The decision to proceed with a vasectomy is a very personal one. So it is important that you have a clear understanding of what a vasectomy is and what it is not. The following will provide you with information that will assist you in deciding whether or not a vasectomy is an appropriate form of contraception for you.
What happens under normal conditions?
The testicles produce sperm and testosterone and are located in the scrotum at the base of the penis. Once produced, the sperm exit the testicle through a delicate, coiled tube called the epididymis, where they stay until they are fully matured. Each epididymis is connected to the prostate by a tube called the vas deferens. This muscular tube generally extends from the lower portion of the scrotum into the inguinal canal (site of most hernias) and then into the pelvis continuing behind the bladder. It is at this point that the vas deferens joins with the seminal vesicle and forms the ejaculatory duct. During ejaculation, seminal fluid and seminal vesicles mixes with sperm to form semen which is expelled through the urethra.
What is a vasectomy?
A vasectomy is a minor surgical procedure designed to interrupt the sperm transportation system between the testicle and the urethra by blocking the vasa deferentia.
How is a vasectomy performed?
In general, vasectomies are performed in the urologist's office. However, the procedure may be done at an ambulatory surgery center or in a hospital setting if the patient and urologist have determined that intravenous sedation is preferable. The decision to proceed in that type of setting may be based upon the patient's anatomy, anxiety or the need for associated surgical procedures.
On the day of the procedure, the patient will be asked to sign a surgical consent form. Certain states have regulations regarding the type and timing of the surgical consent for permanent sterilization.
Once the patient has signed the consent form and has been brought into the procedure room, his scrotal area will be shaved. Some urologists will have the patient shave this area at home. The area will then be washed with an antiseptic solution. Local anesthesia will be injected to numb the area but the patient will be aware of touch, tension and movement during the procedure. However, the local anesthetic should eliminate any sharp pain. The patient is awake during the procedure so, if necessary, he can let the urologist know if he is experiencing pain so more local anesthesia can be given.
With a conventional vasectomy, an urologist makes one or two small cuts in the skin of the scrotum to access the vas deferens. The vas deferens is cut, and a small piece may be removed leaving a short gap between the two remaining ends. Next, the urologist may cauterize the lumen or ends of the vas, then ties the cut ends with suture material. The scrotal incisions may be closed with dissolvable stitches or allowed to close on its own. The entire procedure is then repeated on the other side either through the same initial incision or through a second scrotal incision.
During a no-scalpel vasectomy, the urologist feels for the vas under the skin of the scrotum and holds it in place with a small clamp. A special instrument is then used to make a tiny puncture in the skin and stretch the opening so the vas deferens can gently be lifted out, cut, then tied or cauterized and put back in place.
What should the patient expect after a vasectomy?
Your urologist should provide you with specific recommendations for your care after a vasectomy. It is generally wise to return home immediately after the procedure and avoid strenuous or sexual activity. Swelling and discomfort can be minimized by placing an ice pack on the scrotum and by wearing a supportive undergarment, such as a jockstrap. Most patients can expect to recover completely in less than a week and many are able to return to their job as early as a day after the procedure. Sexual activity can usually be resumed within a week following a vasectomy. However, it is important that all patients recognize that a vasectomy, even though successful, is not effective immediately. The effectiveness of the vasectomy must be proven by having the patient submit at least one semen analysis , which demonstrates that there are no sperm in the ejaculate. The time until disappearance of sperm from the ejaculate varies from patient to patient. Most urologists do not recommend checking the semen for sperm for at least three months or 20 ejaculates, whichever comes first. If sperm continue to be present in the ejaculate, that patient must continue to use contraception. After waiting for three months or 20 ejaculates, one in five men will still have sperm in their ejaculate, and will need to wait longer for the sperm to clear. The patient should not assume that his vasectomy is effective until his semen analysis demonstrates the absence of sperm.
Information provided by the American Urological Association.