Dear Doctor: After three planned children and one unexpected (but much-loved) arrival, my wife and I think a vasectomy is a good idea. What will happen? How permanent is a vasectomy?
Dear Reader: A vasectomy is a safe and effective kind of birth control that works by disrupting the pathway that carries a man’s sperm. This is done via a simple elective surgery in which the vas deferens, which are the two tubes that carry sperm from the testicles to the urethra, are cut or blocked. The procedure, which is usually performed by a urologist, is close to 100% effective, with just one or two pregnancies per 1,000 procedures. The surgery can be reversed, but the success rate of future pregnancies varies.
A vasectomy is done on an outpatient basis, either in the urologist’s office or a surgery center. It’s likely that your doctor will ask you to avoid blood-thinning medications in the week leading up to the surgery. These include non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, and also may include prescription drugs such as warfarin and apixaban. This is done to limit bleeding during the procedure. It’s important to note that you should never stop taking prescription blood thinners without first consulting with your doctor.
The procedure itself is done under a local anesthetic, so the patient is awake. In the traditional method, the surgeon uses a scalpel to make either one or two incisions in the scrotum in order to reach the vas deferens. A segment of each tube is cut away, and the open ends are sealed shut, either by cauterization or with stitches. The incisions in the scrotum are also closed up.
A newer type of vasectomy, known as the “no-scalpel” method, uses a small puncture to access the vas deferens. Studies suggest that the no-scalpel method results in less pain and fewer post-surgical complications, including infections and blood clots. Additional complications can include pain, swelling, bruising and blood in the semen. Delayed complications can include post-vasectomy pain syndrome, or PVPS. This is prolonged post-surgical discomfort or pain and occurs in 1% to 2% of cases.
Following the surgery, you’ll be asked to wear a supportive garment, such as a jock strap or tight-fitting underwear, for a day or two. Ice packs will be used to reduce swelling, and your doctor will advise you on any pain meds you may need. It’s important to rest for a day or two after surgery, and then to limit activity, such as sports or heavy lifting, for at least a week beyond that. If at any time you experience signs of infection, call your doctor immediately. These include fever and redness, swelling or discharge at the surgical site that don’t improve.
Sperm continues to be present after a vasectomy. That means it’s important to keep using birth control until a follow-up semen analysis, performed six to 12 weeks after the procedure, gives you the all-clear. And remember, although a vasectomy will prevent pregnancy, it doesn’t protect against sexually transmitted diseases. Anyone outside of a monogamous relationship should continue to protect themselves with condoms.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.