THE NO-NEEDLE VASECTOMY IS SUPERIOR: here's why
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-needle, no-scalpel vasectomy, performed exclusively in this area by Michael Werner, MD, is minimally invasive and recommended over the conventional technique.
In a no-needle, no-scalpel vasectomy, it is the anesthesia that is different. The surgeon uses a device similar to a strong spray gun that allows the anesthesia to be given through the skin which then infiltrates the tissues underneath. With a conventional vasectomy, numbing medication is injected into the spermatic cord and all of its structures.
Here's why the no-needle, no scalpel vasectomy is superior:
- Faster: the procedure takes about 20 minutes
- Safer: there are fewer post-operative complications
- No-Needle Anesthesia: less anesthesia is needed and it's more effective; results in less pain and less bleeding (see how it works without a needle)
- No Stitches: a smaller incision means there's no need for stitches
IN A PATIENT’S OWN WORDS
I followed instructions to rest the first two days and had NO pain.
“After many conversations with my girlfriend, I decided to take responsibility for our birth control. As a 46 year old divorced medical professional with 4 children and in a long term committed relationship, this was the right decision. I was scared to death to have a vasectomy and in fact I am even afraid of needles for blood work. I made my appointment because I knew that if I didn’t set it up I wouldn’t go through with it.
I was given an appointment within a few days. The office staff was amazing and the surgical coordinator was so helpful with all of my questions. My consult with Dr. Werner could not have been any better. He is so personable and nice, and put my mind at ease promising that he would adjust the medications for me because he could tell how anxious I was.
I then came back a few days later for my pre screening. As I mentioned I am petrified of blood draws. The phlebotomist and medical tech, Ben, drew my blood and I didn’t even feel it. On the day of the procedure I took the medications as prescribed and barely felt or remember a thing. I followed the instructions to rest the first two days and had NO pain! I can honestly say that I would recommend Dr. Werner and his staff to anyone who is ready to have a vasectomy and take on the responsibility of birth control in their relationship.”
– M, Age 46 –
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Top Misconceptions Men Have About Vasectomies
Getting a Vasectomy is a big decision and it’s important to evaluate if it’s right for you. To ensure you are making the right choice, here are some common misconceptions (debunked) below:
• A Vasectomy does not lower your sex drive. A person’s libido, which is their desire to engage in sexual activity of any kind, is dependent on many physiological and psychological factors. The most important of these factors is testosterone levels. Testosterone is made in the testes and then released into the bloodstream. Neither testosterone production nor its release is affected by mechanically disrupting the vas deferens, so libido doesn’t change.
• A Vasectomy does not affect your testosterone levels. Neither testosterone production nor its release is affected by mechanically disrupting the vas deferens in a Vasectomy procedure.
• A Vasectomy does not cause Erectile Dysfunction. We tend to think of the penis and testes as a “package” that go together. This makes sense both “geographically” and in terms of their being related to sexuality and sexual function. However, the penis and testicles have completely different blood supplies and nerves. This is because the testes actually start developing near your kidneys and then migrate into the scrotum during pregnancy. The testicles bring their blood supply and nerves with them. (That is why when you are kicked in the testicles you feel it in your abdomen). Because the penis and testicles have completely different blood and nerve supplies, there is no way that a procedure in the scrotum can damage your penis.
• A Vasectomy does not impact ejaculation.
• A Vasectomy does not cause cancer.
Understanding the Male Anatomy
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.
Procedure Description
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.
What are my options for managing anxiety and discomfort?
As discussed above, the actual anesthesia is a local anesthetic. It is given without a needle using a device called a Madajet. This device pushes the anesthesia through the skin and to the vas deferens and the tissues surrounding the vas deferens which includes the nerves.
For anxiety and pain management, we do recommend that you choose one or both of the below options, in addition to the local anesthetic.
The first option is the use of nitrous oxide, also known as “laughing gas.” You will hold the mask to your face and breathe in the combination of oxygen and nitrous oxide. It does have a very quick effect on anxiety levels and pain perception. You will do this before the local is given and as needed throughout the procedure. If you use this option and do not take any oral pain medication or anxiety medication, you will then be able to drive yourself to and from the procedure unaccompanied.
The second option is for us to write for you, at your preoperative examination, a pain medication and/or an anxiolytic (to decrease anxiety, which is usually a benzodiazepine.) You will take these one hour before the procedure. If you do take one or both of these medications, it does mean that you should not drive while under their influence. Thus, someone will need to drive you to and from the procedure.
You do have the option of using the pain medicine and anxiety medication prior to the procedure as well as using nitrous oxide during the procedure. Again, this means that you will need to be driven both to and from the procedure.
If you’re considering the Nitrous Oxide option, the below list of Frequently Asked Questions may be helpful:
What is nitrous oxide?
Nitrous oxide is a safe and effective anxiolytic and analgesic agent that is mixed with oxygen. Nitrous oxide is used during procedures and treatments to help make you feel more comfortable.
How does the nitrous and oxygen analgesia system work?
The nitrous oxide and oxygen analgesia system delivers a safe mixture of nitrous oxide and oxygen which is inhaled through a mouthpiece or mask, providing you control over self-administration. Your doctor will ask you to breathe normally through your mouth, and within a few short minutes you should start to feel the effects of the gas mixture. The effects of nitrous oxide wear off within 5-10 minutes after the last inhalation of the N2O/O2 mixture.
Will this put you to sleep?
No. The provided nitrous oxide and oxygen ratio is not strong enough to provide anesthesia and put you to sleep. You will be able to hear and respond to any requests or directions the doctors may have.
How will I feel while using nitrous oxide?
Most patients will say it makes them feel relaxed, and their arms and legs feel light. Some patients feel tingling in their extremities and report feeling like they are floating, and/or sinking. As nitrous oxide is often called “laughing gas”, some patients will feel giggly when the gas mixture takes effect. Moreover, your voice may temporarily change during the administration of nitrous oxide since vocal cords are affected by nitrous oxide.
How fast does nitrous oxide take effect and last?
For most patients, the calming, relaxing effects of nitrous oxide will be felt within a minute or two or after a couple of deep inhalation/exhalation cycles. Effects may vary from patient to patient. Once you stop inhaling the gas mixture, you will start feeling back to normal within 5-10 minutes.
Can I drive home after using nitrous oxide?
The effects of nitrous oxide and oxygen on their own are completely out of your system within a few minutes. It is reasonable that you can safely go home about 10 minutes after ceasing use of nitrous oxide and oxygen assuming all other discharge criteria have been met.
Does nitrous oxide eliminate pain?
Nitrous oxide does not eliminate pain. This is important to understand and to set your expectations. This will also not replace an anesthetic which is often used to numb locally (if required). Nitrous oxide is intended to take the edge off, help you relax, make you feel more comfortable, and reduce anxiety. This is not something you would use for extremely painful procedures.
Is nitrous oxide safe?
Nitrous oxide has been used for over 100 years [1] and has a long-standing safety record. When the Nitronox device is used, you are awake (conscious), responsive, and breathing normally on your own.
What are the typical side effects that one might feel?
Side effects are usually minimal. With a self-administered protocol, you are in total control minimizing side effects. Side effects that can occur in some patients are dizziness and nausea. If you do not like how you are feeling, stop inhaling the N2O/O2 mixture and breathe room air. This should quickly reverse any negative effects.
Benefits and Advantages
Provides comfort and reduces anxiety
Self-administered
Fast acting
Quick recovery
Alternative for oral medications and opioids
Will my insurance cover this procedure?
While nitrous oxide has been used during medical procedures for decades, the use of nitrous oxide and oxygen analgesia systems is not currently covered by insurance. It is considered an add-on service for treatments and procedures, which you will discuss with your provider.
References
[1] Nitrous Oxide for the Management of Labor Analgesia. AANA Journal, February 2018, Vol. 86, No. 1
Recovery and when can I start enjoying it?
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.
What Are The Risks? Will it Affect My Sex Life?
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.
Should I (or my partner) have a vasectomy?
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.
Birth Control Option
In A Patient's Own Words
I'm just writing in to thank you for such a seamless, painless, and gratifying vasectomy experience last Friday. I am in disbelief that I was symptom free all weekend and cannot visually see any evidence of the procedure! How is this possible ???
– R, 48 –
"I went to Maze Men's Health because I was interested in the needle-less and scalpel-less technique used by Dr. Werner. The staff was great. Very friendly and professional. You felt comfortable and welcome from the moment you stepped inside the office door. Dr. Werner is great. Photos and diagrams were used to thoroughly explain the procedure. And he is an engaging man so you feel he is going to do the best job possible. He treated me as if I were a family friend. The prep for the procedure was quick and the actual operation lasted no more than 20 minutes. During that time Dr. Werner was cracking jokes, we were having a great conversation and the next thing I knew he was finished. I felt no pain during or after the procedure. This is written on day 2 and I have no pain or swelling in the area. I HIGHLY recommend Maze for anyone thinking about a vasectomy or any other services that they provide. Thanks Dr. Werner!!!"
– A, 52 –
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Last updated: January 2024