When a physician performs a vasectomy, the flow of sperm is interrupted by cutting the vas deferens, the tube that carries the sperm. The no-scalpel vasectomy is recommended over the conventional technique because:
- It is a shorter procedure
- It is less painful (both during and after the procedure)
- The incision is smaller with no need for stitches
- There are fewer postoperative complications
In a no-needle vasectomy, it is the anesthesia that is different. With conventional anesthesia, numbing medication is injected into the spermatic cord and all of its structures. In a no-needle vasectomy, the surgeon uses a device similar to a strong spray gun that allows the anesthesia to be given through the skin and then infiltrate the tissues underneath.
The no-needle anesthesia technique is recommended because:
- It hurts less
- There is no needle
- It causes less bleeding
- The anesthesia is more effective
- Less anesthesia is needed
Some basic facts about male anatomy will help you 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, the flow of sperm is interrupted by cutting the vas deferens, the tube that carries the sperm.
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 semen (fluid) 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.
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.
Another factor to understand is the open-ended versus close-ended vasectomy. In an open-ended vasectomy the testicular end of the vas deferens (tube) 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. An open-ended vasectomy (as compared to a close-ended vasectomy where both sides of the vas deferens are sealed) decreases the pressure in the testicular vas and the epididymis. An open-ended vasectomy is thought to significantly reduce post-vasectomy pain syndrome. It also makes a vasectomy easier to reverse.
- 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 recovery13. 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 back13. 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 considerations, one big question looms when considering a vasectomy: “Will it affect my sex life?.” 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.
- Men who have had a vasectomy also continue to have normal ejaculation with significant fluid. This is because 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 semen (fluid) comes from organs other than the testicles (the prostate, seminal vesicles, and bulbourethral glands). These organs do not make sperm. Thus, men who have had a vasectomy still have normal ejaculation with significant fluid because only the five percent of the fluid made in the testicles, and the sperm, are missing.
- Post-Vasectomy Pain Syndrome
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, above.
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. An open-ended vasectomy (as compared to a close-ended vasectomy where both sides of the vas deferens are sealed) decreases the pressure in the testicular vas and the epididymis. An open-ended vasectomy is thought to significantly reduce post-vasectomy pain syndrome. It also makes a vasectomy easier to reverse.
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 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, 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. So, do not rush into this decision. If you are not totally comfortable with the idea of permanent sterilization, or if you are having the vasectomy just to please your partner (while not sure whether you might want more children in the future), further consideration should be given to the decision.
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 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. (Some couples bank sperm before a vasectomy just to keep their options open. 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 on site).
- 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. It is also important to note that your insurance company may reimburse much, if not all of the costs of a vasectomy. Dr. Werner’s administrative staff will submit the claim for you and do any pre-authorization required by insurance company.