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Vasectomy

Vasectomy: Male Sterilisation

Vasectomy is an extremely common and safe surgical procedure to achieve permanent male sterilisation. It is important that you are well informed so that you can make a sensible decision regarding the risks and benefits of the procedure. Like any surgical operation there are potential side effects and risks. Most side effects associated with vasectomy are temporary, such as a sore or bruised scrotum for a few days. The main complications are bleeding or haematoma formation and wound infection. A small number of men (3-5%) who undergo vasectomy may experience long-term testicular pain possibly due to scarring or nerve injury.

Common Questions

What is a vasectomy?

Vasectomy is an effective and permanent form of male contraception which involves dividing both vas deferens (sperm ducts) which carry the sperm from the testes to the penis. Sperm are made in the testes, once the vas deferens is cut, sperm cannot join with the other fluids which make up the normal ejaculate. This means that you are no longer able to father children.

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Full counselling is provided prior to vasectomy, which is usually performed under local anaesthesia. It should be considered irreversible and importantly you are not sterile from the day of operation. You will be asked to provide post-operative semen samples which will be checked for live sperm. It is imperative that you avoid unprotected intercourse until you are notified you are sterile by your consultant. There is a small failure rate associated with the procedure. Also a small number of men can be troubled by testicular pain after vasectomy (see below).

Is it a reliable form of contraception?

Vasectomy is reliable - but not 100%. About 1 man in every 1000 operations has live sperm persisting in their semen tests after the operation. Even after a successful operation about 1 in 2000 men who have had a vasectomy will become fertile again at some point in the future. This is because, rarely, the two ends of the cut vas deferens re-unite in time (recanalisation).

How is a vasectomy done?

Vasectomy is usually done with a local anaesthetic injection into the scrotal skin and cord. A small cut maybe made in the ‘frozen’ area of skin, or more commonly we employ the ‘no scalpel technique’. With this technique the sperm duct is fix with a small instrument the a sharp forceps is used to pierce the skin to uncover the sperm duct. This is then cut and the two ends are tied. If stitches are required for the skin we used dissolvable material which falls away in 14 days. The operation takes about 30 minutes.

There is usually some discomfort and bruising for a couple of days afterwards. This normally goes away quickly. The discomfort can be helped by wearing tight fitting underpants day and night for a week or so after the operation. It is also best not to do heavy work, exercise, or lifting for a week or so after the operation. Keep things dry that evening but after that you can shower or bath as normal.

Are there any risks with vasectomy?

The commonest complications, although still uncommon, are wound infection, where there scrotal puncture site becomes reddened and sore, or a small collection of blood within the scrotum (haematoma). Infection occasionally requires a short course of antibiotics, the haematoma is self limiting and your body reabsorbs the blood. Very rarely the haematoma can be very dramatic and painful and need draining. There is a small failure rate with the procedure as explained above both immediately after with a small number of men having live sperm in their ejaculate post-operatively. There are also much rarer reports of men documented as being sterile on post-operative semen analysis that then go on to produce live sperm at a later date. This is thought to be due to the previously divided ends rejoining in a process called recanalisation. Occasionally sperm may leak out of the cut tubes and collect in surrounding tissues forming sperm granulomas. These can be quite hard and maybe painful. They are not harmful and do not always require treatment if they do anti inflammatory tablets can help. If very painful they can be excised.

How will I know it has been a success?

Until you receive correspondence from your consultant telling you that your semen samples after the vasectomy show no live sperm you should assume that you are still fertile. You must continue with the contraceptive methods you were using before the operation and avoid unprotected intercourse. Some sperm will already be in the vas above the level of the division at the time of vasectomy. These may survive for several weeks after vasectomy and are present in the semen on ejaculation for a while after the operation. About 12 weeks after the operation you will need to produce 2 semen tests about 3-6 weeks apart. These are looked at under the microscope to check for sperm. If these are clear of sperm you will be given the 'all clear' and discontinue you other contraceptive methods if you so wish.

What happens to the sperm?

Sperm are still produce in the testes as before but as the cannot progress along the sperm duct the body reabsorbs them.

Will it affect erections, my sex drive or increase my risk of cancer?

No. Vasectomy will not adversely affect your erections. The male hormone, testosterone, is by the testes and this continues as normal after the operation. Sperm themselves make up only a very small proportion of the volume at ejaculation to this should not be affected. With the worry or inconvenience of other forms of contraception removed sex may even be more enjoyable. Vasectomy does not increase your risk of developing cancer.

After the operation /recovery/ resuming sex

Before leaving you will be given advice about wound care. Generally we suggest you keep things dry the first 24hrs then shower or bath as normal. If you have absorbable sutures these will fall away after about 14 days. You will also be given some simple pain killers for the following 72hrs.You need to take things easy for a couple of days but you will be able to drive and go back to work as soon as you are comfortable.You can have sex as soon as you feel comfortable but remember to continue using contraception until notified you are sterile.

Further information

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