Vasectomy is an elective surgical procedure that results in male sterilization, often as a means of permanent contraception. During the procedure, the vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and thereby prevent fertilization of ova through sexual intercourse. Vasectomies are usually performed in a physician's office, medical clinic, or, when performed on a non-human animal, in a veterinary clinic. Hospitalization is not normally required as the procedure is not complicated, the incisions are small, and the necessary equipment routine.
There are several methods by which a surgeon might complete a vasectomy procedure, all of which occlude (i.e., "seal") at least one side of each vas deferens. To help reduce anxiety and increase patient comfort, those who have an aversion to needles may consider a "no-needle" application of anesthesia while the 'no-scalpel' or 'open-ended' techniques help to accelerate recovery times and increase the chance of healthy recovery.
Due to the simplicity of the surgery, a vasectomy usually takes less than 30 minutes to complete. After a short recovery at the doctor's office (usually less than an hour), the patient is sent home to rest. Because the procedure is minimally invasive, many vasectomy patients find that they can resume their typical sexual behavior within a week, and do so with little or no discomfort.
Because the procedure is considered a permanent method of contraception and is not easily reversed, patients are frequently counseled and advised to consider how the long-term outcome of a vasectomy might affect them both emotionally and physically. Vasectomies require the consent of the male only, and like with other forms of sterilisation or birth control, only the consent of the patient (not partners, their spouse or families) is required. A vasectomy without the patient's consent or knowledge constitutes forced sterilization.
Medical uses
A vasectomy is done to prevent fertility in males. It ensures that in most cases the person will be sterile after confirmation of success following surgery. The procedure is regarded as permanent because vasectomy reversal is costly and often does not restore the male's sperm count or sperm motility to prevasectomy levels. Those with vasectomies have a very small (nearly zero) chance of successfully impregnating someone, but a vasectomy does not protect against sexually transmitted infections (STIs).
After vasectomy, the testes remain in the scrotum where Leydig cells continue to produce testosterone and other male hormones that continue to be secreted into the bloodstream.
When the vasectomy is complete, sperm cannot exit the body through the penis. Sperm is still produced by the testicles but is broken down and absorbed by the body. Much fluid content is absorbed by membranes in the epididymis, and much solid content is broken down by the responding macrophages and reabsorbed via the bloodstream. After vasectomy, the membranes must increase in size to absorb and store more fluid; this triggering of the immune system causes more macrophages to be recruited to break down and reabsorb more solid content. Within one year after vasectomy, sixty to seventy percent of those vasectomized develop antisperm antibodies. In some cases, vasitis nodosa, a benign proliferation of the ductular epithelium, can also result. The accumulation of sperm increases pressure in the vas deferens and epididymis. The entry of the sperm into the scrotum can cause sperm granulomas to be formed by the body to contain and absorb the sperm which the body will treat as a foreign biological substance (much like a virus or bacterium).
Efficacy +Risks of vasectomy Frequency Risk 1 in 1400 Unwanted pregnancy (failure of vasectomy) 1 in 11 For comparison: unwanted pregnancy w/ typical use of pill 1 in 6 For comparison: unwanted pregnancy w/ typical use of condom 1 in 40 Infection after surgeryNevill et al (2013) Surveillance of surgical site infection post vasectomy. Journal of Infection Prevention. January 2013. Vol 14(1) 1 in 7 Pain at 7 months after vasectomy 1 in 110 Pain at 7 months affecting quality of life
Vasectomy is the most effective permanent form of contraception available to males. (Removing the entire vas deferens would very likely be more effective, but it is not something that is regularly done.) In nearly every way that vasectomy can be compared to tubal ligation it has a more positive outlook. Vasectomy is more cost effective, less invasive, has techniques that are emerging that may facilitate easier reversal, and has a much lower risk of postoperative complications.
Early failure rates, i.e. pregnancy within a few months after vasectomy, typically result from unprotected sexual intercourse too soon after the procedure while some sperm continue to pass through the vasa deferentia. Most physicians and surgeons who perform vasectomies recommend one (sometimes two) postprocedural semen specimens to verify a successful vasectomy; however, many people fail to return for verification tests citing inconvenience, embarrassment, forgetfulness, or certainty of sterility. In January 2008, the FDA cleared a home test called SpermCheck Vasectomy that allows patients to perform postvasectomy confirmation tests themselves; however, compliance for postvasectomy semen analysis in general remains low.
Late failure, i.e. pregnancy following spontaneous recanalization of the vasa deferentia, has also been documented. This occurs because the epithelium of the vas deferens (similar to the epithelium of some other human body parts) is capable of regenerating and creating a new tube if the vas deferens is damaged and/or severed. Even when as much as five centimeters (or two inches) of the vas deferens is removed, the vas deferens can still grow back together and become reattached—thus allowing sperm to once again pass and flow through the vas deferens, restoring one's fertility.
The Royal College of Obstetricians and Gynaecologists states there is a generally agreed-upon rate of late failure of about one in 2000 vasectomies—better than tubal ligations for which the failure rate is one in every 200 to 300 cases. A 2005 review including both early and late failures described a total of 183 recanalizations from 43,642 vasectomies (0.4%), and 60 pregnancies after 92,184 vasectomies (0.07%).
Complications and concerns
Short-term possible complications include infection, bruising and bleeding into the scrotum resulting in a collection of blood known as a hematoma. A 2012 study demonstrated an infection rate of 2.5% postvasectomy. The stitches on the small incisions required are prone to irritation, though this can be minimized by covering them with gauze or small adhesive bandages. The primary long-term complications are chronic pain conditions or syndromes that can affect any of the scrotal, pelvic or lower-abdominal regions, collectively known as post-vasectomy pain syndrome.
Complications not withstanding, many men express concerns regarding potential adverse effects of vasectomy. The risk of testicular cancer is not affected by vasectomy. In 2014, the American Urological Association reaffirmed that vasectomy is not a risk factor for prostate cancer and that it is not necessary for physicians to routinely discuss prostate cancer in their preoperative counseling of men undergoing vasectomy. A 2017 meta-analysis found no statistically significant increase in risk of prostate cancer. A 2019 study of 2.1 million Danish males found that vasectomy increased their incidence of prostate cancer by 15%. A 2020 meta-analysis found that vasectomy increased the incidence by 9%. Other studies agree on the 15% increase in risk of developing prostate cancer, but found that people who get a vasectomy are not more likely to die from prostate cancer than those without a vasectomy.
Postvasectomy pain
Post-vasectomy pain syndrome is a chronic and sometimes debilitating condition that may develop immediately or several years after vasectomy. The most robust study of post-vasectomy pain, according to the American Urology Association's Vasectomy Guidelines of 2012 (amended 2015) surveyed people just before their vasectomy and again seven months later. Of those that responded and who said they did not have any scrotal pain prior to vasectomy, 7% had scrotal pain seven months later which they described as "Mild, a bit of a nuisance", 1.6% had pain that was "Moderate, require painkillers" and 0.9% had pain that was "quite severe and noticeably affecting their quality of life". Post-vasectomy pain can be constant orchialgia or epididymal pain (epididymitis), or it can be pain that occurs only at particular times such as with sexual intercourse, ejaculation, or physical exertion.
Psychological effects A 1990 study indicated that some 90% of men are generally reported in reviews as being satisfied with having had a vasectomy, while 7–10% of people regret their decision.
Younger people who receive a vasectomy are significantly more likely to regret and seek a reversal of their vasectomy, with one study showing people in their twenties being 12.5 times more likely to undergo a vasectomy reversal later in life (and including some who chose sterilization at a young age). Pre-vasectomy counseling is often emphasised for younger patients.
Procedure
The traditional incision approach of vasectomy involves numbing of the scrotum with local anesthetic (although some people's physiology may make access to the vas deferens more difficult in which case general anesthesia may be recommended) after which a scalpel is used to make two small incisions, one on each side of the scrotum at a location that allows the surgeon to bring each vas deferens to the surface for excision. The vasa deferentia are cut (sometimes a section may be removed altogether), separated, and then at least one side is sealed by ligating (suturing), cauterizing (electrocauterization), or clamping. There are several variations to this method that may improve healing, effectiveness, and which help mitigate long-term pain such as post-vasectomy pain syndrome or epididymitis, however the data supporting one over another are limited. Fascial interposition: Recanalization of the vas deferens is a known cause of vasectomy failure(s). Fascial interposition ("FI"), in which a tissue barrier is placed between the cut ends of the vas by suturing, may help to prevent this type of failure, increasing the overall success rate of vasectomy while leaving the testicular end within the confines of the fascia. The fascia is a fibrous protective sheath that surrounds the vas deferens as well as all other body muscle tissue. This method, when combined with intraluminal cautery (where one or both sides of the vas deferens are electrically "burned" closed to prevent recanalization), has been shown to increase the success rate of vasectomy procedures. No-needle anesthesia: Fear of needles for injection of local anesthesia is well known. In 2005, a method of local anesthesia was introduced for vasectomy which allows the surgeon to apply it painlessly with a special jet-injection tool, as opposed to traditional needle application. The numbing agent is forced/pushed onto and deep enough into the scrotal tissue to allow for a virtually pain-free surgery. Lidocaine applied in this manner typically achieves anesthesia within 10 to 20 seconds. Initial surveys show a very high satisfaction rate amongst vasectomy patients. Once the effects of no-needle anesthesia set in, the vasectomy procedure is performed in the routine manner. However, unlike in conventional local anesthesia where needles and syringes are used on one patient only, the applicator is not single use and can only be properly disinfected by autoclaving.