Is Vasectomy for You?

Vasectomy is a simple, safe, and effective surgical procedure that makes a man sterile (unable to father a child). Because a vasectomy should be considered irreversible, it's a serious step to take. You and your partner should understand all the facts and share in the decision.

A permanent decision

Few decisions in life are permanent, but having a vasectomy is one of them. So, before you make this decision, you and your partner must be sure that you don't want any more children. Is there any circumstance that might make you change your mind? For instance, if you divorced or became a widower and remarried, would you want more children? If you choose to have a vasectomy, you should have no doubts about these issues.

• FACT: A vasectomy does not affect your ability to have sex. Sterilization won't affect your ability to have erections or orgasms, and doesn't visibly change your semen.

• FACT: There is no conclusive evidence that vasectomy causes health problems. You may have heard that sterilization causes prostate cancer, heart disease, or other health problems, but there's no conclusive evidence that this is true. If you're concerned, your doctor can give you more information. Note, however, that having a vasectomy does not protect you from sexually transmitted diseases.

• FACT: A vasectomy will not solve marital problems. The only aspect of your life that a vasectomy changes is your ability to father a child. Sterilization is not a solution for sexual or marital problems.

Choosing sterilization requires careful consideration. If you decide that a vasectomy is right for you, you can enjoy newfound freedom and spontaneity. And you can feel comfortable knowing that your family won't get unexpectedly larger

How a vasectomy works

To understand how a vasectomy works, you need to know how sperm is produced, stored, and released by your reproductive system.

When you have a vasectomy, the two vas deferens are cut to keep sperm from traveling from the testes to the penis. This is the only change in your reproductive system. The testes still produce sperm, but since they have nowhere to go, they die and are absorbed by your body. Your prostate and seminal vesicles still produce fluids, so your semen doesn't look or feel any different. Your male hormone level remains the same, so your hair distribution, the pitch of your voice, and your sexual drive don't change.

The vasectomy procedure

A vasectomy is an outpatient procedure that can be done in a doctor's office, clinic, or hospital. A vasectomy is almost always performed using local injected anesthesia. Several days before your vasectomy can be performed, you'll be asked to read and sign a consent form that states you're aware of the possible risks and complications and understand that the procedure, though usually successful, is not guaranteed to make you sterile. Be sure that you have all your questions answered before signing this form.

Preparing for surgery

Don't take any aspirin for 3 to 5 days before your procedure, and ask your doctor about any other medications you take. The day of your surgery, shower and thoroughly clean your scrotum. Your doctor may also ask you to shave your scrotum. Eat a light snack instead of a heavy meal before your surgery. Bring a pair of clean cotton briefs or an athletic supporter with you to the doctor's office or hospital. If you're nervous before your surgery, the doctor may give you some medication to help you relax.

During surgery

You will be asked to undress and lie on the exam table. Sterile drapes are placed over you to help prevent infection. You're given injections of a local anesthetic in your scrotum or lower groin. This anesthetic prevents you from feeling pain. Once the anesthetic takes effect, one or two small incisions are made in the skin of the scrotum with a scalpel or a pointed clamp (no-scalpel method). Each of the vas deferens is lifted through the incision and cut, and a section may be removed. You may feel a pulling sensation during this process. The two cut ends are tied or clipped closed, or they may be sealed by heat (cauterized). The incision or incisions may be closed with one or more stitches.

After surgery

If you have been given medication to help you relax, you will need to have someone drive you home. The local anesthetic begins to wear off after an hour or so. Any discomfort you feel is usually mild. If you need it, pain medication can help.

Healing

Once you're home, you can do several things to aid your recovery:

• Stay off your feet as much as possible for the first 2 days to lessen the chance of swelling. An ice pack or bag of frozen peas can help keep swelling down.

• Wear snug cotton briefs or an athletic supporter for support.

• Ask your doctor how long to wait before bathing (usually 48 hours).

• Wait until your doctor says it's okay to return to work.

• Avoid heavy lifting or exercise for at least 5 days after surgery.

• Ask your doctor when you can begin having sex again. Remember that you must use another form of birth control until your doctor says you're completely sterile.

For about a week, your scrotum may look bruised and slightly swollen. You may have a small amount of bloody discharge from the incision site. You may also feel a little pain. These symptoms are normal.

Possible Risks and Complications Even with a minor operation like vasectomy, problems can occur. If you experience any of the following or any other symptoms you're concerned about, call your doctor. The following complications might occur during the first few days after your surgery: Internal bleeding in the scrotum sometimes occurs, usually within two days of surgery. Symptoms include increasing pain, excessive swelling, a large black-and-blue area, or a growing mass. Infection may occur. Some signs of infection are fever, chills, drainage from the incision site, and a very painful incision site. Other complications, though rare, may occur in the first few months after surgery. These are the most common: Sperm granuloma is a lump at the site where the vas deferens is tied off. It's caused by leaking sperm. The lump usually dissolves by itself, but surgery is occasionally required to remove it. Congestion is a buildup of sperm in the epididymis. It may cause inflammation of the epididymis (epididymitis) and some aching about 3 to 12 weeks after surgery. It usually disappears without treatment. Sperm antibodies are a common response of the body to absorbed sperm. There's no evidence that these antibodies are harmful, but a large number of them may make it difficult to become fertile again, if you should ever change your mind. Testicular discomfort lasting several years after the procedure occurs rarely. Spontaneous return of fertility occurs very rarely. This can happen if the cut ends of the vas deferens reconnect (recanalization). It's usually detected by a semen test after surgery, although it occasionally occurs after the semen test has been performed.

Sex after a vasectomy

A vasectomy won't affect your sexual functioning. When you start having sex again, you'll still have erections and orgasms, and your sexual relations will feel the same as before. If you had a good relationship with your partner before vasectomy, it shouldn't change because of a vasectomy.

Until you're sterile

It's absolutely essential that you continue to use some other method of birth control after your vasectomy until your doctor tells you that your sperm count is zero. To make sure no sperm are left in your semen, you'll have a postoperative semen exam. This exam is commonly done about 6 weeks after surgery and again about 3 months after surgery. You usually collect the semen at home in a small jar, and bring it to a lab. You're sterile only when these semen samples show no evidence of sperm.

After you're sterile

After your doctor tells you you're sterile, you no longer need another form of birth control. You're free to have sex without the fear of unwanted pregnancy. However, keep in mind that a vasectomy does not protect you from sexually transmitted diseases. If you're not in a mutually monogamous relationship, practice safe sex by using condoms.

If you change your mind

Although a vasectomy must be considered irreversible, a surgical procedure called a vasovasostomy might restore fertility. During this procedure, the cut ends of the vas deferens are reconnected to allow the free flow of sperm. It's a major operation that's expensive and not always covered by insurance. It's also not guaranteed to restore your ability to father a child. As an alternative, sperm banks can freeze sperm collected before your vasectomy and store it in case you want a child in the future. However, achieving pregnancy with stored sperm is also expensive and uncertain.

Other birth control methods

Before deciding on a vasectomy, you and your partner should have already considered other methods of birth control. Some of these methods are more effective than others, and all are effective only when used correctly. Ask your doctor for more information.

Condoms

A condom is a thin sheath that fits over the penis or lines the vagina before intercourse. Condoms block semen from entering the vagina. Latex and polyurethane condoms also help protect against many sexually transmitted diseases.

Birth control pills

Birth control pills are taken daily by a woman to prevent eggs from being produced. A prescription is required for this method, and side effects are possible.

Diaphragm or cervical cap

The diaphragm is a small, thin rubber cup. The cervical cap is similar, but smaller. Either one can be filled with spermicide and placed over the opening to the woman's uterus to keep sperm out. A prescription is required for these methods.

Spermicides

Spermicides are chemical foams, creams, or jellies that kill sperm. They are placed directly into the vagina and are often used with other forms of birth control such as condoms or diaphragms. Some people have allergic reactions to spermicides.

Norplant

Norplant is a set of small capsules that release hormones for five years. This form of time-release hormone prevents a woman from producing eggs. The capsules are placed under the skin of the arm. A prescription and a minor insertion procedure are required, and side effects are possible.

Female sterilization

This method, also called tubal ligation, is a surgical procedure that blocks the tubes that carry eggs to the uterus. It's more complicated and expensive than vasectomy. Like vasectomy, it's considered permanent.

Depo-Provera

Depo-Provera is a time-release hormone that prevents a woman from producing eggs. It is given by injection every three months. A prescription is required for this method, and side effects are possible.

IUD

An IUD (intrauterine device) is a small metal or plastic loop or ring that is inserted into the uterus. It prevents a fertilized egg from attaching to the uterine wall. A prescription is required for this method, and side effects are possible.

Natural family planning

This method, also known as the rhythm method, requires abstaining from sex during the woman's fertile period, which generally lasts from 5 to 15 days during each menstrual cycle. To learn more about this method, ask a qualified physician or natural family planning practitioner.