The Month of March Means Time For the Prime Cut – Vasectomy

Vasectomy remains one of the easiest and cost effective methods of permanent contraception. Many men opt for the outpatient procedure during the month of March so they can chill out and stay glued to the TV for March Madness the month-long college basketball tournament.

In the past few years, there’s an annual spike of vasectomies of approximately 10% in men getting the prime cut shortly before the nationally-televised tournament begins.

The idea is that, with weeks of games to catch up on, they’ll have plenty to keep them occupied and distracted while they recuperate on the sofa for a few days.

I perform the no-scalpel, no-needle vasectomy in my office. The procedure is usually accomplished in 15 minutes. A single, small, less than 1\4 inch opening, is created on the scrotum using a local anesthetic that does not require a needle to render the skin free of any pain or discomfort. The procedure consists of dividing the vas or the tubes located in the scrotum that transports sperm from the testicles to the ejaculation fluid that exits the penis at the time of orgasm. The vas ends are sealed with tiny clips or sutures. By dividing the vas, no sperm can reach the seminal fluid (semen), which is ejaculated from the penis during sex. Since there is no sperm in the semen, a woman’s egg can’t be fertilized – and the procedure has nearly 100% success rate. Most men will not feel any pain during the procedure. In most cases the small opening requires no sutures and the opening will close within 1-2 days after the procedure.

After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in his ejaculate volume, since sperm make up only a tiny part of the semen.

Many men ask what happens to the sperm produced by the testicles. Because the sperm cannot come out after the vas deferens is cut, like other dead body cells, the sperm disintegrate and are reabsorbed by the body.

After the procedure, men are instructed to go home and lay flat in bed and apply an ice pack or a pack of frozen peas on top of the scrotum for 30 minutes of each hour. However, many will feel some minimal discomfort for a couple of days after the procedure. Most men can return to all activities including sexual intimacy within 5-7 days after the procedure

After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in a man’s ejaculate volume, since sperm make up only a tiny part (less than 5%) of the semen.

The procedure does not affect the hormones produced in the testicle (testosterone) and therefore, there is no impact on a man’s virility or libido. The only change is in his fertility!

Bottom Line: Vasectomy is an effective and nearly painless means of contraception. So if you want to watch NCAA basketball games in peace and quiet, talk to your doctor about a vasectomy. It’s a cut above the rest!

Vasectomy Reversal After A Vasectomy

I am often asked if a vasectomy can be reversed. Most often a man divorces, has a new wife and they wish to have children in their new marriage. Can the vasectomy be reversed?

Normally, sperm – the male reproductive cells that fertilize a woman’s egg – are made in the testicle. Sperm travel away from the testicle through a tube called the vas deferens. There is one vas deferens for each testicle. The vas deferens connect with a reservoir where the sperm is held, ready to be leave the reservoir during sex. The sperm also mixes with secretions from the prostate gland that keep the sperm alive. When the sperm is ejaculated, it travels through another tube, the urethra, inside the penis and is deposited in the woman’s vagina at the cervix or the “gatekeeper” to the uterus.

A vasectomy cuts or blocks the vas deferens. Once the vas deferens is blocked, sperm cannot pass from the testicle to the reservoir where semen and secretions from the prostate gland are stored.

After a vasectomy, a man continues to have normal ejaculations of semen, but the ejaculate no longer contains sperm. This can only be discerned if the ejaculate is examined under a microscope.

In a traditional vasectomy, the surgeon uses a scalpel to make small incisions in the skin of the scrotum near the base of the penis to reach both vas deferens. (The scrotum is the fleshy sac that contains the testicles.) The vas deferens are cut or blocked to prevent sperm from traveling. The incisions in the scrotum are then closed with two or three small stitches.

In my practice, I perform the no-scalpel, no-needle vasectomy, which is less painful, has less bleeding and fewer complications. The surgeon makes one or two tine openings about the size of an eraser to access the vas deferens.

The puncture is widened slightly, then the surgeon cuts or blocks each vas deferens.

The puncture site can be covered with a tiny dressing. No stitches are needed.
A vasectomy is intended to produce permanent sterilization. Special microsurgery can reverse a vasectomy and restore fertility in some cases. Vasectomy reversal is a delicate, expensive procedure. And it is only successful in about 60 to 70 percent of cases.

The Safety of Vasectomy Using No Scalpel, No-Needle Technique

Vasectomy remains one of the most effective and safest methods of contraception. The only technique that would be cheaper is the diaphragm and abstinence. Both of which have a high failure rate. The next few blogs will discuss the safety of vasectomy.

Besides the fact that a vasectomy is very popular, one must remember that there is no form of fertility control, except abstinence, which is completely free of potential complications. In all, vasectomy remains one of the safest and best forms of permanent contraception, provided that the patient is aware of and understands the potential risks associated with the procedure. The side effects and complications of vasectomy are divided into “early” and “late” categories, depending on when they occur. The risks and complications of the procedure, including potential vasectomy pain, are examined below in greater detail.

Vasectomy and Pain

Men worry about pain and discomfort during and after the procedure. In my practice less than 5% of respondents said they had pain, much lower than the well-recognized and commonly published rate. In addition, seldom do any of the men require post operative pain medication. I suggest bed rest and ice over the scrotum the day of the procedure and non-steroidal anti-inflammatory medication such as Tylenol or Aleve for post operative pain.

Early Complications

Shortly after the procedure there may be mild discomfort, and most men are able to return to work in 1-2 days. A small amount of oozing (light bleeding, less than the size of a quarter) and swelling in the area of the tiny opening are not unusual. This should subside within 72 hours. Occasionally, the skin of the scrotum and base of the penis turn black and blue. This is not painful, lasts only a few days, and goes away without treatment. For a period of 7 days following the vasectomy, sex should be avoided. Strenuous exercise (for example climbing, riding motorcycles or bicycles, playing tennis or racquetball) should also be avoided for 7 days, and nothing heavier than 8-10 pounds should be lifted after the procedure until day 7 when all activities including heavy lifting can begin.

Rarely (less than 1%), a small blood vessel may bleed into the scrotum and continue to bleed and form a clot of blood (hematoma). A small clot will be reabsorbed by the body with time, but a large one usually requires drainage through a surgical procedure.

Importantly, the vasectomy procedure is not always 100% effective in preventing pregnancy because, on rare occasions, the cut ends of the vas may rejoin. This occurs very infrequently; the published rate is about 1 in every 600 vasectomies. My vasectomy failure rate, defined as either persistent motile sperm in the ejaculate or a pregnancy after the procedure, is less than 1/1000 cases.

Since sperm can survive for several months in the vas deferens above the point where they were interrupted, it is very important that another form of contraceptive is used until sterility is assured. To determine whether the ejaculate is devoid of sperm, an ejaculate must be brought in for formal microscopic examination after the procedure. Since “clearing the tubes” through ejaculation is a relatively inefficient process, it make take 15 ejaculations to empty the system entirely of sperm. In terms of time after the procedure, roughly 90% of men will have no sperm in the ejaculate 3 months later. This is the reason we ask men to provide us with a semen sample after 15 ejaculations or 3 months after the vasectomy. Occasionally, it may take 6 months or longer after the procedure to flush out all the sperm. The semen specimen must demonstrate no sperm before unprotected intercourse is permitted.

Bottom Line: Vasectomy is a safe form of sterilization and there are few complications.  Each man who considers proceeding with a vasectomy needs to weigh the benefits vs. the risks and complications associated with the procedure.  Most men will find that the procedure is the best way to proceed with contraception.