Vasectomies for Male Sterilization
A Permanent Decision
About 1,000,000 men get a vasectomy each year. A vasectomy is a simple, safe, easy, and inexpensive method of birth control when compared with oral contraceptives and a tubal ligation. The Urology Team believes that vasectomy should be considered to be a permanent procedure. There are reversal procedures, but they are not 100% successful. In addition, these reversal procedures are generally not covered by any insurance and can be quite expensive. Ask yourself whether you would want more children if you separated from your partner, if your partner died or if one of your children died. A man can bank (i.e. freeze) his sperm before his vasectomy is performed but it is expensive and most men do not do so.
Anatomy
A vasectomy is an outpatient procedure that can be done in the office in greater than 95% of the cases when the anatomy is favorable. On occasion, individuals with certain medical problems or a history of previous scrotal surgery may require vasectomy under a general anesthetic in an outpatient setting.
The sperm are produced on the inside of the testicles in specialized rows of cells. The sperm maturation cycle is about 90 days. This means that the sperm that are produced today will not be ready for ejaculation for about 3 months. Once the sperm are mature, they pass out of the testicle through the epididymis, which becomes the vas deferens, which subsequently carries the sperm up into the base of the prostate. The seminal fluid is made up of sperm from the testicle and fluid from the prostate and seminal vesicles. The sperm themselves represent less than 1% by volume of the total ejaculate.
Preoperative Evaluation/Consultation
The preoperative consultation with one of the physicians of the Urology Team will consist of an interview, medical history review, and physician examination. The operation will be described completely to the patient's satisfaction. If both the patient and the physician are in agreement, the vasectomy will be scheduled at their mutual convenience.
Risk Involved with the Procedure
In general, vasectomy is a very safe procedure with very low risk or complication. Some patients can get infection at the vasectomy site. This may cause drainage of yellowish fluid, pain, redness and heat around the area of incision. This usually responds to local hygiene and oral antibiotics. Bleeding can occur at the vasectomy site, but is usually only enough to cause some bruising of the skin. On occasion, bleeding underneath the skin can be such that a hematoma can occur. While seldom serious, it should be reported to any physician in The Urology Team. About 40% of patients having a vasectomy develop a rise in sperm antibodies for a period of up to six months. This immune reaction is not harmful and the person having the vasectomy will feel no different. According to work done at the National Institute of Health, men that have had a vasectomy are not more likely to develop heart disease or prostate cancer than men who have never had a vasectomy.
Three or four times out of one thousand, one or both ends of the severed vas deferens will get together and re-canalize. This generally occurs within the first month or two after the procedure. In other words, even though a vasectomy is supposed to be permanent, the procedure does not always work. Those individuals will not be able to attain two negative semen samples after their procedure. Therefore, contraception must be used until two semen samples are determined to be clear of sperm, which usually takes two or three months.
Cost
Depending upon the area of the country, vasectomies charges or cost vary. In general, most insurance companies will cover a very large portion of this cost, leaving a relatively small co-pay or deductible for the patient. You will be responsible for checking with your insurance coverage and what co-pay will be due at the time of your procedure or if self pay, please call the Billing department for private pay prices. Added cost or billing to your insurance company will include Semen Analysis and Pathology examination of the vas deferens tissue.
Day of Procedure
Being prepared for this day is very important. Follow the preoperative instructions closely and be sure to bring required items to the office. The front desk will present you with a consent form to read and sign. On the day of your vasectomy, you may ask your physician for a mild sedative prior to the procedure. Please bring someone with you to drive you home. The local anesthetic begins to wear of after an hour or so. Any discomfort you feel is often mild and should respond to ice packs or oral pain medications.
The Procedure
The vasectomy will take about 10- 20 minutes to perform. A local anesthetic is injected into the scrotal skin adjacent to the vas deferens. This affords almost immediate anesthesia. A small incision is made in the scrotum, the vas deferens is exposed, and a small portion is removed. The severed ends are then either clipped, tied with suture or cauterized. The skin incisions are usually closed with one suture, which dissolves in seven to ten days. The patients can take showers the following morning. The patient is advised to be very sedentary for 48 hours after the procedure to reduce the incidence of complications. Ice packs can be applied to the scrotum periodically for the first 24 to 36 hours to ease swelling. After 48 hours, the patient may begin physical activity, including intercourse, as comfort allows.
The Urology Team believes there is no advantage to a "no scalpel" technique. With the "no scalpel" technique, a small incision is made with a different instrument, but the effect is the same.
The VASCLIP® procedure is The Alternative to Vasectomy. The implantable VASCLIP® is a small, hinged, polymeric lock that stays in place after it is applied to each vas deferens. About the size of a grain of rice, the VASCLIP® gently closes the vas deferens, without cutting the tube, and stops the flow of sperm. Because the VASCLIP® procedure does not require cutting or cauterizing (burning) the vas deferens, complications such as swelling and infection have been shown to be significantly reduced in a clinical study.
The VASCLIP® procedure should be considered permanent. As with any procedure that occludes the vas deferens, patients must continue to use other forms of birth control and have Semen Analysis tests performed until they are advised by their physician that they are infertile. This Vasclip® is not covered by most insurance companies. Please call the Urology Team Billing Department at 512-231-1444 for expenses related to the purchase of the Vasclip. However, the Urology Team does not offer the Vasclip due to its high failure rate.
Will It Hurt?
Local anesthetic is used if the procedure is performed in the office. Some discomfort may be felt when the local anesthetic is injected or when the tubes are brought into the incision. As with most surgery, there is some discomfort after the operation. It will be different for each man. However, most men say the pain is slight. Athletic support, ice packs and an over the counter analgesic is the best medicine for your discomfort.
Post Procedure Instructions and Observations
You will receive a packet of information that also includes your post procedure instruction. These instructions will answer questions regarding activity level, pain control and possible reactions to the vasectomy. A staff member will review these instructions with you one more time reinforcing the importance of following them.
Post-Op Instructions
Once you are home you can do several things to assist in your recovery. The most important advice is to follow the instructions that have been provided to you on your instruction sheet.
For about a week your scrotum may look bruised and slightly swollen. You may also have a small amount of bloody discharge from the incision site.
Post Vasectomy Pain Syndrome
Scrotal pain, referred to as post-vasectomy pain syndrome, occurs in a small percentage of patients. Apparently the vas deferens is blocked and sperm builds up in the epididymis causing it to swell. This increased pressure in the epididymis causes pain but it is a rare occurrence. Usually, hot baths, analgesic medication and time resolve it, but occasionally more invasive treatment is needed.
Will Vasectomy Affect My Sexual Activity?
Ask your Doctor when you can resume sexual activity. Remember that you must use another form of birth control until your doctor says you are completely sterile.
Your erections, orgasms and ejaculations will very much be the same. Most men say they have greater sexual pleasure because they no longer have to worry about an unwanted pregnancy. Remember that sterility is not impotence. The hormones that affect masculinity are still made in the testicles. They still flow throughout the body in the blood stream.
Semen Analysis & Pathology Analysis
To make sure that you are sterile you will have a postoperative semen exam. Your semen is less than 1% sperm. The rest is seminal fluid from the prostate and other glands. The change in the amount of fluid is too little to notice. After a vasectomy your sperm is absorbed in the body. The Urology Team will provide specimen cups with specific instructions on when to collect and transport the semen sample to the lab. *It is important for you to know if your insurance company covers the cost of semen analysis for laboratory specimens. The UTPA may also send a clip of tissue to the pathologist for analysis. Your insurance company will be billed for these services. The Urology Team will notify the patients of the presence or absence of sperm in the ejaculate. If you have not heard from The Urology Team within a two-week period of taking semen specimens to the lab please call The Urology Team right away. Once two consecutive negative samples are obtained, the patient then can have unprotected intercourse.
Vasectomy Reversal
Sometimes it is possible to reverse the operation, but there are no guarantees. Vasectomy Reversal is more expensive than the vasectomy and often not covered by your insurance company. It is a very intricate microsurgical procedure that is performed by several physicians at The Urology Team. For more information, visit our Vasectomy Reversal section.
How Can I Get a Vasectomy?
Contact our office (512-231-1444) for help. If you have an HMO, you may be required to visit your family physician first. The family physician will then refer you to our office with a referral. If you have a PPO, you can visit our office directly. Because insurances are so complicated, we encourage you to call the number listed on your insurance card to verify the process needed to get approval for the vasectomy.