Posts Tagged ‘sterilization’

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

October 12, 2014

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.

What Happens After A Vasectomy?

October 10, 2014

A vasectomy, using the no-scalpel, no needle technique takes just a few moments to accomplish in the doctor’s office. However, there are some precautions that are necessary after the procedure.

Most often, men are concerned about the pain involved in a vasectomy procedure as well as having a healthy, functional sex life afterwards. The no needle technique using a local anesthetic and the no-scalpel procedure which allows the procedure to be accomplished through a quarter inch opening without requiring an incision, causes minimal or no pain during or after the procedure.

Post Vasectomy Advice

  • The vasectomy procedure lasts anywhere from 10-12 minutes.
  • Patients do not require any general anesthesia and often take a Valium tablet before the procedure to remove the anxiety often associated with the procedure.
  • A bag of frozen peas or ice should be placed on top of the underwear over the scrotum to help reduce any swelling. Instead of frozen peas, you can place a few ice cubes in a zip lock bag and place this over the scrotum for a few hours after the procedure.
  • You may feel an ache in your testicles which is treated with extra strength Tylenol or Aleve.
  • You will need to have a ride home if you take the Valium.
  • It is recommended that vasectomy patients abstain from sex for 3 days.
  • You should have no activity the day of the procedure and minimal activity for 2-3 days after the procedure. You can resume all activity including heavy lifting and bike riding seven days after the procedure.
  • You will need to use some form of contraception until your semen is examined under the microscope to be certain that all sperm are absent from the ejaculate. I suggest that you have 15 ejaculations using contraception and then bring in a specimen for me to examine. If no sperm is seen, I will ask for a second specimen a few days later and if the second specimen is without sperm, you will be considered sterile and can stop using contraception.

Bottom Line: While pain tolerance varies from person to person, the pain following a vasectomy is generally a mild discomfort as long as instructions are followed. Avoid heavy lifting and strenuous exercise, take pain medication when necessary and place ice on the scrotum to speed up recovery time.   Finally, a vasectomy is not a protection against sexually transmitted diseases (STD).

Vasectomy-The Prime Cut, Most Men Are Satisfied With The Decision and the Procedure

June 22, 2013

I have performed nearly 6000 vasectomies in my career and I have found very few men are disappointed with the procedure or the results. The majority of men don’t have any reservations after the procedure.
Often men will ask if the procedure is reversible and the answer is that the vasectomy can be reversed. However, men should make the decision to have a vasectomy only if their family is complete or they don’t plan to ever have children. The cost of the vasectomy is less than $1000 but the cost of the reversal can be north of $20,000. The vasectomy is done with a local anesthetic only takes 10-15 minutes and a reversal requires a general anesthesia and can take 2-3 hours to complete.

A study conducted at the University of Iowa reported half of the men said they considered a vasectomy for a year or less before having the procedure; 85 percent had a high level of certainty they made the right decision. The most common reason for the sterilization was that a man didn’t want additional children and felt a vasectomy was the best birth-control option. Over 90 percent were married, and had two or more children.

Almost a third of the men had some anxiety about the procedure, primarily concern about possible pain and “fear of the unknown.”
Bottom Line: Vasectomy remains one of the best forms of permanent sterilization. Most men are satisfied with the procedure and the results and would do it again and recommend it to others.

March Madness, Manhood, and Vasectomy

March 29, 2013

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What does March Madness and vasectomy have in common?  You probably answered very little.  However, many men who opt for a vasectomy as a permanent form of contraception are making the decision to have their “prime cut” this week or next week so they can watch the Sweet Sixteen and Final Four while recovering from the 15 minute procedure that can be easily done in the doctor’s office without a scalpel or without a needle.

 

Many male basketball fans may be looking for the perfect excuse to lounge in front of the television all week.  Many urologists, including myself, have the perfect solution: Get a vasectomy.

 

There are practices that offer a “3-Point Shot” plan – one vasectomy, one free pizza, and one weekend excuse to watch college basketball.

 

It is common for many men schedule the procedure on a Thursday or Friday so they can have the weekend to relax.  While the NCAA tournament lasts longer than the recovery period for a vasectomy, which is usually 2-3 days, this is a good excuse for basketball aficionados to catch a few games while enjoying uninterrupted viewing of basketball games.

 

So if you want to have a few days to watch the games without interruption, give your urologist a call and arrange an appointment.  For more information, go to my website, www.neilbaum, and watch a video about the procedure and how it can be done without pain or discomfort.

The Sterilization Decision-Vasectomy vs. Tubal Ligation

May 25, 2012

You have had all the children you would like and you like to ensure that you won’t have another pregnancy then you need to make the sterilization decision.

So who is going to become sterilized? This him-or-her question should be decided with great care. For couples weighing whether they’re ready to permanently prevent pregnancy, here are some important questions to ask.

At this time men have just one option when they want to permanently turn off the possibility of sperm getting to an egg– and women can choose from several. For men, the option is a vasectomy. A doctor cuts and seals off the two tubes that allow sperm to travel from the testicles to the outside world.

The vasectomy can be done without a scalpel and without a needle to inject the local anesthetic so it is nearly painless. The procedure takes about 10-12 minutes but the man is not sterile right away. He needs to ejaculate approximately 15 times to purge sperm from the vas above the area where the occlusion of vas takes place. (See Figure)

After 15 ejaculations, a specimen must be examined under a microscopic to be absolutely certain that there is no sperm in the ejaculate and then the man is sterile.
Women can have a tubal ligation, also called a “tubal” or “getting your tubes tied.” Her fallopian tubes are sealed off, keeping her eggs from meeting any sperm. Or a doctor can do an in-office procedure in which he inserts tiny devices into the tubes through the uterus, blocking them permanently.
Women become sterilized nearly three times as often as men. About 16% of reproductive-age women had opted for tubal sterilization in 2002, compared to 6% of the male member of the relationship who submits to a vasectomy.

What Could Go Wrong?
Women were 20 times more likely to have a serious problem related to a tubal than men face from a vasectomy. In addition, men tend to recover more quickly from a vasectomy than women do from a tubal ligation. A tubal ligation requires anesthesia and deep incisions into her abdomen both of which are concerns.
The most common problems related to vasectomy include bruising, infection, and inflammation in the epididymis, a sperm-holding structure near the testicle. But each of these seems to occur in less than 5% of cases.

How Much Does It Cost?
In terms of cost, a vasectomy is definitely more cost-effective. In general, a tubal costs about three times as much as vasectomy.
If you have health insurance, check on whether it will cover the procedure and what costs may still be your responsibility. Talk with your health care provider to see what your costs are for other birth control options, since other forms of birth control may be more cost-effective.
Bottom Line: There are effective methods of sterilization. A discussion with your doctor will help you decide which one is right for you, vasectomy or tubal ligation.

No-Scalpel Vasectomy-Almost Painless Male Contraception

March 28, 2010

Vasectomy is the process of dividing the vas (the tube that delivers the sperm from the testis to the prostate) in order to prevent conception. It is the most common method of male contraception in this country where about 500,000 vasectomies are done each year. Since vasectomy simply interrupts the delivery of the sperm, it does not change the hormonal function of the testis and sexual drive and ability remain intact. Since most of the semen is composed of fluid from the prostate, the semen will look the same. Vasectomy is thought to be free of known long term side effects, and is considered to be the safest and most reliable method of permanent male sterilization.

The technique of the No-scalpel Vasectomy was developed in 1974 by a Chinese physician, Dr. Li Shunqiang, and has been performed on over eight million men in China.

After injecting the scrotal skin and each vas with a local anesthetic, we use a special vas-fixation clamp to encircle and firmly secure the vas without penetrating the skin. One blade of a sharp forceps or clamp is then used to penetrate the scrotal skin. The tips of the forceps are spread, opening the skin much like spreading apart the weaves of fabric. The vas is thus exposed and then lifted out and occluded by any of the standard techniques, such as cautery or sutures. The second vas is then brought through the same opening and occluded in a similar fashion. The skin wound contracts to a few millimeters and usually does not require suturing.

Compared to the traditional incisional technique, the No-Scalpel Vasectomy usually takes less time, causes less discomfort and may have lower rates of bleeding and infection. Recovery following the procedure is usually complete in two to three days. Hard work or straining (athletic pursuits or heavy lifting) is not recommended for seven days. Most patients should wait to have intercourse for a week after the procedure (You should feel no discomfort).
Common reasons given for having a vasectomy.

  1. You want to enjoy sex without worrying about pregnancy.
  2. You do not want to have more children than you can care for.
  3. Your partner has health problems that might make pregnancy difficult.
  4. You do not want to risk passing on a hereditary disease or disability.
  5. You and your partner don’t want to or can’t use other kinds of birth control.
  6. You want to save your partner from the surgery involved in having her tubes tied and you want to save the expense.

COMMON QUESTIONS ASKED AND ANSWERED ABOUT NO-SCALPEL VASECTOMY
How can I be sure that I want a vasectomy?
You must be absolutely sure that you don’t want to father a child under any circumstances. You must talk to your partner and it certainly is a good idea to make this decision together, consider other kinds of birth control and talk to friends or relatives who may have had a vasectomy. Think about how you would feel if your partner had an unplanned pregnancy. Talk to your doctor, nurse, or family planning counselor.

A vasectomy might not be right for you if you are very young, if your current relationship is not permanent, if you are having a vasectomy just to please your partner and you do not really want it, you are under a lot of stress or you are counting on being able to reverse the procedure at a later time.

How does the vasectomy prevent pregnancy?
Sperm is made in the man’s testicles. The sperm then travels from the testicle through a tube called the vas into the body where it enters the prostate gland. In the prostate, the semen is made and here the sperm mixes with the semen. The prostate is connected to the channel in the penis and hence the sperm and semen are ejaculated. In a vasectomy, the vas or tube is blocked so that sperm cannot reach the prostate to mix with the semen. Without sperm in the semen a man cannot make his partner pregnant.

What is different about a no-scalpel vasectomy?
No scalpel-vasectomy is different from a conventional vasectomy in the way that we get to the tubes or vas to block them from passing sperm out of the testicles. An improved method of anesthesia helps make the procedure less painful. In a conventional vasectomy, the physician may make one or two small cuts in the skin with a knife, and the doctor would then use sutures or stitches to close these cuts at the end of the procedure. In the no-scalpel vasectomy, instead of making two incisions, the doctor makes only one tiny puncture into the skin with a special instrument. This same instrument is used to gently stretch the skin opening so that the tubes can be reached easily. The tubes are then blocked, using the same methods as conventional vasectomy, but because of the lack of scalpel technique there is very little bleeding and no stitches are needed to close the tiny opening. This opening will heal quickly with little or no scarring. No-scalpel vasectomy was introduced in the United States in 1988 and is now used by many doctors in this country who have mastered the technique.

Reasons for having a no-scalpel vasectomy as compared to conventional vasectomy

  1. No incision with a scalpel–only a small puncture with a sharp probe
  2. Usually no stitches
  3. Usually a faster procedure
  4. Usually a faster recovery
  5. Usually less chance of bleeding and other complications
  6. Usually less discomfort
  7. Just as effective as regular vasectomy

Will it hurt?
When the local anesthetic is injected into the skin of the scrotum, vou will feel some discomfort, but as soon as it takes effect you should feel no pain or discomfort. Afterwards, you will be sore for a couple of days and may want to take a mild pain killer such as Tylenol, but the discomfort is usually less with the no-scalpel technique because of less trauma or injury~ to the scrotum and tissues. Also, there are no stitches in most cases. We will provide you with complete instructions about what to do after surgery.

How soon can I go back to work?
You should be able to do routine physical work within 48 hours after your vasectomy, and will be able to do heavy physical labor and exercise within a week.

Will the vasectomy change me sexually?
The only thing that will change is that you will not be able to make your partner pregnant. Your body will continue to produce the same hormones that give you your sex drive and maleness. You will make the same amount of semen. Vasectomy will not change your beard, muscles, sex drive, erections, climaxes or your voice. Some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex is more relaxed and enjoyable than before.

Will I be sterile right away?
No. After a vasectomy there are some active sperm left in your system. It may take a dozen to two dozen ejaculations to clear the sperm out downstream from where the vasectomy is performed. You and your partner should use other forms of birth control until we have had a chance to check your semen specimens at least twice to make sure that they are free of sperm.

Is the no-scalpel vasectomy safe?
Vasectomy in general is safe and simple. Vasectomy is an operation and all surgery has some risk such as bleeding, infection and pain, but serious problems are unusual. There is always a small chance of the tubes rejoining themselves, and this is the reason that sperm checks are necessary. There have been some controversies in the past about the long-term effects of vasectomy, but to our knowledge there are no long-term risks to vasectomy.

How long will the no-scalpel vasectomy take?
It depends on the surgeon, but on average, the operation lasts between fifteen to thirty minutes.

When can I start having sex again?
As a rule, we suggest waiting a week before having intercourse. Remember, however, that the vasectomy only divides the vas and has no effect on the sperm that are already beyond that point. IT IS IMPORTANT NOT TO HAVE UNPROTECTED INTERCOURSE UNTIL THE ABSENCE OF SPERM FROM THE EJACULATE HAS BEEN CONFIRMED WITH TWO (2) NEGATIVE SPERM CHECKS TWO WEEKS APART.

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