Urologist Dr. Paul Chung shares what to expect during and after this minor outpatient procedure, and about effectiveness and reversal.
Some men or couples don’t want to have any children; others don’t want to have more children. Modes of contraception, such as condoms, are effective when used properly, but the most effective birth control option – other than sexual abstinence – is vasectomy.
“There’s a very high level of long-term success for vasectomy,” says urologist Dr. Paul H. Chung. “The subsequent chance of pregnancy is less than 1 in 2,000 patients who undergo a successful vasectomy.”
Patients have also asked Dr. Chung about the pros and cons of a vasectomy verses tubal ligation. “I would say that a vasectomy is a simpler procedure that is faster, safer, less expensive and requires less time off,” he says. “The procedure requires only local anesthesia, has less post-surgical complications and can often be performed in the office.”
A vasectomy is a minor outpatient procedure for men that prevents their sperm from mixing with semen when ejaculated from the penis. To accomplish this, a urologist cuts and/or seals the vas deferens, or “vas,” which is a long tube through which sperm travel from the testicle to the ejaculatory duct.
Vasectomy can take as short as 10 minutes to complete. In some states such as New Jersey – but not Pennsylvania — some urologists may provide sedation to their patients in the office while performing the procedure. In states where use of major sedation in physicians’ offices is not permitted, some urologists opt to perform it in an operating room.
The majority of physicians, however, perform vasectomies in their offices with their patients awake, applying just some local sedation to the scrotum and the genital region to minimize discomfort.
“Patients generally tolerate vasectomy extremely well, with some experiencing some minor pain during the procedure,” says Dr. Chung. “They are able to walk out of the office without any help.
“Post-procedure, patients do not require prescription pain medication,” he adds. “Many studies have shown that it isn’t needed. Patients can take over-the-counter meds if they need help with their minor discomfort, which should end within a week(s). Applying an ice pack to the scrotum and wearing a jock strap or tight underwear to support it can also provide relief.”
Following vasectomy, couples should continue using some other form of contraception until the procedure’s success is established via a test of the patient’s semen to make sure it is free of sperm.
As effective as vasectomy is, there is still the rare instance where it isn’t. That’s why it’s important that men have their semen tested after a waiting period of at least two months. This allows time for healing to occur at the vas, and for residual live sperm remaining inside the tube from before the procedure to die. Some urologists may want to wait longer to perform the test, and some may want to do it more than once.
“In those rare instances where testing shows sperm in the semen, we will typically do a repeat test about three months later,” says Dr. Chung. “If this second test is, like the first, positive for semen, some urologists may wait a few more months to perform a third test; others will immediately go ahead and repeat the vasectomy. The possibility of such cases is extremely rare, with less than 1% undergoing a repeat vasectomy. Although rare, this is why men must be sure to follow up their procedure with semen testing. If they don’t want to go back to their urologist, there are reliable home testing kits they can use. But either way, testing is very important.”
Difficult to Reverse
Patients should be certain before opting for vasectomy. Reversing the procedure can be difficult, expensive and not necessarily effective.
“Patients should always consider their vasectomy to be permanent,” advises Dr. Chung. “Technically, it can be reversed. However, there are some challenges with that. Reversing a vasectomy is not a procedure that most urologists can do; it needs to be done by one who has microscopic training in reversal surgery. Locating someone near you who can do it may not even be an option.
“Even then, it may not be successful. Just because the tubes are opened doesn’t mean that the sperm will once again mingle with your semen as they did before. Chances of success decrease overtime. The best chance for success is when it’s done sooner rather than later.”
In addition, vasectomy reversal – unlike vasectomy itself – is not covered by medical insurance, so patients would have to pay for it entirely out-of-pocket.
There are other options for men concerned that they may change their mind about having children later. They can bank and freeze some sperm before their vasectomy so they have some available for future fertilization techniques.
Also, vasectomy doesn’t take away the body’s ability to make sperm – just its ability to transport it into the semen. So, if they really want to, men who’ve had a vasectomy could even get a biopsy of the testicle to remove some sperm which could be used with special fertilization techniques.
No Ill Effects
Men may be worried about the after-effects of vasectomy, but actually, there is nothing to worry about, Dr. Chung assures.
“Vasectomy does not change one’s ability to get an erection,” he says. “It does not change one’s hormones. It does not change one’s libido. It doesn’t change how one urinates. It does not change anything except the sperm’s ability to travel into the semen and potentially cause pregnancy.”
[Main photo credit: iStock.com/shapecharge]