Vasectomy is a common urological procedure to result in permanent birth control. Over 520, 000 are performed a year in the USA. It is an outpatient procedure that is done in the clinic/office. It takes about half an hour. A piece of the vas is removed and either clips or ties are applied and some urologists turn the vas back or place the two ends in different levels. Ice pack, rest and pain medication are recommended after the surgery. Protected intercourse is needed until no sperm in the semen is confirmed. This is checked after a certain number of ejaculations (e.g. 15-20) or based on time frame (6 weeks or more after vasectomy). The patient is NOT CLEARED FOR UNPROTECTED INTERCOURSE until the follow up semen analysis shows no sperm. Certain questions often asked are listed below:

Will a man have normal erections after vasectomy?
Yes – any affect on erections may be psychological – there are no changes hormonally that cause a problem. Some residual discomfort may play a role possibly.

Will a man still produce fluid?
Yes – the main fluid a man produces is “down stream” from the vasectomy.

Will a man still reach climax?
Yes….no further explanation needed

Will a man still have normal libido (sex drive)?
Yes. Again the problem may be psychological or if he still has some pain may lead to less desire.

Can a vasectomy increase the chance of testicular cancer?
No. There is no connection between the two. Also there is no connection with prostate cancer or any other cancers.

Are there any diseases that a vasectomy can lead to?
No. There have been some associations made that a vasectomy can lead to an increased risk of heart disease, and Alzheimer’s disease. These have not been supported by adequate studies.

Can a vasectomy reverse itself spontaneously?
This is called “recanalization” and unfortunately the answer is yes but rarely and the statistics range from 1 in a 1000 to 1 in 10,000 chance. The reason for this is that there is a sort of “honey combing effect” that the body manages to do in some cases. This however may be very much related to the technique of vasectomy performed and to the man being compliant with the instructions to get his semen checked to make sure there are no sperm. Under 50% of men get checked to make sure that they have no sperm. It is recommended that the analysis not be performed until at least 15-20 ejaculations have occurred. Some doctors recommend a time line e.g. analysis after 6 weeks. The exact time line is not completely clear.

Can a vasectomy be reversed deliberately?
Yes. Of the 520,000 or more men who have a vasectomy in the USA per year, approximately 6% feel that they have made a mistake or a change in their life situation has occurred to consider reversing this permanent means of contraception. It is important to also know that if a man is under 30 years of age, he has a 12 times higher chance of wanting a reversal. See male infertility section.

What is the no scalpel vasectomy?
This isn’t quite what everyone thinks. No scalpel does not mean “no pain” or miraculously the surgery is performed like something out of Star Trek. No scalpel unfortunately doesn’t really mean it is any less anxiety provoking, nor any less of a procedure. The main issue is exactly what the name suggests. In place of a scalpel is an instrument that stretches the skin to open it up…..still requires local anesthetic. The main issue is that most times no stitch in the skin is required and the hole is small. Recovery may be better but I have not noticed any difference.

Dr Ajay Nangia is a national leader in the care of men desiring male contraception especially vasectomy. He has been involved with the future national American Urological Association guidelines in vasectomy care and has written on the topic of vasectomy care over several years. He is the regional expert in the care of men who have complications from vasectomy. He has a high volume practice for vasectomy care and specializes in the "No-Scalpel" technique. Dr Weigel also performs vasectomies and has been doing so for over 30 years.

As a patient some time should be taken thinking about the options. It is an important milestone so it is important to get it right the first time. If a patient is unsure, vasectomy may not be the right option. For more information on vasectomies, procedures and follow-up protocols, please click here to read the review article by Lee Warner, PhD, MPH; Denise Jamieson, MD, MPH; Ajay Nangia, MBBS, FACS.

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