Vasectomy is a simple, safe and effective surgical procedure that makes a man sterile (unable to father a child). Choosing sterilization requires some consideration. This allows a man to feel comfortable that his family will not grow inexpectedly. Sterilization of the male is a relatively simple outpatient procedure performed in an office setting under local anesthesia. Therefore, it is quite inexpensive (around $400) compared to female sterilization. Because no general anesthesia is required, it is a relatively safer procedure in the male. Patients are generally advised that this is an irreversible procedure, recognizing that VASOVASOSTOMY can be performed at a later date should a patient decide to reverse his vasectomy. However, vasovasotomy carries a 50% fertility rate with about a 90% rate of sperm recovery. The reason for the discrepancy in sperm recovery versus fertility is thought to be due to sperm antibodies which are produced once a vasectomy is performed. These sperm antibodies have no ill effects on the male with the exception of lowering fertility rate should an individual decide to have more children.

Sterilization does not effect one's ability to have orgasms and does not visibly change one's semen. There is no consensus that sterilization results in prostate cancer or heart disease. Two recent large epidemiological studies have suggested there is a slightly higher incidence of prostate cancer in men that have undergone vasectomy. The higher incidence rate was 15 individuals out of 10,000. Two other epidemiological studies have suggested that there is no real relationship of vasectomy and prostate cancer. The American Urological Association has recommended that men begin yearly screening for prostate cancer at age 50 with a digital rectal exam and serum PSA. Those men who are at high risk for prostate cancer, i.e. family history of prostate cancer, or African-American men, should begin prostate screening at age 40. A vasectomy will not solve marital problems. Sterilization is not a solution for individuals having marital dysfunctions.

Sperm is ordinarily produced in the testicles, stored momentarily in the epididymis and eventually transferred to the ampullae of the vas where combined with fluid from the prostate and seminal vesicles becomes the ejaculate. Interruption of the vas deferens simply interrupts the flow of normal sperm from the testis and epididymis to the ampullae of the vas area. The sperm that cannot pass through this obstruction is absorbed and disposed of in the blood stream. Because the body is not ordinarily exposed to sperm, antibodies to sperm ordinarily are not produced. However, after a vasectomy it is common for a man to develop antibodies to his own sperm. The body is able to get rid of the sperm without any subsequent effects. There is no perceived increase in pressure noted, although there is a tiny increase in pressure noted with experimental devices in the epididymis and rete testis. Male hormone level remains the same since testosterone is produced by the testis and passes directly into the blood stream. There will be no change in hair distribution, voice or sexual drive after a vasectomy.

The procedure is performed in the office as an outpatient. The patient will be asked to read and sign a consent form that states he is aware of the possible risks and complications of the procedure. Patients are asked not to take any aspirin or any anti-inflammatories that might interfere with coagulation of blood for approximately 3-5 days before the procedure. It is wise that the patient partake of a fluid breakfast before having the procedure.

During the procedure the patient will be asked to undress and lie on the exam table. Sterile drapes will be placed over the scrotal area. Local injection will be placed, not in the testicle but in the skin overlying the cord or vas deferens. This anesthetic prevents the patient from feeling pain. Once the anesthetic takes effect, which is instantaneous, two small incisions are made over the vas deferens and the vas is identified and either doubly ligated, clipped or possibly coagulated with a coagulator. The patient will feel only a pulling sensation during this process but no pain. The two incisions are then generally closed with a single chromic suture which will fall out spontaneously in 7-10 days postoperatively.

Following surgery it is very important that an individual plan at least two days of rest at home. A patient should stay off his feet whenever possible and apply an ice or frozen bag of peas to the surgical area to prevent swelling. Usually showers are permitted within 48 hours after surgery. Most patients have this procedure performed on a Friday and are back to work on Monday, with full activity in a week to 10 days following surgery. During this week to 10 day period, there should be no heavy lifting or exercise. Sexual activity is usually resumed 10 days to two weeks following the surgery.

Risks of the procedure include bleeding and infection. Infection is very rare because of the high vascularity of the scrotum. Bleeding is a much more common occurrence and generally is only of concern if there is internal bleeding with swelling of the scrotal tissue. It is expected the area will become black and blue. Much of the bleeding, either external or internal, can be prevented by application of ice packs or frozen peas. Generally antibiotics are given in order to prevent infection. Long-term complications include sperm granuloma, which simply is a lump at the site where the vas deferens was ligated, which can leak sperm. This usually dissolves by itself or can be removed surgically if it causes pain. Congestion, or buildup of sperm in the epididymis, is common but usually does not cause any perceptible discomfort to the patient. Sperm antibodies are common following a vasectomy, but to date have not been shown to cause any long-term health problem. Sperm antibodies may, however, interfere with becoming fertile again once a vasectomy is reversed with a vasovasostomy. Testicular discomfort is usually of only days duration and does not last months or years after the procedure. Spontaneous recannulization of the two cut vas deferens on one or both sides can result in a failed vasectomy (1 in 400 cases). Patients are generally offered a repeat vasectomy at no change if this occurs. Semen checks are done at one month postoperatively on two subsequent occasions separated by 2-3 days to insure that there is no viable sperm in the specimens.

Some unforeseen events could occur requiring the vasectomy to be reversed. Generally patients who are divorced and remarry or suffer the loss of a child may decide to have their vasectomy reversed. Again, pregnancy rates are approximately 50% with sperm retrieval in approximately 90% of patients who are reversed within 10 years of their original vasectomy. The discrepancy in pregnancy rates versus sperm retrieval rates is thought to be due to the production of sperm antibodies. This operation (vasovasostomy) is expensive and often is not covered by insurance. Therefore, it is of critical importance than an individual be reasonably certain that he does not want further children before undergoing a vasectomy. Sperm banks generally are not available in the Dallas area to store sperm for patients who are undergoing vasectomy. This is because of the liability in storing sperm for subsequent pregnancy is such that few sperm banks are willing to store sperm in vasectomized patients.

There are obviously other means of birth control that can be utilized for individuals who are unsure that they wish to undergo a vasectomy including condoms, birth control pills, diaphragms, hormones, female sterilization, spermicides, vaginal sponges, IUD and even natural family planning. However, in those individuals who are content with their family's size and have given vasectomy considerable thought, this procedure remains one of the most popular sterilization techniques in America.

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