The no-scalpel vasectomy was created in 1974 in China. It is a significantly better way to do a vasectomy. In this day and age, there is absolutely no reason why you should have a conventional vasectomy.
- Pain (both during and after the procedure)
- Incision Size
- Time for the Procedure
- Postoperative Complications
In performing a traditional vasectomy, the urologist grabs all of the structures in the spermatic cord, which includes the vas deferens (the tube carrying the sperm) as well as the nerves, arteries, veins, lymphatics, and muscle, between two large clamps. The skin between them is cut, and then the vas deferens separated out and cut.
In performing a no-scalpel vasectomy, the vas deferens is pushed up against the skin. After anesthesia has been given, it is grabbed through the skin in a small ring shaped clamp. Thus only the vas deferens and a small amount of tissue around it is isolated, rather than the whole cord. A sharp clamp is used to make a small hole in the skin, and the vas deferens grabbed, and pulled out. It can then be divided, cauterized, and the two sides isolated from each other, prior to putting them back in the scrotum. The incision is so small, that most patients cannot find it. No stitches are needed to close it. Usually, both of the tubes can be grabbed through the same small opening.
Traditionally, the numbing medication (anesthetic) is injected into the spermatic cord and all of its structures. This is slightly uncomfortable, and more anesthesia is needed. A collection of blood, from going through a vein, is also often found.
In the 1970’s a device called a “Madajet” was developed. It is basically a strong spray gun, which allows the anesthesia to be given through the skin, and infiltrate the tissues underneath.
The advantages are that it:
- Hurts Less
- There is No Needle (which scares some people)
- Causes Less Bleeding
- Gives Better Anesthesia
- Uses Less Anesthesia
One of the most common complications from a vasectomy is continued discomfort in the scrotum. This is referred to as post-vasectomy pain syndrome. It is thought to arise from pressure building up in the part of the vas deferens going back to the testis, after it is cut and sealed. This builds up pressure in the more delicate collecting duct (epididymis). See Male Anatomy, below.
In an open-ended vasectomy the testicular end of the tube (vas deferens) is not sealed. It is left open, and the very small amount of fluid, carrying the sperm, drains into the scrotum, and is quickly reabsorbed. The other end of the tube is sealed, and the tissue tied around the end, so that there is no way for the sperm to find their way into the far end of the tube, and into the ejaculate. This decreases the pressure in the testicular vas and the epididymis and thus post-vasectomy pain syndrome. It also makes a vasectomy easier to reverse.
Let’s take you through some basic male anatomy in order to better understand what a vasectomy is all about. The sperm are made in the testes (testicles). They then travel through the testis and are collected in a structure outside the testis called the epididymis. The epididymis is a thin-walled tube that runs down the center of the back of the testis. As it gets closer to the bottom of the testis, the epididymis becomes thicker and straighter. Eventually, when it reaches the scrotum, it straightens out completely and becomes quite thick and muscular. This muscular tube is called the vas deferens, and it carries the sperm combined with a very small amount of fluid.
When a physician performs a vasectomy, he is interrupting the flow of sperm by cutting the vas deferens, the tube that carries the sperm. The inside of one side of the tube is sealed (the side leading to the body) and this side is then buried in tissue, so the ends cannot connect. A few doctors may intentionally damage the epididymis, but this is unnecessary and inadvisable as it increases the chances of inflammation, and makes surgical reversal more difficult.
When a man ejaculates, he pushes out fluid containing mature sperm, but only five percent of the ejaculated fluid actually comes from the testicles. Most of the fluid (semen) comes from organs other than the testicles (the prostate, seminal vesicles, and bulbourethral glands). These organs do not make sperm. This is why men who have had a vasectomy still have normal ejaculation with significant fluid: only the five percent of the fluid made in the testicles, and the sperm, are missing.
Since most people would rather avoid surgical cutting, here are the facts. The no-needle, no-scalpel vasectomy was developed in China in 1974, where it is a very common method for birth control. Rather than having to make cuts in the skin to reach the vas deferens, the physician identifies the tubes under the skin and then isolates them with a specialized clamp after the anesthesia has been given. He then uses a special tool to make a tiny puncture and uses the instrument to stretch the opening so the vas deferens can be reached. The vas deferens from each side are pulled through the hole one at a time and cut and blocked. Unlike a conventional vasectomy, there is very little bleeding and scarring and no stitches are required.
- Complications and Failure Rate
- Serious complications are rare. Approximately 1 out of 150 patients will develop a hematoma (a collection of blood in the scrotum) which will prolong the recovery. Infection is extremely rare and can usually be treated with oral antibiotics. Approximately 1 in 1000 vasectomies will have delayed failure, meaning that no sperm is seen at one point after the procedure (confirmed by a semen analysis) and then comes back. The mechanism of this is unknown. Even with this failure rate, it remains the type of birth control least likely to fail, and the least invasive permanent method of birth control.
- Effects on Sex Life
- Above all these considerations, one big question looms: “Will it affect my sex life?” And the answer is a resounding “no”, except that it will alleviate the need for birth control. Many men report that their sex lives are actually improved because they are no longer afraid of an unwanted pregnancy. The testosterone levels, which affect sexual function, are not changed by a vasectomy.
How will I feel after a vasectomy? The good news is that since a no-needle, no-scalpel vasectomy is performed with a single small incision in the skin, and the minimal manipulation of the structures in the scrotum, the recovery is usually quite easy. Many of our patients tell us the recovery from simple dental procedures has been more difficult. Most men return to work the next day or, if the procedure is performed on a Friday, almost always on Monday. Tenderness and swelling of the surgical site and bruising of the scrotum are usually minimal. Ice should be applied intermittently for the first 24 hours.
- Resuming Sex
- You can resume sex five to seven days after the vasectomy. However, you must continue to use contraception until it is shown you have no sperm in your ejaculate.
- Time until “ejaculating blanks”; (All of the juice, none of the seeds)
- Once the tubes have been interrupted, no new sperm should be getting into the fluid you ejaculate. However, the amount of sperm that has already passed the point where the tube is interrupted is larger than you might think. You will need to clear the system of sperm by ejaculating. It does not matter, in terms of sperm clearance, whether this is through masturbation or with a partner. Because of this you will need to use birth control until you are cleared by your urologist (i.e., until after there are no sperm in the semen when you ejaculate). Six weeks after the vasectomy you will be asked to produce a semen specimen, which will be evaluated. If there are no sperm, you can begin unprotected intercourse. If there are still some sperm, you will need to repeat the analysis in two to three weeks, after additional ejaculations, to make sure there are no sperm.
You should understand that a vasectomy is considered a permanent sterilization procedure. While it can often be reversed, the decision to have a vasectomy should not be made assuming that it can be reversed. Reversal is a complicated and time-consuming surgical procedure that requires very specific expertise. If you are sure that your family is complete, your relationship is strong, you want to take responsibility for the prevention of pregnancy, and you (and your partner if you have one) want to be free of the need to use birth control, then a vasectomy may be right for you. It is certainly a much simpler procedure than female sterilization.
- When Not to Have a Vasectomy
- This is obviously a major decision because of its permanence. If you are not comfortable with the idea of permanent sterilization, are rushing into the decision, or are having the vasectomy just to please your partner (while not sure whether you might want more children in the future), a vasectomy should require some additional consideration.
- Regretting the Decision
- Going into this you should realize that a vasectomy should not be considered temporary birth control, but permanent sterilization. Some couples who fear they might change their minds, bank sperm before a vasectomy just to make sure it is still available for use. This is something that can be done at our laboratory since Dr. Werner, who is an expert in male infertility, has a full andrology laboratory, MAZE Labs, on site. Another option is a vasectomy reversal. A vasectomy reversal is a complicated and time-consuming surgical procedure. There is no guarantee that it will succeed.
We’ve presented you with a lot of information so far, but there is one simple truth we’d like to share: the no-needle, no-scalpel open-ended vasectomy is, simply put, a better procedure. You should have your vasectomy done this way and find a urologist with significant experience with this technique. Michael A. Werner, M.D., FACS, is a board-certified urologist, with specialty fellowship training in male infertility and sexual dysfunction. Besides doing a large volume in his office, he travels internationally performing and lecturing about them.
- Your insurance company may reimburse much, if not all of the costs of a vasectomy. We will submit the claim for you and do any pre-authorization required by insurance company.
- Starting the Process
- You will need to contact your urologist for a preliminary consultation. If you are working with Dr. Werner, he will discuss the procedure and any concerns you might have. He will also examine you. At that point, you may book your procedure. It will not be done the day of your initial consultation. If, like many of our patients, you are traveling a long distance, we will try hard to minimize your visits to cut down on time away from home (for example, your post-procedure semen analysis could be done by a doctor near you). We’d like the entire process to be as easy on you and your partner as possible.
- Regretting the Decision
- Going into this you should realize that a vasectomy should not be considered temporary birth control, but permanent sterilization. Some couples who fear they might change their minds, bank sperm before a vasectomy just to make sure it is still available for use. This is something that can be done at our laboratory since Dr. Werner, who is an expert in male infertility, has a full andrology laboratory, Maze Labs, on site. Another option is a vasectomy reversal. A vasectomy reversal is a complicated and time-consuming surgical procedure. There is no guarantee that it will succeed.