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What is a vasectomy?
A vasectomy is a minor surgical procedure used by surgeons to make a man sterile. It is one of the most popular forms of contraception worldwide, and is regarded as safe, simple and highly effective. A vasectomy is performed by cutting the vas deferens, the small tubes that carry sperms from the man's testicles to become part of his semen. Although the man continues to have sexual intercourse and climax as before, his semen does not contain sperm and he cannot father a child following a vasectomy.
What is a "No-Scalpel" Vasectomy (NSV)?
The No-Scalpel technique is one of two main methods surgeons use to perform a vasectomy. Many doctors favour the No-Scalpel method because - unlike the traditional vasectomy approach - a scalpel is not required and there are no incisions (only one or two small punctures in the skin). In addition, the NSV often results in less discomfort after the procedure with a reduced risk of bleeding or infection. Also, there is no perceptible scaring.
How long does the No-Scalpel procedure and recovery take?
The procedure itself usually takes about 15 minutes, sometimes less. However, including the Surgery routine, paperwork and preparation, the total time in a doctor's Surgery may be about an hour. The procedure is likely to produce tenderness, discomfort and slight swelling in the first two or three days afterwards, with a return to nearly all usual activities typically within a week. (Follow your doctor's instructions carefully, take your time and use the schedule that is right for you.)
How effective is a No-Scalpel vasectomy?
A vasectomy of any type is considered as one of the most effective means of protection from pregnancy. Although no procedure is totally safe or effective, the failure rate for a vasectomy is less than one percent. (By comparison, the failure rate for condoms is 12 percent or more; for diaphragms, it's 18 percent.) Couples who want a highly reliable and permanent form of contraception often opt for a vasectomy where the success rate is over 99 percent.
Does it work immediately?
No, any vasectomy does not make you sterile right away, and you'll want to continue using some other means to guard against pregnancy until your doctor tells you otherwise. Immediately after a vasectomy, active sperm remain in the semen for a period of time. It may take 30-40 ejaculations and several weeks before your semen is free of sperm. Your doctor will test the semen, perhaps several times over several weeks, and let you know when you can safely consider the vasectomy to be complete. This may be as long as three months.
What happens to the sperm?
The body absorbs unused sperm cells normally - whether or not you' have had a vasectomy. After the procedure, the testicles will continue to produce sperm, but they will not leave the body in the semen. They dissolve and are simply and naturally absorbed by the body.
Will my sex life be affected?
A vasectomy only blocks sperm and does not affect your sexual drive, your ability to have an erection, orgasm or ejaculation or your ability to have and enjoy sex. Sperm is only a small fraction of the total liquid in your semen. The amount of fluid, intensity - even colour and texture - does not appear to change when sperm is absent. Male hormones continue in the bloodstream, and secondary characteristics (such as beard or voice) do not change. Some couples say their relationship is improved by not having to worry about contraceptive techniques or unplanned pregnancy.
What is the cost of a No-Scalpel vasectomy?
This may be done under NHS if you reside within our PCT area and your GP is able to refer you to us. But we have to operate within allocated quotas so waiting time may be long. If this is carried out privately we charge £180 which includes pre-operative and post-operative appointments also.
Are there risks or complications?
Yes, as with any surgical procedure, there could be complications and you should ask your doctor to go over these carefully with you. However, any type of vasectomy ranks among the safest procedures and the majority of complications, if any, are usually minor and easily treated. These include a chance of infection, bleeding or transient bruising, temporary swelling or fluid accumulation.
Following the procedure, some men experience pain, often as a dull ache, caused by a pressure on the miniature tubes of the epididymis. This is usually treated successfully with medication, but the removal of the epididymis is sometimes recommended.
Some studies have found that some men, who had a vasectomy 20 years earlier, have a slightly higher risk of prostate cancer than others who did not have a vasectomy. Other studies did not have the same results. There is no proven such risk that there is any link of Prostate cancer with Vasectomy.
Can a vasectomy be reversed?
You should consider any vasectomy to be permanent. There are delicate microsurgery operations that may be able to reverse the effects of a vasectomy, but there is no assurance that the flow of sperm can be restored or pregnancy will result in every case. The likelihood of success can vary greatly depending on individual circumstances, including how much time has passed since the vasectomy. If you are seriously considering a vasectomy, it's best to assume that it will be a permanent change.
In Summary:
- Be prepared to ask a lot of questions; informed decisions are best.
- Always discuss your issues with the doctor of your choice.
- A vasectomy is a simple, safe and highly effective procedure.
- The No-Scalpel method is often preferred over the traditional vasectomy.
- Results are not immediate; it may be weeks before sterility is complete.
- Vasectomy does not change your ability to have an erection or enjoy sex.
- The procedure is safe, risks are low and complications are rare.
- A vasectomy should be considered permanent and may not be able to be reversed later.
Vasectomy will not solve marital or sexual problems. But it can help you enjoy sexual relations more—free from the fear of unwanted pregnancy. And it can be the right choice if the female partner does not want or cannot take birth control pills or use other forms of contraception.
Who are the best candidates for vasectomy?
Because this is a personal decision, there are no absolute rules, and the best answer lies in being informed. However, here are some suggestions to consider as to who is a good candidate:
- Men and their partners over the age of 25, who are seriously committed to not having more children now, or in the future.
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- Men for whom other forms of contraception are not safe alternatives for themselves or their spouse.
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- Men who want to enjoy sex without the fear of unwanted pregnancy.
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- Men who do not feel ‘forced’ into this decision by others or financial circumstances.
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- Men who want to take the responsibility of contraception.
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- Men who are concerned about passing on a genetic disease or hereditary disability.
Before making a decision, discuss these and all related issues with your spouse, and seek the advice of your physician.
In Summary:
- A vasectomy should be considered permanent, so consider your decision fully and carefully.
- Be informed and discuss all your options with your spouse and your physician.
- Some men (or couples) may not be well suited for a vasectomy, particularly if either partner is under the age of 25.
- Short-term, temporary or changing circumstances may not be good reasons to consider a long-term or permanent procedure.
- A range of contraceptive methods provides couples with a variety of alternatives worth considering.
Absence from work or limited activity
Doctors often recommend that a patient rest following the procedure and avoid strenuous activity or heavy lifting for two or three days. Individuals can usually return to work within three days, and most patients say they feel completely back to normal in about a week.
Common fears of Vasectomy, In Summary:
- Having a procedure near his testicles is a nearly universal fear for men.
- Knowledge and understanding help balance anxiety.
- A vasectomy is considered safe, simple, fast and highly effective.
- A vasectomy is often preferable over surgical options for the woman.
- Discomfort following the procedure is often mild and easily relieved.
- Rest is advised for a few days; return to work is typically three days.
- Always discuss concerns and risk factors with your doctor; ask questions.
The Male Reproductive Anatomy
Here's a simple diagram that illustrates the primary elements of the male reproductive system.
Here is what to expect.
A vasectomy surgically blocks the vas deferens, preventing sperm from becoming part of the seminal fluid that leaves the body at sexual climax. Vas deferens are the thin tubes in the scrotum that would normally carry sperm from the testicles to become part of the ejaculate. When the sperm channel is interrupted, the man becomes sterile and can no longer father a child.
A typical vasectomy is done in the GP’s Surgery
The two most common vasectomy techniques are the traditional vasectomy, and the No-Scalpel Vasectomy (NSV). Both methods accomplish the same result, but the No-Scalpel Vasectomy has become more popular with both doctors and patients.
Because the No-Scalpel Vasectomy is widely accepted as simpler and safer, the information presented in this site favours NSV. We are members of BANSV (British Association of No Scalpel Vasectomists)
GENERALLY: Some expectations and considerations.
What a vasectomy is:
- It is a safe and simple male sterilization procedure.
- It is highly effective (over 99 percent), but it is not guaranteed.
- It is considered a permanent procedure.
What vasectomy isn't:
- It usually isn't painful - a local anaesthetic takes care of that.
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- It isn't as invasive or as expensive as the sterilization procedure for women (tubal ligation).
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- It shouldn't be considered uniformly reversible.
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- It isn’t immediately effective because sperm in the vas deferens may be viable for many weeks.
What vasectomy doesn't do?
- It doesn't affect male hormone levels, since testosterone is released into the bloodstream, not through the vas.
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- It doesn't affect sexual function. Vasectomy doesn't reduce sex drive or sensation. The semen appears the same, although the sperm is missing.
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- It doesn't protect against sexually transmitted diseases.
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- A vasectomy will not affect your manliness. The amount and appearance of semen will not change noticeably and sex will feel the same.
BEFORE: Preparing for your vasectomy.
There are some simple things that you can do to get ready for your GP Surgeon’s visit in advance of your appointment.
1. Do not take aspirin or other anti-inflammatory medication for 10 days before the procedure. Such medication can increase the risk of bleeding.
2. Shave all scrotal hair. Shower thoroughly and wear or bring clean, snug underwear (not the boxer shorts) on the day of your appointment.
3. Arrange in advance for someone to drive you home following the procedure. While you might feel able to drive, post operative discomfort could become distracting. For your comfort and safety, it is advisable to arrange for a ride home.
4. Prepare questions that you may have for your doctor. You will be asked to sign a consent form stating that you understand the risks involved and that sterility cannot be guaranteed.
5. Your total appointment may last as much as an hour, but the vasectomy procedure itself only requires about 20 minutes in most cases.
DURING: The usual steps in a No-Scalpel Vasectomy.
Your doctor may describe the routine to expect in his Surgery, and your experience may differ from these steps. Generally…
1. You will be asked to strip below your waist level and lie on the operating table.
2. The procedure site will be painted with anti-septic solution
3. Sterile drapes will be placed over the operating area to guard against infection.
4. After a local anaesthetic is administered, a small puncture is made in the scrotum. (The punctures in the skin do not require a scalpel.)
5. Either the right or left vas deferens is lifted through this opening. The vas is cauterised and cut, and a section may or may not be removed. You may feel a pulling sensation during this process. The two ends of the vas are heat sealed (cauterised), or tied, before being returned to the scrotum.
6. The opposite vas deferens is then lifted through the opening for the same procedure. The remaining opening can heal with closure by stitches or naturally without stitches.
AFTER: Care following the vasectomy.
Any discomfort is usually mild and pain relievers should be used if necessary. The local anaesthetic begins to wear off after an hour or so. Recovery time after a No-Scalpel Vasectomy is usually less than after a traditional vasectomy.
Here are a few general guidelines following an uneventful vasectomy:
· Go directly home and rest; elevate your feet. Plan to stay off your feet as much as possible for a couple of days.
· Your doctor will likely prescribe or advise you to buy over the counter an analgesic (pain killer tablets) to control the pain after the local anaesthetic wears off.
· Apply an ice pack to the scrotum periodically during the first 24 hours after the procedure to ease swelling.
· Wear snug cotton underwear to help apply pressure against the procedure area and for support of the scrotum for the first week or two.
· Surgeon will usually see you 24 – 48 hours after the operation.
· Contact your doctor if you experience fever and shivers, increasing pain, drainage (sign of infection), a growing mass (sign of internal bleeding or infection), or other concerns.
In Summary:
- A vasectomy is safe, simple, effective and permanent, but sterility is not immediate.
- It is normally done in a doctor’s Surgery and requires about 20 minutes.
- It does not affect sexual function.
- Your doctor may instruct you to not take aspirin or other medication in advance of the procedure.
- Prepare any questions to review with your doctor in order to make an informed decision.
- The No-Scalpel Vasectomy does not require a scalpel; there are no incisions (only one small puncture), and frequently, no stitches.
- Pain or discomfort following the procedure usually is mild and controlled with medication. Return to work is typical in a week or less.
- Carefully review and follow the instructions and information from your doctor.
The birth of No-Scalpel birth control.
In the early 1970s a new procedure known as "no-scalpel vasectomy" was developed in China by Dr. Li Shunqiang. This minimum-invasive procedure may appeal to some men who are otherwise uncomfortable with the idea of having their genitals 'cut'. In NSV, as with the traditional vasectomy, the skin of the scrotum is opened for the procedure. A local anaesthetic is used in all cases to allow the patient to be comfortable during either procedure. During the past few decades, over 15 million no-scalpel vasectomies have been performed with this technique now used around the world.
Urologists and family practitioners who perform conventional vasectomies have generally taken additional training to perform the no-scalpel procedure. If this method appeals to you, you may want to identify a physician who possesses this advanced training, expertise and experience for the No-Scalpel method.
How the No-scalpel vasectomy is performed.
As the name suggests, the "No-Scalpel" method does not involve a scalpel, but a small opening is still necessary. Key to the No-Scalpel Vasectomy are the special instruments that allow the procedure to be done with generally less manipulation of the patient's tissues. In a NSV procedure, the doctor usually locates the patient's vas deferens under the skin of the scrotum by hand, and holds the tiny tube in place with a small clamp. Small pointed forceps separate the layers of tissue and then creates a tiny puncture in the skin to form an opening for the vas deferens to be gently lifted out, then cut, tied, clipped and/or cauterized and put back into place.
The surgeon may elect to close the opening in the skin with sutures. However, because the skin puncture is much smaller than a conventional incision, it can close quite quickly without the necessity of suturing.
Like a conventional vasectomy, local anaesthetic is administered to allow the patient to be comfortable.
No-Scalpel Benefits.
Physicians who perform the no-scalpel method of vasectomy believe that their procedure produces less complications and discomfort with a faster recovery time. Other physicians who continue to use the standard technique may not believe that there is a significant advantage.
In Summary:
- An experienced surgeon may use one of several vasectomy techniques.
- Traditional and No-Scalpel Vasectomy techniques are equally effective.
- NSV may appeal to some men, but a local anaesthetic is used in all cases.
- Patients should discuss the procedure in detail with their surgeon.
What are the general risks?
Any surgical procedure carries some risk, but vasectomy is considered to be low-risk, and complications are uncommon. It is important to note that vasectomy should be considered a permanent form of birth control, and it does not protect against sexually transmitted diseases or AIDS.
Discuss any concerns and risks associated with vasectomy with your physician. The following is a list of most, but not all, of the risk issues to consider.
Allergic Reaction Rarely, some men may experience itching and hives, as an allergic reaction to local anesthetic.
Antibodies Sperm which are no longer released through ejaculation and absorbed by the body may attract antibodies produced following vasectomy.
Bleeding Generally painless bleeding may occur following vasectomy and collect under the skin, so that the penis and scrotum appear bruised and/or swollen. The scrotum skin is very thin, which may make bruising appear worse than it actually is and is a normal reaction after vasectomy.
Chronic Orchialagia Rarely; the patient may experience a dull ache in the testicles following vasectomy that is thought to be caused if the epididymis becomes congested with dead sperm and fluid. If this condition occurs, it usually disappears within six months.
Congestion A common name for chronic orchialgia (see above).
Epididymitis This uncommon condition occurs when the larger tube behind the testicle, connected to the vas, becomes inflamed and swollen. The application of heat and the use of anti-inflammatory medication usually clear this up within a week.
Failure Pregnancy may result if a man fails to abstain from sex or use alternative forms of birth control during the waiting period, until the testing for live sperm is completed. There is also one chance in 10 thousand that the cut vas will spontaneously rejoin.
Hematoma Bleeding inside the scrotum rarely may cause painful swelling immediately following a vasectomy. The result is known as a hematoma, and while seldom serious, it should be reported to a
Infection If blood collects under the skin following vasectomy, it can become infected. Infection of the incision site, or deeper tissue, occurs in less than 5 percent of all cases. Such infections usually respond favorably to antibiotic treatment, antimicrobial creams and hot baths, usually within a week.
Post-operative Pain Some degree of scrotal pain or ache is normal following a vasectomy. The use of acetaminophen (Tylenol), with or without codeine frequently is recommended over aspirin, which can cause bleeding. Painful discomfort normally disappears within a day or two, while a slight ache may remain longer.
Sperm Granulomas Very rarely, sperm leakage from the testicular cut end of the vas may cause a small and usually painless lump. This lump does not pose a danger and frequently resolves over time.
In Summary:
- Although a simple, safe and common surgical procedure, any surgical procedure includes some risk.
- A vasectomy is considered to be low risk, and complications usually are uncommon.
- Some pain and discomfort may be expected, but this normally decreases and disappears within days, given routine post operative care.
- It’s important to review possible risks and complications with your physician.
The First Few Weeks after Surgery
You should not consider, and probably won’t feel like, resuming sexual intercourse from 72 hours to a couple of weeks following surgery. Before you do resume sexual activity, remember that you will not be considered sterile for several weeks. Until your doctor determines that you are sterile, continue to use an alternate form of birth control.
And you should also remember that a vasectomy does not protect you or your partner from sexually transmitted diseases.
Once sexual activity is comfortable for you, it is important to resume ejaculation, since it takes between 30-40 ejaculations before any remaining sperm is released. In fact, sperm can remain in the semen for three to six months following your vasectomy.
You can expect your doctor to advise you when to bring in your first semen sample for examination. This is usually within 10-12 weeks after vasectomy. You may be able to collect your seminal specimen at home and local hospital lab. Use the sterile containers that your doctor’s Surgery will provide you for all semen samples.
You are generally considered sterile only after your semen analysis confirms that there are no sperms in your semen. The doctor will inform you of this on receiving the lab result and then you and your partner may discontinue other contraception.
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