Think Before You Snip
Vasectomy is a surgical procedure that renders a man infertile by blocking sperm in the vas deferens. After a man ejaculates, sperm can’t come out into the semen because of the surgically induced blockage.
Methods of Vasectomy
The traditional vasectomy involves either one midline or two lateral incisions about an inch or so long in the scrotum. The surgeon then brings up the vas deferens, a tube about the thickness of a piece of spaghetti and cuts out a piece of each vas deferens.
The no-scalpel vasectomy involves a small puncture incision over each vas deferens where the surgeon accesses the vas through incisions roughly ¼ of an inch and uses special instruments to perform the procedure. The advantage of this approach is smaller incisions, but no studies have shown faster recovery times or lower complication rate with this approach. Dr. Sun prefers this approach.
< 0.5%
Chance of having sperm in your ejaculate after a vasectomy.
~15 min
Length of time it takes to perform a vasectomy procedure.
Four Considerations Prior to Vasectomy
- Are you sure? As a urologist who specializes in reversing vasectomies, I stand to gain the most if men change their minds and want their vasectomies reversed. Around 50% of marriages end in divorce in the United States. Many men who remarry marry women that want to have children and therefore one can see why vasectomy reversal is a robust business. Ultimately, success rates of vasectomy reversal are high, but reversals are longer procedures that health insurance usually doesn’t cover.
- Take a week off from heavy activity. Although vasectomy is considered a minor procedure, major complications can happen. The most common complication after vasectomy is transient pain. The more active a man is in the first few days after vasectomy, the more likely he’s going to hurt, swell and in very rare cases, bleed and form a hematoma.
- Get checked. Vasectomy has a very high success rate. The chance of having sperm in the ejaculate after vasectomy is well under 0.5%. At about 3 months after the vasectomy, you will send in a semen sample from the comfort of your home using a kit and it will send you (and me) a report ensuring that no sperm are in the ejaculate.
- Speaking of unprotected sex, vasectomy just keeps sperm from traveling into the ejaculation. It is by no means a way to prevent sexually transmitted infections. The same amount of fluid comes out after a vasectomy and therefore transmission of bodily fluids doesn’t change after a vasectomy.
Six Myths About Vasectomy
Vasectomy is a common office procedure for men and is an excellent form of permanent, non-drug birth control for couples. However, a lot of men are reluctant to undergo the snip. Most of the reluctance comes from myths surrounding vasectomy. Here are some common ones I hear and the truth behind the myth.
- I won’t ejaculate after a vasectomy. Ejaculatory fluid, semen, is made in the prostate and the seminal vesicles, which are not cut during vasectomy. The amount of fluid that comes out of the testicle with sperm is less than 1% of the overall volume. The muscle contractions that force fluid out during ejaculation come from the pelvis and again, are not affected by vasectomy.
- Vasectomy will decrease my testosterone level. While it is true that the testicle makes both sperm and testosterone, Testosterone is transported through the bloodstream, not the vas deferens. Testosterone levels don’t go down as a result of vasectomy.
- Vasectomy will give me erectile dysfunction. Fortunately, this is physically impossible. Fundamentally, a vasectomy is just cutting the tubes that transport sperm, located in the scrotum. The nerves which control erection actually lie on TOP of the penis, nowhere close to the vasectomy site. A vasectomy does not affect the nerves, the blood flow, or the tissues of the penis in any way.
- Vasectomy will give me prostate cancer. This myth actually started in medical literature about 15 years ago. There was a large longitudinal study that suggested a link between men who underwent vasectomy and developed prostate cancer later in life. First of all, this makes no medical sense. Sperm production has nothing to do with prostate cancer development, and many studies have been done since to show no connection between the two. What is more likely is that men who undergo vasectomy are more enfranchised in the medical community and therefore get screened more often for prostate cancer. The majority of prostate cancer is found through screening, therefore, a man who undergoes vasectomy is more likely to get screened for prostate cancer than a man who doesn’t.
- Vasectomy will shut down sperm production. Vasectomy just blocks the pipes, it doesn’t shut down the factory. Men continue to make sperm; they just have nowhere to go. Sperm typically live about 3-5 days. Therefore, if a guy doesn’t ejaculate every 5 days or so, his sperm die anyway—only to be reabsorbed and replaced by millions more. After vasectomy, the same thing happens, sperm are always in a constant state of production → decay → reabsorption → production, regardless of whether they have anywhere to go.
- It’s easier for my wife to get her tubes tied. Nice try. Tubal ligation in the United States is usually done under general or epidural anesthesia, usually takes a while longer than the 10-20 minute vasectomy and has a higher serious complication rate.
Pre-op Instructions for Vasectomy
- Do not take any Aspirin or NSAID medications (Advil, Aleve) for 1 week prior to the vasectomy.
- Please wear tight fitting underwear on the day of the vasectomy – under armor or better yet, something like a jock strap.
- Wear some nice warm pants – we want that scrotum nice and warm and loose when you come in for the procedure. Hot and sweaty is far better than cold and contracted.
- Do some manscaping of the scrotum before the procedure. Your balls should be as smooth and hairless as possible. Believe me, you’d rather shave yourself than have me do it! Seriously, please shave your balls. Theres nothing worse than trying to do a delicate, precise surgery in the middle of a jungle.
- Please eat a regular meal and drink plenty of fluids on the day of your procedure. It’s OK to eat before your procedure – in fact, I encourage it. We don’t want you coming in on an empty stomach and fainting.
Post-op Instructions for Vasectomy
- Please ice your scrotum for at least 24 hours: 20 minutes on scrotum, then take ice off for 5-10 minutes and repeat. This will really decrease your bruising and swelling. If you want to ice for longer – more power to you!
- It is OK to shower immediately after your procedure, but no baths.
- For the first 48-72 hours, you want to mostly be relaxing on the couch. Standing / walking is fine but take it easy. This is a great time to binge some Netflix.
- Wear tight compression shorts or a jock strap for the first week to help take pressure off the scrotum. We want the boys high and tight, not swinging around.
- Resume light to moderate physical activity about a week after the procedure.
- Two weeks after the procedure, you may resume strenuous activity (such as bicycling) and sexual activity.
- Remember that you are still considered fertile until you have a negative semen analysis in 3 months, and you are told there is no sperm in it.
- It is normal to have small marble-sized balls / swelling around the incision sites / where the sutures are placed. These will resolve on their own over time. If you have swelling greater than a golf ball around your incision sites, please call Dr. Sun to discuss further.
- It is normal to have a little blood ooze from the incision site in the first 48 hours. If you see bleeding like this, pinch the incision with gauze and hold for about 5 minutes; this usually stops any minor skin bleeding.
- You can apply a little Neosporin or other antibiotic ointment to the incision sites for the first week to help keep any bacteria away.
- It is not normal to have fevers or have redness or significant drainage from the incision sites. If you have these symptoms – please call our office.
- Your first choice for pain meds after surgery should be Tylenol or Advil.