Vasectomy, the snip-snip

FEATURE — A discussion about vasectomy is likely to cause grown men to cringe, cross their legs, and ball up in a fetal position.  Many men who enter a doctor’s office for a vasectomy reveal that they are only there because their wife forced them to come.  Frequently their friends and co-workers have filled their minds with stories (some of them fictitious) about vasectomy and the recovery.

Let’s review the facts: Vasectomy is a safe and effective procedure for male sterilization.  It is less expensive and safer than female sterilization.  Vasectomy does not impair sexual interest or performance.  Although vasectomy can be reversed, it should be considered a permanent choice for male sterilization.  For these reasons, the “snip-snip” is a snap!

Compared to female sterilization, vasectomy is more effective, less expensive, and has fewer complications.

Vasectomy is performed under local anesthesia, and often with a mild sedative.  Before vasectomy, a physical examination (with emphasis on testicular or other scrotal abnormalities) should be performed to rule out testicular cancer or other disease.

Vasectomy usually takes 20-30 minutes to perform.  During the procedure, the structure called the vas deferens is closed.  There is a vas deferens on each side of the scrotum.  This muscular tube has a diameter somewhere between a spaghetti noodle and a cell phone charging cord.  Its only function is to propel mature sperm toward the prostate and urethra for ejaculation.

Access to these tubes is usually through a single ½ inch opening in the upper scrotum.  This is usually done via a non-scalpel approach.  This means that a sharpened instrument called a hemostat punctures the skin and spreads the tissue.  The non-scalpel technique moves tissue to the side, rather than cutting through tissue.  While both techniques are effective, the non-scalpel technique causes fewer complications.

The inner part of the vas deferens, the part that transmits sperm, is about the size of a human hair.  The goal of vasectomy is to close this inner channel to prevent sperm from traveling to the prostate and urethra during ejaculation.  This can be done using cautery (which uses electricity to heat and scar the tube shut), tiny clips, suture, displacement of one end of the tube apart from the other, or a combination of these.

Vasectomy diagram, St. George, Utah, undated | Image courtesy of Dr. Taylor, St. George Health and Wellness
Vasectomy diagram, St. George, Utah, undated | Image courtesy of Dr. Taylor, St. George Health and Wellness

After vasectomy, there may be absorbable stitches in the skin.  These sutures do not need to be removed.  It is common to experience a dull ache in the scrotum that radiates to the groin (that is where the nerves travel).   For the first few days, the more time spent reclining, with frequent ice packs to the scrotum, the less pain and swelling you will experience. After three days, however, one may usually return to normal work and home life.  Narcotic pain medicine, if used at all, is usually not needed after the second day.

Ejaculation should be avoided for one week after vasectomy.  Other forms of contraception must be used until it is proven that all the sperm are absent.  A semen analysis after approximately 15 ejaculations (or after eight to 16 weeks, surgeon preference) is required before resuming unprotected intercourse.

The most common complications following vasectomy are bleeding and infection.  Thankfully, these are rare and only occur one to two percent of the time.  Serious complications are extremely rare.  Post vasectomy pain syndrome (pain that persists beyond the normal recovery period) occurs in roughly one percent of men.  The risk of pregnancy after successful vasectomy with proven absence of sperm is approximately 1 in 2000.

Vasectomy does NOT impair sexual interest or performance.

As described above, the tube that is occluded during vasectomy only carries sperm.  Testosterone is the hormone that causes sexual interest and improves erectile ability.  Testosterone is produced by the testicle and secreted directly into the bloodstream.  This production and secretion are not affected by vasectomy.  Vasectomy also does not increase risk for prostate cancer, heart disease, stroke, hypertension, dementia, testicular cancer, or immune-complex diseases such as lupus.

vasreversals
Vasectomy reversal diagram, the small vas deferens opening is sewn back together. | Image courtesy of Dr. Gregory S. Taylor, St. George Health and Wellness

Vasectomy can be reversed

Vasectomy can be reversed to restore fertility.  However, this operation is much more involved than a vasectomy.  Vasectomy reversal is not commonly covered by insurance and can cost $2,500-5,000.  This surgery is often performed under general anesthesia or deep sedation.  It is a much more delicate operation that involves reconnecting the hair-sized opening with tiny suture (Figure 2).  The opening is so small that a surgical microscope is often used for better visualization.  Vasectomy reversal is approximately 50-65 percent successful.  Vasectomy reversal fertility rates are best with a young female partner and when the vasectomy was performed recently.   Although vasectomy can be reversed, individuals considering vasectomy should consider this a permanent form of sterilization.

Written by Gregory S. Taylor for St. George Health & Wellness magazine and St. George News.

Dr. Gregory S. Taylor is a board-certified urologist who joined St. George Urology in 2006. He completed residency at Oregon Health and Science University (2006), medical school at University of Utah (2000) and undergraduate studies at BYU (1996).  He enjoys Southern Utah’s outdoors with his family and dog, Fergus.

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10 Comments

  • Frank September 13, 2014 at 9:21 am

    Ouch ouch ouch

  • The Rest Of The Story September 13, 2014 at 11:32 am

    Vasectomy may be a good solution for a monogamous couple who wants to avoid pregnancy, but it does not protect against STD’s. A single man…or a newly-single man who becomes sexually active again…should still use a condom.

    • bobber September 13, 2014 at 12:19 pm

      thank you captain obvious

    • Koolaid September 13, 2014 at 4:10 pm

      Newly single? Whatcha talkin’ about? This is Utah where with the men, more than one wife is expected.

  • Koolaid September 13, 2014 at 4:09 pm

    Well this certainly goes against the religious propaganda that marriage is between one man and one woman to breed lots of kids. If they can’t breed and produce, then they can’t be married. Vasectomies therefore should be outlawed in Utah, unless it’s state and city politicians getting them.

  • Scooter September 14, 2014 at 9:26 am

    I had a vasectomy 20 years ago, on a Friday afternoon, and was back to work and feeling great the following Monday morning. Easiest and best thing I ever did for myself and my spouse. On a 1-10 pain scale, it was barely a 1 … do it.

  • RAinbow equality September 14, 2014 at 10:08 am

    This patience must be crazy I can truly see his nuts. We need to make it mandatory for criminals, second generation welfare, animal abusers like the rodeo participants, and old folks who we put out to pasture at the age of around 60 to have not only vasectomy but to have the main blood supply cord (intro penal tubular) to but cut so no erection can be achieved. Of course leave the old ladies alone because the young ugly men that drink or come up from the south may have to pick these old ladies up at the elks for fun. Love Is the most imponant and old women need to feel love and any thing else. Love all then don’t be picky. Love conquers all who are a little homely, over weight or just old ladies. So freely love

    • Mean Momma September 14, 2014 at 4:07 pm

      Were you high when you typed this? Makes no sense at all…smh

    • rainbows are gay September 15, 2014 at 12:56 pm

      I agree with RAINBOW EQUALITY. All rainbows should he treated equally. Unless it’s a double rainbow – those are way awsomerest and exponentially more gay. It’s like gay squared.

      • JOSH DALTON (INCOGNEGRO) September 15, 2014 at 1:19 pm

        Gays just be gay…can we have our rainbow back now?

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