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Vasectomy

 
 

What is it?

The vas is the name of the tube that carries the sperm from each testicle, up into the groin and then deep inside the body to the base of the penis. A vasectomy means that a piece of the vas on each side is taken out just above each testicle and the ends are tied off. The sperm cannot pass into the penis, so you will no longer be fertile. However, you will still make fluid at intercourse.

The Operation

The skin of the scrotum will be numbed with an injection of local anaesthetic just as a dentist numbs a tooth. A 1cm (1/2 inch) cut is made in the front of the scrotum. There may be stitches to close the wound. You can expect to feel some pushing and pulling, but it is less uncomfortable than having a tooth filled.

The operation takes about 20 minutes. You do not need to shave or starve beforehand and you can drive home straight away afterwards. You should wear Y-front or slip underpants, but not boxer shorts. Alternatively, you can have a general anaesthetic in which case you would be asleep during the operation. You would need to starve beforehand, but you would be able to go home the same day. You would not be fit to drive, use machinery or make big decisions for 24 hours. Sometimes a cut is made on each side of the scrotum. Once the vas tubing has cleared itself of sperm (which may take several weeks), the operation is very reliable.

However, in spite of all surgical efforts, pregnancies do occur in about 1 in 2000 vasectomy cases. This is a very low chance and is lower than the chance of pregnancy when the contraceptive pill is used, lower than the 1 in 500 chance of pregnancy after female sterilisation, and much lower than when the sheath, coil or diaphragm are used. The operation can be reversed by re-joining the cut ends but the rate of success in producing further pregnancies is only about 1 in 3. It is best to have a vasectomy on the understanding that it is not reversible.

YOU NEED TO DECIDE THAT COME WHAT MAY YOU DO NOT WANT MORE CHILDREN. Bear in mind that 1 in 3 marriages break up nowadays. Do not make a hasty decision about vasectomy, it is basically permanent.

Any Alternatives

Most of the other methods of contraception are not permanent, form example the condom, coil, the Pill and the long-term female injection treatment. Less proven ways include the morning after contraceptive pill and the contraceptive pill for men. Clipping the tubes in the female is worth thinking about. It is not as reliable as a vasectomy and needs a general anaesthetic. Removal of the womb in the female is clearly a permanent solution. You should only think about this if your partner has, for instance, fibroids and heavy/painful periods.

After - At Home

After a local anaesthetic you will not have any discomfort for an hour or two, so that is a good time to get home. Take painkillers such as aspirins or paracetamol, if you feel discomfort coming on. It is not severe. Take things quietly for the rest of the day. After a general anaesthetic you will feel sleepy for two to four hours. The nurses will help you with everything you need until you are able to do things for yourself. Painkillers will control discomfort from the wound. On the next day you may feel sore. You can take off the dressings and wash, bathe or shower but try to keep the wound(s) dry for five to seven days. You will have spare dressings to cover the wound. Use underpants to hold them on. On the third day you may notice black bruising in the skin. This fades away in a day or two. After a week the wound settles almost completely and the stitches will have dissolved out. The operation does not interfere with the passing of urine. The urine will not sting or get bloody.

You need to have a sperm count done about 10 weeks after your operation to test that the tubing is clear of sperm. Straight after your vasectomy you will probably be given dated specimen pots and forms. On each appointed day you should produce a specimen by masturbation, and take it to the hospital to be tested. If the tests are not clear then the hospital will write to you with further pots and forms. When the tests are finally clear the hospital will inform you. Only then should you stop using a contraceptive. (These tests are sometimes arranged by your general practitioner). You can work the next day, but you may find it more comfortable to take a day off after the operation. It is sensible to avoid mild sports for three or four days and contact sports for a week or so. You can start sex again as soon as the wound is comfortable, usually after about a week. Remember, you are still fertile until the sperm tests are clear. Continue to use a contraceptive until you get the go ahead from the hospital or your general practitioner.

Possible Complications

If you have this operation under general anaesthetic there is a very small risk of complications related to your heart or your lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

After a vasectomy, the testicles will still make sperm, but these sperm are melted away by the body as quickly as they are made. The testicles do not swell or feel heavier or tense afterwards.

The testicles still make sex hormones, so that you

  • will still grow a beard
  • have the same abilities at sex
  • remain just as aggressive
  • do not put on weight
  • will not change your voice.

You will still make fluid at intercourse after a vasectomy because this fluid is made further down the tubing than the tied off part of the vas. The operation appears free from long-term side effects. There is always a swelling about the size of a marble on each side, due to the internal stitches, and minor bleeding. This settles down in a week or two. About 1 in 100 men notice bleeding which causes swelling bigger than marble size or which comes through the dressings. This usually happens to patients who do not follow the instructions for rest after the operation. If this happens (it will be in the first 12 hours or so), get surgical help immediately. Sometimes the stitches do not drop out in a week. If this happens they can be nipped out easily. Very rarely there is some pain and discharge due to infection four or five days after the operation. This responds to antibiotics. Even more rarely swellings appear four to six weeks after the operation on each side where the internal stitches have been. These can be removed if necessary. Minor twinges may be felt for several weeks. There is a 5% chance that you will develop sperm grannulomata (hard rounded tissue the size of a small marble) on one or both sides. This happens on the side of the vas that is still connected to the testis. It is basically sperm that can’t move forward, doesn’t melt as quickly and gets accumulated and eventually gets converted into scarred tissue. These are usually harmless and most of the time get softer and smaller. There is small chance however, that they may become painful or infected and then you will need another operation to remove them.

Very rarely, the vessels that provide the blood supply to the testis can be damaged during the operation and this can result in necrosis (dying) of the testis which requires another operation to remove it.

Also, very rarely, patients feel some chronic pain (mild to moderate and sometimes severe) in or around the area of the operation. This is probably due to damage to the small nerves in the area of the operation or chronic irritation of the nerves from the scarred tissue in the area. Finally, some patients experience sexual problems after the operation. It is almost certain that the operation is not the cause of such problems. The cause is either psychological (feeling of “disability” after the operation) or more frequently they are problems that existed before the operation and for psychological reasons become more prominent after the experience or “trauma” of the operation.

 

 
 
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