Definition & Overview

Vasectomy is a surgical procedure to cut the vas deferens in men to prevent the sperm from reaching the semen and being ejaculated during sexual intercourse.

The sperm is produced by the testicles, a pair of oval structures enclosed in the scrotum at the back of the penis. The sperm then travels through the epididymis and to the long tube called the vas deferens. When the sperm reaches the seminal vesicles and the ejaculatory ducts, it mixes with the seminal fluid to form the semen. During sexual intercourse, the semen carries the sperm through the parts of the female reproductive system until it reaches the egg and fertilizes it.

Cutting the vas deferens is an effective method of contraception since the sperm is no longer ejaculated along with the seminal fluid. The testicles' ability to produce sperm will not be affected by the procedure but the sperm will be absorbed by the body instead of being mixed with the seminal fluid. Some physicians advise their patients to freeze their sperm in the event that they wish to reproduce even after they had undergone the procedure.

Who Should Undergo and Expected Results

Vasectomy is offered to men who no longer wish to have children. Since it is considered a permanent contraception method, eligible patients are often advised to consult first with their family and seek counseling so they are able to carefully weigh the pros and cons of the procedure before making any decision. In some cases, younger men are advised to wait for a few more years before getting a vasectomy—to lessen the possibility of regretting the decision later on.

As for the expected results, vasectomy has a high success and satisfaction rating, with less than one percent chance of the patient’s partner getting pregnant after the procedure is performed. It is important to note though that vasectomy does not take effect immediately as it does not eliminate the remaining sperm in the ejaculatory ducts. Until a sperm count test can confirm that the patient’s semen is free from sperm, alternative contraceptive methods, such as condoms, must be used to prevent unwanted pregnancy.

Following the procedure, patients typically feel numbness and pain in the genital area. As such, they are usually prescribed with pain medications to immediately address these side effects as well as antibiotics to ward off infection. They are also advised to wear a jockstrap or fitted underwear to support the scrotum while in recovery. Normal, daily activities, including sexual intercourse, can be resumed a few days after the operation.

There are cases in which the patient would come to regret his decision to undergo vasectomy. A reversal procedure may be performed but this is significantly more complex than vasectomy and does not provide 100% guarantee of restoring a man’s fertility.

How is the Procedure Performed?

Vasectomy can be performed using two techniques depending on the surgeon's recommendation and patient's unique circumstances. Both techniques require the isolation and division of the vas deferens and operative management of the vasal ends as well as the administration of local anesthesia to the scrotum so the procedure is painless and comfortable for the patient.

The first technique (traditional method) involves making small incisions on each side of the scrotum to locate the vas deferens. The physician then cuts the tubes by removing small portions of it before the ends of the vas deferens are cauterized and tied off. The incisions are then closed using stitches.

The other method aims to accomplish the same but without making incisions. Instead, the scrotum is punctured using a sharp needle and a small clamp with a pointed end is inserted to locate the vas deferens. The tubes are then cut and tied off. No stitches are needed to close the puncture wound.

There are some cases in which the physician uses a soft silicon or polyurethane plug to block the vas deferens. The tubes are not cut and remain intact.

Possible Risks and Complications

Vasectomy is relatively safe and simple. However, just like any other medical procedure, there are still possible risks and complications that go with it, including the following:

  • Bleeding in the scrotum, which can occur right after surgery
  • Hematoma, or the collection of blood in the incision site
  • Infection
  • Post-vasectomy pain syndrome, a chronic condition characterized by constant pain in the epididymis
  • Pain during sexual arousal, intercourse, and ejaculation
  • Primary progressive aphasia, a form of dementia linked to vasectomy
  • Failed procedure, in which the severed ends of the vas deference reconnect, allowing the transport of sperm to mix with the seminal fluid, leading to unplanned pregnancy.

Though rare, some patients regret their decision of undergoing vasectomy usually due to their desire to build a family with a new partner following a relationship breakdown, unexpected death of child/children, and improved finances, which means they can support more children. This may have an impact on their mental health and adversely affect their relationships with their partners. This is the reason why patients are advised to freeze their sperm before undergoing the procedure. Those who have elected to skip this part have the option to undergo vasectomy reversal.

References:

  • Roncari D, Jou MY (2011). Female and male sterilization. In RA Hatcher, et al., eds., Contraceptive Technology, 20th rev. ed., pp. 435–482. New York: Ardent Media.

  • Trussell J, Guthrie KA (2011). Choosing a contraceptive: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 20th ed., pp. 45–74. Atlanta: Ardent Media.

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