A vasectomy is a surgical procedure performed on males in which the vas deferens (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, cauterized (burned or seared) or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but they die and are absorbed by the body.
Description
Vasectomies are often performed in the doctor's office using a local anesthesia. The patient's scrotum area will be shaved and cleaned with an antiseptic solution to reduce the chance of infection. A small incision is made into the scrotum (the sac containing the testicles that produce the sperm). Each of the vas deferens (one from each testicle) is tied in two places with nonabsorbable (permanent) sutures and the tube is severed between the ties. The ends may be cauterized (burned or seared) to decrease the chance that they will leak or grow back together.
Sterility does not occur immediately after the procedure is finished. Men must use other methods of contraception until two consecutive semen analyses confirm that there are no sperm present in the semen. This will take four to six weeks or 15-20 ejaculations to clear all of the sperm from the tubes.
"No scalpel" vasectomies are gaining popularity. Instead of an incision, a small puncture is made into the scrotum. The vas deferens are cut and sealed in a manner similar to that described above. No stitches are necessary and the patient has less pain. Other advantages include less damage to the tissues, less bleeding, less risk of infection, and less discomfort after the procedure.
In some, cases vasectomies may be reversed. However, this procedure should be considered permanent as there is no guarantee of successful reversal.
Who Performs the Procedure and Where Is It Performed?
Vasectomy is a minor procedure that can be performed in a clinic or doctor's office on an outpatient basis. The procedure is generally performed by a urologist, who is a medical doctor who has completed specialized training in the diagnosis and treatment of diseases of the urinary tract and genital organs.
Questions to Ask the Doctor
How often do you perform vasectomies?
What is your rate of complications?
How long will the procedure take?
What will the procedure cost? Will my insurance cover the cost?
Do you perform vasectomy reversal? What is your success rate?
Definition
A vasectomy is a surgical procedure performed on adult males in which the vasa deferentia (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, cauterized (burned or seared), or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but they die and are absorbed by the body.
Purpose
The purpose of the vasectomy is to provide reliable contraception. Research indicates that the level of effectiveness is 99.6%. Vasectomy is the most reliable method of contraception and has fewer complications and a faster recovery time than female sterilization methods.
The cost of a vasectomy ranges between $400 and $550 in most parts of the United States. Some insurance plans will cover the cost of the procedure.
Demographics
Approximately 500,000 vasectomies are performed annually in the United States. About one out of every six men over the age of 35 has had a vasectomy. Higher vasectomy rates are associated with higher levels of education and income.
Description
Vasectomies are often performed in the doctor's office or an outpatient clinic using local anesthesia. The area around the patient's scrotum (the sac containing the testicles that produce sperm) will be shaved and cleaned with an antiseptic solution to reduce the chance of infection. A small incision is made into the scrotum. Each of the vasa deferentia (one from each testicle) is tied in two places with nonabsorbable (permanent) sutures and the tube is severed between the ties. The ends may be cauterized (burned or seared) to decrease the chance that they will leak or grow back together.
"No scalpel" vasectomies are gaining in popularity. Instead of an incision, a small puncture is made into the
In a vasectomy, an incision is made in the man's scrotum. The spermatic cord is pulled out (B) and incised to expose the vas deferens, which is then severed (C). The ends may be cauterized or tied off (D). After the procedure is repeated on the opposite cord, the scrotal incision is closed (E). (Illustration by GGS Inc.)
scrotum. The vasa deferentia are cut and sealed in a manner similar to that described above. No stitches are necessary and the patient has less pain. Other advantages include less damage to the tissues, less bleeding, less risk of infection, and less discomfort after the procedure. The no-scalpel method has been used in the United States since 1990; as of 2003, about 30% of vasectomies are performed with this technique.
The patient is not sterile immediately after the procedure is finished. Men must use other methods of contraception until two consecutive semen analyses confirm that there are no sperm present in the ejaculate. It takes about four to six weeks or 15–20 ejaculations to clear all of the sperm from the tubes.
In some cases vasectomies may be reversed by a procedure known as a vasovasostomy. In this procedure, the surgeon reconnects the ends of the severed vasa deferentia. A vasectomy should be considered permanent, however, as there is no guarantee of successful reversal. Vasovasostomies are successful in approximately 40–50% of men.
Diagnosis/Preparation
No special physical preparation is required for a vasectomy. The physician will first assess the patient's general health in order to identify any potential problems that could occur. The doctor will then explain the possible risks and side effects of the procedure. The patient is asked to sign a consent form which indicates that he understands the information he has received, and gives the doctor permission to perform the operation.
Aftercare
Following the surgery, ice packs are often applied to scrotum to decrease pain and swelling. A dressing (or athletic supporter) which supports the scrotum can also reduce pain. Mild over-the-counter pain medication such as aspirin or acetaminophen (Tylenol) should be able to control any discomfort. Activities may be restricted for one to two days, and sexual intercourse for three to four days.
Risks
There are very few risks associated with vasectomy other than infection, bruising, epididymitis (inflammation of the tube that carries the sperm from the testicle to the penis), and sperm granulomas (collections of fluid that leaks from a poorly sealed or tied vas deferens). These complications are easily treated if they do occur. Patients do not experience difficulty achieving an erection, maintaining an erection, or ejaculating. There is no decrease in the production of the male hormone (testosterone), and the patient's sex drive and ability are not altered. Vasectomy is safer and less expensive than tubal ligation (sterilization of a female by cutting the Fallopian tubes to prevent conception).
According to both the World Health Organization (WHO) and the National Institutes of Health (NIH), there is no evidence that a vasectomy will increase a man's long-term risk of testicular cancer, prostate cancer, or heart disease.
Normal Results
Vasectomies are 99% successful in preventing conception. As such, male sterilization is one of the most effective methods of contraception available to consumers.
Morbidity and Mortality Rates
Complications occur in approximately 5% of vasectomies. The rates of incidence of some of the more common complications are:
mild bleeding into the scrotum: one in 400
major bleeding into the scrotum: one in 1000
infection: one in 100
epididymitis: one in 100
sperm granuloma: one in 500
persistent pain: one in 1,000
Fournier gangrene is a very rare but possible complication of vasectomy in which the lining of tissue underneath the skin of the scrotum becomes infected (a condition called fasciitis). Fournier gangrene progresses very rapidly and is treated with aggressive antibiotic therapy and surgery to remove necrotic (dead) tissue. Despite treatment, a mortality rate of 45% has been reported for this condition.
Alternatives
There are numerous options available to couples who are interested in preventing pregnancy. The most common methods are female sterilization, oral contraceptives, and the male condom. Female sterilization has a success rate of 99.5%; oral contraceptives, 95–99.5%; and the male condom, 86–97%.
Resources
Books
"Family Planning: Sterilization." Section 18, Chapter 246 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Periodicals
Hartanto, Victor, Eric Chenven, David DiPiazza, et al. "Fournier Gangrene Following Vasectomy." Infections in Urology 14, no.3 (2001): 80-82.
Organizations
Alan Guttmacher Institute. 1120 Connecticut Ave., NW, Suite 460, Washington, DC 20036. (202) 296-4012. www.agiusa.org.
Planned Parenthood Federation of America. 810 Seventh Ave., New York, NY 10019. (212) 541-7800. www.plannedparenthood.org.
Vasectomy is the operation to sterilize the male by dividing the vas deferens on both sides, and thus to interrupt the passage of sperm.
Vasectomy has been known for some hundred years — the first operation performed specifically for the purpose of sterilization took place in Indiana in 1899. It was initially believed that by suppressing the sperm-making functions of the testes, an increase in the sex hormone could be brought about, producing improvements in physical health and sexual vigour. This led to its practice as a ‘rejuvenation’ operation, known as the ‘Steinach’ operation after the Viennese professor whose laboratory experiments led to this conclusion. The numbers of men who underwent this operation in the hopes of increasing their sexual powers cannot be known, but Kenneth Walker, the British expert in male sexual disorders, believed that ‘uncritical and unprincipled medical men’ widely exploited this belief during the 1920s. He himself was sceptical of its benefit in increasing sexual power, attributing any apparent improvement to suggestion.
As a means of contraception, the operation was also, of course, much easier to perform and less drastic than the equivalent operation on the female. However, in spite of the publicity the operation gained in connection with rejuvenation, for many years it was confused in both the lay and the medical mind with castration. The very legality of such a ‘mutilating operation’ was in question.
It increased in popularity as a method of contraception during the 1960s, particularly for couples who had completed their families and were reluctant for the wife to continue taking the Pill for an indefinite period. Unlike female sterilization, it tends to be the choice of couples who share responsibility for fertility control.
There are currently various different operative techniques but the method that is gaining popularity is the ‘no scalpel’ method invented by Professor Li Shungqiang of Sichuan Reproductive Health Institute, Chengdu, Sichuan, P R China, and worldwide this method is now the most commonly used. It is a very minimal technique using specially designed instruments which enable the vas to be divided through a small puncture wound; the ends are then separated by a bit of tissue. It is interesting to note that Professor Li started life as a neurosurgeon but during the cultural revolution he was redirected to work in family planning. Many lesser men would have become very depressed but he immediately set about devising new operations, culminating in his no scalpel technique. It has now been used on hundreds of thousands of men and probably no other living surgeon has influenced the lives of more men.
A question that is commonly asked is ‘Where do the sperm go after vasectomy?’ The sperm-producing cells are in the seminiferous tubules inside the testicle and sperm exit from the top of the testicle into a softer area, the epididymis. The epididymis to a certain extent acts as a filter, and abnormal sperm and debris associated with cell division are cleared from the ejaculate. After vasectomy the whole sperm production has to be absorbed through the epididymis: an exaggeration of its normal function. Seminal fluid continues to be produced normally by the prostate gland and seminal vesicles.
The effect on subsequent sex-life appears to be beneficial in the majority of cases, in spite of the concern often expressed that it may have a deleterious effect on virility (harking back to the old association with castration) — commonly, increased sexual satisfaction and libido has been reported (perhaps substantiating Steinach, or merely reflecting the release from fear of conception). However, this is more likely to occur when the man has deliberately chosen to undertake vasectomy, unlike the case of the Indian men who were persuaded into vasectomy, in return for portable radios, during a drive to reduce the population problem of the subcontinent.
In recent years there has been some concern about the safety of vasectomy. It has been shown that there is no association between vasectomy and heart attacks or vasectomy and testicular cancer, although there have been worries about both. There is still some concern about the association between vasectomy and prostate cancer, but it seems very likely that this apparent association is because of the introduction of new methods to diagnose prostate cancer, and the way statistics are collected, rather than any cause and effect.
Vasectomy is highly reliable provided that an additional method of contraception is employed during the first weeks following the operation, during which live sperm may still be present in the seminal fluid.
The major disadvantage is that it cannot readily be reversed: even with recent developments in microsurgery, the operation to reunite the severed vasa deferens reopens them in 80-90% of cases, but the success rate in terms of achieving pregnancy is at best only 50%. There have been attempts at temporary, reversible blocking or clipping of the tubes, but so far these have failed to achieve a degree of reliability in any way comparable with the permanent operation.
There is a very small late failure rate (approximately 1 in 2000), but vasectomy remains surer than female sterilization. The only more certain method of contraception is complete abstinence.
Severing of the vas deferens, which carries sperm from the testes to the prostate gland, to cause sterility or prevent infection. This relatively simple procedure, which can be performed in a doctor's office with local anesthetics, removes the ability to father children without affecting ability to achieve erection or orgasm. The vas is cut near its beginning, in the scrotum. The cut ends may be sealed off or left open. Reversal is more likely to succeed in the latter case; microsurgery has improved the success rate.
vasectomy, male sterilization by surgical excision of the vas deferens, the thin duct that carries sperm cells from the testicles to the prostate and the penis. Vasectomy is a popular method of birth control: in 1983, figures showed that approximately 10 million men had been sterilized in the U.S. since 1969. Excision of the vas deferens is a minor surgical procedure that can be performed in a physician's office in less than half an hour. A small incision is made on one side of the scrotum (the external sac housing the testes) and the vas deferens is located, cut, and the ends tied off. The incision is closed and the procedure is repeated on the other side. After surgery, it is necessary to wait until a negative sperm count is obtained before discarding other means of contraception, because viable sperm cells are retained in the seminal vesicles (the pair of storage pouches where sperm is mixed with other components of semen) and along the various sperm ducts. In addition it is usually advised that the patient be reexamined after a year, because the severed ends of the vas deferens occasionally reknit. Sterility resulting from vasectomy is considered to be permanent, and attempts at surgically reversing vasectomy, called vasovasotomy, have had limited success. In India, where the government is trying to stem the tide of overpopulation, money is paid to men who submit to voluntary vasectomy. Efforts to overcome the irreversibility of vasectomy have also led to experimentation with the implantation of faucetlike devices that can be made to open or close the sperm duct in a simple operation. Such devices have functioned successfully in animals but are still considered experimental in humans because of their unproved reversibility, high cost, and the degree of surgical skill needed to implant them. Another option suggested to those undergoing vasectomy is to preserve their fertility by depositing semen in sperm banks. Such semen samples are frozen in liquid nitrogen below −300°F (−185°F) and are considered to be viable for an indefinite period. However, there is considerable debate over the scientific and ethical aspects of sperm freezing, and the practice is still considered experimental. Researchers have examined the possible negative physiological effects of vasectomy, but there is no conclusive evidence that any link exists between the procedure and disease.
Bibliography
See S. D. Mumford, Vasectomy: The Decision-Making Process (1978); G. Denniston, Understanding Vasectomy (1978).
A surgical procedure in which the ducts that carry sperm out of the testes are cut and tied off so that no sperm can pass. Vasectomy is a form of male sterilization and is used as a method of birth control. The procedure has no effect on a man's capacity to produce semen; the only difference is that his semen will no longer contain sperm.
