Family Planning for Men – Vasectomy
Your doctor has referred you to me as you have requested a vasectomy operation. This information sheet tells you about the operation, its reliability and possible problems. Read it carefully before your appointment and if possible bring your partner along to the appointment (although this is not essential). You may also find it helpful to keep this leaflet until after your operation as it also tells what to expect after vasectomy.
What is Vasectomy?
The sperm are made inside the tubules of the testes. These tubules join together to form approximately 20 ducts that drain from the testis into the epididymis (soft area behind testis) and from there, the sperm pass to the vas deferens. The vas deferens carries the sperm to the pipe in the penis where they are released during ejaculation. Vasectomy involves dividing and blocking the vas deferens on each side of the scrotum just above the testes with the intent of preventing passage of the sperm. The operation is most commonly done under local anaesthetic, which involves an injection into the scrotal skin and around the vas without making you sleepy. There is no need to fast prior to the procedure. After the operation you will have a stitch on each side of the scrotum that will dissolve on its own, usually within 2 weeks.
Please bring a pair of tight, clean underpants or swimming trunks to provide plenty of support to the scrotum after the operation. This helps reduce the risk of swelling and bruising.
Advantages of Vasectomy
It is a simpler operation than female sterilisation and does not require so much time in hospital. Unlike the contraceptive pill or contraceptive injection there are no hormonal side effects like headaches or mood swings. Your own hormones are unaffected and there should no difference in your sexual function. Unlike the condom or cap, there is no interference with sexual satisfaction
Approximately 1 in 10 men experience minor local problems after the operation, these normally resolve without treatment in a few days and are described below.
Soon after the operation, once the anaesthetic effect has worn off, you may need mild painkillers such as paracetamol, panadol, nurofen etc. to relieve the discomfort.
Most men will notice some bruising and swelling around the operation site, this usually resolves in a few days. Rarely, the site can become infected (red discoloration of the wound). If the wound is persistently painful, becomes red and swollen, or there is a discharge from the stitch area you should seek advice from your General Practitioner as you may need a course of antibiotics to treat an infection.
Occasionally a small amount of bleeding continues after the operation and the blood accumulates in the scrotum as a swelling or ‘haematoma’. If this happens it will usually resolve without intervention, but if the swelling is large (mandarin orange sized) then you should be seen by a doctor. Even then it does not usually cause long-term problems.
How much time is required off work really depends upon the type of job you do. Most men only take a couple of days off work but if your job is very heavy or you still feel uncomfortable, then you may need a week or so. You should avoid strenuous activities, contact sports, swimming, etc. until the area is entirely comfortable and the wound has healed.
You can start having sex again when you feel comfortable to do so (usually after 4-5 days), but do not be alarmed if you see a small amount of blood in the seminal fluid, as this should clear quickly.
You and your partner must continue to use your usual method of contraception until you receive the ‘all-clear’ following two specimens of semen that contain no sperm. It may take up to 20 weeks or longer for sperm remaining in your tubes to clear away (usually after >20 ejaculations). You will be asked to send in 2 semen samples, obtained after ejaculation, at 16 and 20 weeks after the operation to ensure that two consecutive samples are free of sperm. At this stage you will be advised that it is safe to discontinue your usual method of contraception.
Problems after Vasectomy
- Testicular discomfort: Approximately 5 in 100 men experience some minor testicular discomfort or pain, perhaps only intermittently, months or even years after the operation. After vasectomy the sperm are usually absorbed back into the body from the epididymis (soft tissue behind the testis). However, distension of the epididymis or leakage of sperm from this area may cause testicular discomfort or pain. In most cases this settles down after a few months but very occasionally it may be more troublesome requiring further treatment or surgery. Rarely ( 1 in 2000) there may be persistent long-term swelling or pain, which may require further medical attention.
- Failure of operation:Vasectomy is the surest method of family planning apart from abstinence! However, no doctor can absolutely guarantee vasectomy as a method of contraception. Around 1 in 200 men continue to produce samples containing sperm (mostly dead) month after month, which usually clears up with frequent sexual intercourse (approximately 15-20 times with the usual method of contraception). If these small numbers of sperm persist, then this may indicate that the operation has failed. This is usually due to technical difficulties relating to the operation. You will be invited to speak to me about the possibility of repeating the operation. Late failure is a more difficult problem. The cut ends of the vas occasionally rejoin again years after the original operation. The exact frequency of its occurrence is difficult to know but generally a figure of 1 in 2000 is quoted. This far less than the female sterilisation rate which is 1 in 200. Unfortunately there is no way to guarantee against this happening.
- Link with other disease: There have been a number of reports in the medical literature about a possible link between vasectomy and prostate cancer, testicular cancer, heart diseases, kidney stones or immune diseases. Only one large study has provided credible evidence of a very small increased risk of aggressive prostate cancer in men who have had a vasectomy, particularly if they had vasectomy at a young age. As such men undergoing vasectomy may be well advised to seek screening for prostate cancer by PSA testing once they reach the age of 50.
Vasectomy should be considered an irreversible operation. If you have any doubt about your plans to have more children, it would be better not to have a vasectomy at this stage. It is the policy of Lothian Health Board (and most other health boards) not to allow the operation of vasectomy reversal in NHS hospitals as an NHS procedure. If you do change your mind and wish to have your vasectomy reversed then this would have to be arranged at a private hospital. The chances of achieving pregnancy after vasectomy reversal range from 1 in 5 to 4 in 5, depending on the length of time since vasectomy, and the age and fertility of your partner. As there can be no guarantee of a successful vasectomy reversal it is better to view vasectomy as an irreversible operation.
It is possible to store sperm prior to vasectomy as an insurance policy against changing your mind, although it may be argued that if you are considering this you should probably not proceed to vasectomy at this stage. Sperm banking is costly; later use of stored sperm is complicated and time consuming, and even then success is not guaranteed. Furthermore, there is no provision for sperm banking prior to vasectomy in Edinburgh. If you wish to arrange storage you should contact the London Gynaecology Centre in Harley Street, London.