conducts urine and semen through the penis.
Preparation
It is important not to eat or drink anything for 8 hours prior to the procedure. If you are on aspirin or a blood thinner, please stop the medication one week prior to the vasectomy. On the day of the vasectomy, cleanse and shave the scrotum while showering or bathing. It is recommended that you wear supportive jockey shorts.
Procedure
Vasectomy is a minor surgical procedure, usually performed in the ambulatory surgery center. It is done under local anesthesia with intravenous sedation and monitoring under the expert care of an anesthesiologist. Intravenous sedation makes the procedure much more comfortable for the patient and easier for the surgeon. The entire procedure typically takes less than 20 minutes.
After sedation is established, the scrotum is cleansed with antiseptic solution. The area is draped with sterile surgical towels so that only a small area of skin is exposed. A long-acting local anesthetic is administered and via two tiny punctures in the scrotum, the vas is accessed. There are many different ways to interrupt the sperm flow—I prefer removing a ½ inch segment of each vas deferens, doubly clipping each end, and using cautery to seal the edges. The small puncture in the skin is closed with a suture that will dissolve on its own.
After Vasectomy
- You may experience swelling, minor pain, and spotting for several days. Restricting activities for the first 24 hours will reduce the chance of swelling, bruising, bleeding, and pain.
- Application of an ice pack to the scrotum intermittently for the first 24 hours—20 minutes on and 20 minutes off—is highly effective to reduce swelling.
- Mild discomfort is typical and is treated with prescription-grade anti-inflammatory medication that will be prescribed.
- Wearing elastic, supportive jockey shorts is helpful to keep the scrotum immobilized. The best underwear for men after vasectomy is Adjustable Pouch Underwear, made by UFM (Underwear for Men) www.ufmunderwear.com. Use coupon code “NJU” for a 25% discount. I recommend purchasing a few pairs in advance of the vasectomy.
- Restrict heavy lifting, exercise, and sex for about 5-7 days. Sedentary activities can be resumed as soon as you are feeling well enough.
- Use contraception until the semen analysis shows absence of sperm in the semen.
Follow-Up
It is imperative to obtain a semen analysis to ensure absence of sperm in the semen. It can take weeks to months until all the sperm are cleared and may require as many as 20 or so ejaculations to achieve this. It is important to continue using contraception until the sperm count is zero. You will be sent home with instructions, a prescription and a specimen cup and can provide the specimen for semen analysis 6 weeks or so after the vasectomy.
Risks
- Temporary bleeding, hematoma, bruising, pain.
- Ongoing pain due to congestive epididymitis: On very rare occasions, the epididymis can become painfully swollen with sperm congestion, which is treated with anti-inflammatory medication and rest
- Infection: Extremely rare because the scrotum has such a robust blood supply
- Sperm granuloma: This is a small, hard lump that feels like a bead at the end of the divided vas deferens. It can occur when sperm leak from the severed vas and inflame the surrounding tissue. This is usually treated with rest and anti-inflammatory medication and, on rare occasions, surgery is required to remove it.
- Recanalization (leading to failure of the procedure): This is when the cut ends of the vas deferens grow back together and fertility is re-established, an extremely rare situation occurring in approximately 1/2000 patients.
Common Questions and Answers
Q. Will my testicles still make sperm after my vasectomy?
A. Yes, but your body absorbs and disposes of them.
Q. Will I notice a difference in my ejaculate volume?
A. Since the sperm only contribute a small amount to the seminal volume, there should be no noticeable difference in the volume of the semen.
Q. Does vasectomy protect me against sexually transmitted diseases?
A. No, no, no…I repeat no! Use protection!
Q. Is sex different after vasectomy?
A. No, although some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex after vasectomy is more relaxed and enjoyable.
Q. Does vasectomy affect my ability to get an erection or change the way I urinate?
A. No.
Q. Does vasectomy affect my testosterone level?
A. No.
Q. Is vasectomy reversible?
A. It is reversible with the best results achieved in the initial 10 years following vasectomy. Vasectomy reversal is a complicated procedure requiring general anesthesia and microscopic reconnection of the blocked vas deferens. It typically takes several hours to perform. It’s a big deal whereas a vasectomy is a little deal. Another option for fertility following vasectomy is sperm retrieval with in vitro fertilization.
Q. Is it true that vasectomy can cause prostate cancer?
A. Vasectomy does not cause prostate cancer; however, men who undergo vasectomies have relationships with urologists, the specialists who are attuned to prostate issues, and therefore, men who undergo vasectomy are more likely to undergo prostate cancer screening than the average man who does not see a urologist.
Q. Why should I bother with sedation? How about just local anesthesia?
A. I have yet to meet a patient who enjoyed having a needle placed into his scrotum and local anesthetic injected. With sedation, there will be no awareness of that happening. Furthermore, with the inevitable anxiety that patients experience concerning surgery on their genitals, there is typically a reflex contraction of the muscles that lift the testicles high in the scrotum and sometimes into the groin, making the procedure technically more difficult. The sedation promotes emotional and physical relaxation and makes the procedure technically much easier for the surgeon and much more pleasant for the patient.
Q. How is a semen analysis done?
A. The specimen is provided by ejaculating into a specimen cup. Place the cup into a paper bag and bring it to the designated lab along with the prescription for the semen analysis. Try to get it to the lab as quickly as possible. The specimen will be studied microscopically for the presence of sperm.
Q. When can I have unprotected sexual intercourse?
A. Unprotected sexual intercourse is not advisable until the semen analysis demonstrates the absence of motile sperm.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. He is the co-founder of PelvicRx and Private Gym. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
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