Vasectomy

Posted in Contraception

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What is vasectomy?

Vasectomy is the name for male sterilisation. It involves a simple surgical procedure which cuts the vas deferens, which are the small tubes that carry sperm from the testes through to the penis during ejaculation. There is no change in the volume or appearance of the ejaculate. Vasectomy is a safe, effective and permanent form of contraception. A vasectomy is intended to be a permanent method of birth control. It can be difficult to reverse, especially if it was done a long time ago. It is suitable for men who are sure that they do not want to have any children in the future. When a man is thinking of having a vasectomy it is worth taking into consideration whether there is a possibility that he could change his mind if an existing child died, or if he was to enter into a new relationship in the future. When a man in a relationship is considering a vasectomy it is better for the decision to have been discussed with his partner and agreed upon, however a man does not need permission from his partner to have a vasectomy.

How effective is vasectomy?

A vasectomy is over 99% effective. About one in every 700- 1,000 vasectomies fail and the man may stay fertile or become fertile again. This can happen if the tubes are not fully blocked off, if they grow back together or if a third vas deferens exists. Normally this is picked up when the sperm count is done three months after the operation, but it can occur at any time, even years after the vasectomy.

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How is vasectomy done?

A vasectomy is a simple procedure which only takes about 20 minutes to perform. It is done using local anaesthetic to numb the area. Some doctors may also use a light sedation, which means the man is in a light sleep during the procedure. The doctor usually makes a small opening in the front of the scrotum (below the base of the penis), locates the vas deferens and cuts both sides. Sometimes a small part of each vas deferens is removed. The opening in the skin of the scrotum is then closed with a stitch or by pressing the skin edges together. The local anaesthetic may sting and there may be some sensation during the procedure, but it is generally not painful.

The man will usually spend up to 2 hours in total in the clinic. As the local anaesthetic wears off there can be some tenderness and discomfort in the scrotum and groin. This can be managed with rest, oral pain relief, ice packs, and tight fitting underpants.

After the vasectomy, the man should rest for the remainder of the day, preferably with the groin elevated a little to assist in minimising any swelling.

He can return to normal activities the next day if he has a desk job. Normal day-to-day activity is not harmful, but if a man’s work is physically strenuous he may need to take some sick leave. Sexual activity can be resumed whenever it feel comfortable to do so.

When is the vasectomy effective?

A man will still have sperm in his vas tubes, and therefore in his semen, for some time after the operation. It takes a minimum of 20 ejaculations to clear all the remaining sperm. It is very important that semen samples are tested three months after the vasectomy operation to ensure the procedure has been effective. Until a man has the all clear an alternative form of contraception, e.g. condoms, will need to be used.

Where do the sperm go?

Sperm continue to be produced in the testes after the operation but they are harmlessly re-absorbed by the body.

Complications Vasectomy is a simple and safe procedure. It is common to experience some tenderness following the operation. Some men may also experience some minor bruising and swelling which may last a few days. As mentioned, rest, ice packs, oral pain relief and supportive underwear will minimise these symptoms.

A small number of men experience bleeding or infection after a vasectomy. Rest, support of the scrotum, pain relief and antibiotics will resolve most problems quickly. Occasionally sperm can leak from the ends of the cut tubes and produce small, hard lumps at the site of the operation. These usually do not cause any problems.

Very occasionally the spontaneous re-joining of a tube may occur leading to sperm in the semen. This is called recanalization and can occur at any time after a vasectomy.

Some men form antibodies to their own sperm after the operation, but these do not appear to affect any other part of the body or cause any disease or discomfort. This would usually take years after a vasectomy to occur. These antibodies may be one of the reasons that men sometimes cannot father a child even after having a reversal operation.

Very rarely some men have persisting discomfort in the scrotum following vasectomy. While this usually settles with time, very occasionally it does not, and further surgery may be needed to relieve this discomfort.

The vasectomy operation does not involve removing the testes, will not affect the man’s ability to produce semen, and does not change a man’s sexual function or his male characteristics. He will still be able to enjoy sex as he did before and ejaculation should feel the same. The only difference will be that the semen will not contain any sperm.

Reversal of vasectomy

Some surgeons have been reasonably successful at re-joining vas tubes that have been cut. However, these surgeons normally only take on cases they consider to be straightforward, and even if the operation is successful, there is no guarantee that the man will then be able to father a child. If a man is considering a vasectomy, he should regard it as a permanent decision. If he thinks there is any possibility that he may want to father children in the future he should not have a vasectomy.

How to arrange vasectomy

Vasectomy is performed by some GPs, specialist urologists, or at some sexual health centres. Ask your local doctor or call Sexual Health & Family Planning ACT on 62473077 for more details and contact information.

References:

  1. Contraception: an Australian clinical practice handbook
  2. Andrology Australia: Vasectomy
  3. FPNSW: Fact sheet: Vasectomy

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