Vasectomy should only be undertaken as a permanent, irreversible form of contraception.
The testicles produce sperm. Leading from each testicle is a tube called the vas deferens. Sperm are made all the time and are stored in, and pass along these two tubes. Each vas deferens passes up from the scrotum into the tummy, meeting in the prostate gland (this is located at the lower part of the back passage).
At ejaculation, the sperm pass along each vas deferens, reaching the prostate. The prostate gland produces a liquid that the sperm enter, to form the semen that then passes out from the tip of the penis. The sperm make up only a very small part of the semen (less than 2% of the average total volume of 2.5-3.5ml) - the majority is the fluid from the prostate gland.
The purpose of vasectomy is to destroy part of the length of each vas deferens. Thus, although sperm continue to be produced by the testicles, they can no longer reach the prostate and thus leave the penis. However, each vas deferens acts as a store for sperm and it can take up to twenty ejaculations to empty them. Only after this time does the vasectomy provide adequate contraception.
After vasectomy, the sperm that continue to be made in the testicles are reabsorbed.
Vasectomy is done under local anaesthetic - the patient remains awake and unsedated.
The method used employs no scalpel or stitches, but rather something called diathermy. This is a process whereby electricity is passed through a fine metal rod into the skin, producing very high temperatures in the immediate vicinity. This is used to cut the skin of the scrotum, to destroy part of each vas deferens and to close the wound at the end of the vasectomy.
There is no need to shave the scrotum for vasectomy. The skin is, however, cleaned with an iodine-based solution at the start of the vasectomy.
After the local anesthetic has been applied to the skin of the scrotum and deeper structures, a single small cut (approximately 1cm long) is made in the scrotum. The vas deferens of the first testicle is then found and pulled through this hole using a small pair of forceps. It is freed from surrounding tissue and then destroyed along part of its length, by diathermy. It is then replaced into the scrotum and the procedure repeated through the same hole for the other vas deferens. The edges of the hole are then sealed with the diathermy, leaving a dry smaller wound that is covered with a loose dry dressing.
Until you have produced two consecutively clear semen samples you will have to continue using an alternative form of contraception.
Vasectomy fails when a vas deferens rejoins. If this happens before the semen samples are collected it is called an early failure. In such cases the semen samples will not become negative and the vasectomy will have to be repeated. Various studies have shown this to occur in 0.2-1% of vasectomies. Rarely, a vas deferens can rejoin after the semen samples have become negative for sperm - that is, after the vasectomy has been considered a success. Such late failures can happen years later and studies show this arises in less than 0.1% of cases.
All problems can be minimised by wearing supportive underwear after the vasectomy, and relaxing with your feet up for the first 48 hours. Additionally you should avoid lifting for one week, all sport for two weeks and contact sports for 3 weeks.
Most men will suffer a mild degree of testicular swelling and discomfort for a few days to weeks after vasectomy. The problem may be aggravated by sexual excitement and ejaculation. In the first days after the vasectomy, applying an icepack (e.g. a bag of frozen peas wrapped in a towel) will reduce the swelling and make you more comfortable. The problem generally resolves rapidly, but may need anti-inflammatory medication (such as ibuprofen). Supportive underwear, rather than boxer shorts, for the first few weeks after vasectomy is also likely to minimize any discomfort.
Local bruising develops in most men after vasectomy. It is usually localised to the scrotum but can spread to the penis and as far as the groin and thighs. Anti-inflammatory painkillers such as ibuprofen (not to be taken by those with asthma or indigestion/ulcers) can help.
Infection is a risk in any surgery. This might be experienced as flu-like symptoms and/or excessive swelling, tenderness or pain. If you are worried your wound has become infected please contact your GP or myself as soon as possible.
The wound can occasionally bleed. Some men experience a small blood loss from the wound, while a few lose quite a lot. If you are worried and need to stop the bleeding you can do so by squeezing firmly the wound edges between thumb and finger for five minutes. If this fails to arrest the bleeding please contact myself, your GP or, out of hours, NHD direct or A+E, immediately.
In some cases, a small blood vessel within the scrotum may bleed after vasectomy. This can occur several days after the operation and is often the result of over-strenuous activity. This may lead to the scrotum filling with blood clot (haematoma). In such cases the scrotum will become painful and very swollen. Should this occur you should contact your GP or me immediately.
Chronic (long term) post-vasectomy testicular pain is a recognised complication of vasectomy. Generally however, it causes little inconvenience and most men do not regret having their vasectomy because of it.
Its cause is uncertain (Journal of Andrology 2003;293-8).
Estimates of how frequently it occurs vary widely. Figures range from 0.9% to 54% (i.e. affecting from less than 1 in 100 to as many as 54 in 100) (The Journal of Family Planning and Reproductive Health Care 2002;28(3):142-4)
One of the most recent reviews of vasectomy surgery, in the British Medical Journal (BMJ 2005;330:296-9), states the risk of this occurring is less than 10% (i.e. less than 10 in 100 patients).
Studies have found that even among men who do get long term testicular pain after vasectomy, only a minority regret having had the surgery because of the pain. Moreover very few go on to have treatment for this problem (Br J Urol 1992;69:188-191, and BJU International Mar 2004; 93(4):571-4).
Small lumps/nodules may form around the cut end of either vas deferens. These arise in most men and are usually painless. They are due to scar tissue, collections of blood or sperm. Rarely they cause long term pain and need to be removed.
Vasectomy reversal is a difficult and lengthy procedure requiring a stay in hospital and a general anaesthetic. Pregnancy rates after reversal surgery are quoted in the range 10-50%. Positive sperm counts are even more common, but often the sperm are not active because of the development by the man of antibodies against their own sperm.
Reversal surgery is possible, but is not available through the NHS. The cost of such surgery varies widely but you would expect to pay at least £1500.
Neither orgasm nor ejaculation, or the production of male sex hormones are affected by vasectomy. Similarly, sex drive is unchanged.
Testicular cancer is no more common in men who have had vasectomy than in other men.
Studies looking for a link between vasectomy and prostate cancer have produced conflicting results. No clear link has so far been established.
Relax with your feet up for 48 hours; this will make pain/complications less likely
Wear supportive underwear or swimming trunks for 48 hours and do not return to boxer shorts for at least a week
The local anaesthetic will wear off within a few hours. If you feel uncomfortable, a painkiller such as ibuprofen (not to be taken by those with asthma or indigestion/ulcers) or paracetamol should help.
After 48 hours have a bath or shower and soak off the dressing - do not try to pull it off. Dry the area thoroughly but gently and apply a new clean dry dressing
Because the wound is small and heals so well, stitches are not needed. It will heal in 7-21 days. However, it should be kept dry for 48 hours and you should not use any toiletries (such as talcum powder or bath oils) on it until this time.
You can have sex as soon after vasectomy as you feel comfortable, though it is best to wait 2-4 days. You will need to continue using other contraception until you have produced two consecutive negative semen samples.
Avoid sport and heavy lifting for at least one week. Heavy and contact sport should not be undertaken for a minimum of three weeks.
You should not ride a bike, motorcycle or horse for at least three weeks.
Most men will be fit to return to work two days after vasectomy. Those whose jobs involve heavy lifting should stay off work for a week, and for the first week after returning reduce the amount of lifting.
Last updated 16/10/2005