What you should know about vasectomy?

Dear Dr. B: My husband and I have two beautiful children. We have decided that my husband should get a vasectomy. What should we know about vasectomy?

Answer: Vasectomy is a type of contraception – a surgical method of male sterilization. Contraception allows us to choose the number of children we want. There are many ways to do this. Most methods are designed for women. For men there are only two methods of contraception: condom or vasectomy.

More than 220 million couples worldwide use sterilization as their contraceptive method of choice. In western countries, about 20 – 25 percent of couples of reproductive age choose vasectomy as their method of contraception. Approximately 500,000 vasectomies are performed in the United States annually.

In my own practice the number of vasectomies done each year has gone up. For example, in the year 2003, I did 194 no-scalpel vasectomies compared to year 2000 when I did 117. In the last seven years, I have done 896 vasectomies.

Vasectomy is a permanent and irreversible procedure. Reversal procedures are being done but the success rate varies a lot. Therefore, it is important that you exercise this option carefully. You should undertake pre-operative counseling and consultation with your family physician and the surgeon doing the procedure.

Vasectomy is an office procedure. It is done under local anesthetic. Except for some discomfort for few seconds associated with infiltration of local anesthetic, the procedure itself is painless. But most patients are anxious. In my practice, I prescribe pre-operative sedation which helps calm the nerves.

The procedure is usually bloodless. It is done through a very tiny opening in the middle of the scrotum with a special instrument (not a scalpel) and no stitches are required.

Are there any post-operative complications?

Studies have shown that no-scalpel method has fewer complications than the conventional method.

Swelling and pain due to bleeding or infection is a possibility. The incidence can be anywhere from one to 10 percent. Mostly it is minor. About five percent of patients may have some chronic discomfort in the scrotal area. The nature of this can vary a lot.

Can vasectomy fail? Failure rate for tubal ligation is 18 per 1000 procedures. For vasectomy, the failure rate is one per 500 to 1000 procedures. In the last 13 years, I have had two documented vasectomy failures. One was in 1991 and second one in 1993.

Vasectomy does not immediately render the patient sterile. The sacs that hold semen contain sperms after vasectomy has been done. Other methods of contraception should be used until semen analyses (after two and three months) show that no sperms are left. Unfortunately, 30 percent of patients do not go for sperm analyses. That is not good.

Sperm granuloma, the cause of some pain after vasectomy, is caused by leakage of sperm from the vas. It develops in about 15-40 percent of men after surgery and may cause pain in three percent.

Vasectomy does not adversely affect a man’s sexual function. Current evidence does not show that vasectomy causes prostate or testicular cancer or would adversely affect a man’s health in any way.

Post-operatively, patients are advised to use ice-packs and to take it easy for couple of days. Exertion should be avoided for a week. If there are no complications then no pain killers are required.

So, vasectomy is a safe and effective method of long-term contraception. Remember, it is permanent and irreversible. Reversal procedures are being done but the success rate can be low. On the other hand, it is also important to remember that vasectomy can fail and there is no guarantee of permanent sterility.

Update (May 3, 2007): I have recorded a short video about this procedure on my video blog which can be viewed here.

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