Vasectomy

What Is A Vasectomy?

A vasectomy is a permanent method of male contraception. It involves cutting both the tubes (vas deferens) that carry sperm from your testicles. This prevents sperm from mixing with semen and reaching your penis (see figure 1). So a vasectomy should prevent your partner from becoming pregnant.

It Is Your Decision To Go Ahead With The Operation Or Not.

This document will give you information about the benefits and risks to help you to make an informed decision. If you have any questions that this document does not answer, ask Dr Vasudevan.

What Are The Benefits Of Surgery?

You or your partner should not need to use another method of contraception. However, you should use another method of contraception until you are told by Dr Vasudevan that you are sperm-free. A Vasectomy can fail and allow your partner to become pregnant (failure rate: less than 2 in 1,000 over one year).

Are There Any Alternatives To A Vasectomy?

The only other method of male contraction is to use a condom but the risk of failure is higher (failure rate: on average 15 in 100 over one year). Using a condom is the only method of contraception that provides some protection against sexually transmitted infections. A sterilisation is a permanent method of female contraception (failure rate: 5 in 1,000 over one year). It involves blocking both fallopian tubes (tubes that carry the egg from your ovary to your womb and sperm to the egg).

There are non-permanent methods of female contraception. These do not need a general anaesthetic.

Hormone implants (failure rate: 5 in 10,000 over one year).

A coil or intra-uterine contraceptive device (IUCD) (Failure rate: less and 2 in 1,000 over one year).

Oral contraceptive pill (failure rate: 8 in 100 over one year).

If you think one of these methods may be more suitable for you, discuss with Dr Vasudevan.

What Does The Operation Involve?

The healthcare team will carry out a number of checks to make sure you have the operation you came in for. You can help by confirming to Dr Vasudevan and the healthcare team your name and the operation you are having.
The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. Your anaesthetist will discuss the options with you and recommend the best form of anaesthesia for you. You may also have injections of local anaesthetic to help with the pain after the operation. You may be given antibiotics during the operation to reduce the risk of infection. The operation usually takes about 15 to 20 minutes.
If you have a local anaesthetic, this will be injected alongside each vas tube at the top of your scrotum and in your skin where the cuts will be made. Dr Vasudevan will usually make one small cut on each side of your scrotum.
Sometimes they will make a single cut on the middle of your scrotum. Dr Vasudevan will cut the tubes that carry sperm from each testicle to your penis and close the ends with stitches, slips or an electric current (cauterisation).
Dr. Vasudevan may close any cuts on your scrotum with dissolvable stitches.

What Should I Do About Medication?

Let Dr Vasudevan know about all the medication you take and follow his advice. This includes all blood-thinning medication as well as herbal and complementary remedies, dietary supplements, and medication you can buy over the counter.

What Can I Do To Help Make The Operation A Success?

If you smoke, stopping smoking several weeks or more before the operation may reduce your risk of developing complication and will improve your long-term health. Try to maintain a healthy weight. You have a higher risk of developing complication if you are overweight. Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health.

You can reduce your risk of infection in a surgical wound.

Part of your scrotum may need to be shaved before the operation. You will either be asked to do this yourself when you are in hospital or the healthcare team will do it for you.

Try to have a bath or shower either the day before or on the day of the operation and make sure your scrotum is clean.

Keep warm around the time of the operation.

What Complications Can Happen?

Dr Vasudevan will try to make the operation as safe as possible but complications can happen. Some of these can be serious and can even cause death (risk: 1 in 400). You should ask Dr Vasudevan if there is anything you do not understand. Dr Vasudevan may be able to tell you if the risk of a complication is higher or lower for you.

Complications of anaesthesia

Your anaesthetist will be able to discuss with you the possible complication of having an anaesthetic.

General complications of any operation

Pain- It is normal to get some mild discomfort and tenderness in your scrotum for up to 10 days. You may need to take simple painkillers such as paracetamol to make sure you are comfortable.

Bleeding during or after the operation (risk: 1 in 100)- It is common for your scrotum to be bruised and to be bruised around the cuts. This usually settles with a few days. If the bleeding is heavy, you may need another operation.

Infection of the surgical site (wound) or in your scrotum (risk: 1 in 100)- It is usually safe to shower after two days but you should check with the healthcare team. Let Dr Vasudevan know if you get a high temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but you may need another operation.

Specific complications of this operation

Becoming fertile again- If the tubes re-join, sperm will mix with your semen and you will be fertile again. There is no way of knowing if this has happened other than by testing your semen, as it looks the same if you are fertile or not. Sometimes the tubes re-join after just a few weeks (risk: 1 in 400). At this stage, you should still be using another method of contraception. However, the tubes can re-join many months later, after you have been told that you are sperm-free (risk: 1 in 2,000 over a lifetime).

Long-term pain in your testicles (risk: 1 in 25) -The pain is probably caused by scar tissue forming around the fine nerves. Although the pain is not severe, it can last for months and you need painkillers.

Congestive epididymitis, where the tube-like structure that stores sperm gets blocked, causing pressure and pain (risk: less than 6 in 100). This usually settles with time.

Sperm granuloma, where sperm leeks and causes small painful swellings on the end of the vas tube that has been cut. This usually settles but you may need another operation (risk: 2 in 100).

How Soon Will I Recover?

In hospital

After the operation you will be transferred to the recovery area. You may need painkillers. It is helpful to hold an ice-pack against your scrotum to reduce any pain and help prevent bruising. (Do not put ice directly on your skin). Wearing a scrotal support or firm underwear will help ease any discomfort, and minimise bruising and swelling.
You should be able to go home the same day.
However Dr Vasudevan may recommend that you stay a little longer.
If you do go home the same day, a responsible adult should take you home in a car or taxi and be able to stay with you for at least 24 hours. Be near a telephone in case of an emergency.
If you are worried about anything, in hospital or at home, contact the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Do not drive, operate machinery (this includes cooking) or do any potentially dangerous activities for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination.
If you had a general anaesthetic or sedation, you should also not sign legal documents or drink alcohol for at least 24 hours.
Your testicles will probably ache for a few days. To reduce the risk of bleeding, do not have sex or do strenuous exercise, like running and riding a bicycle, for five to seven days.
Your sexual feelings, semen ejaculation or ability to have an erection should not be affected by the operation.
You should be able to return to work after about two days (about a week if your work involves strenuous exercise).
If you notice swelling or have a discharge from your wounds, or still have pain after four weeks, contact Dr Vasudevan.
Regular exercise should help you to return to normal activities as soon as possible.
Do not drive until you are confident about controlling your vehicle and always check your insurance policy.

The future

It can take around 20 ejaculations to clear out any sperm that may be left.
Dr Vasudevan will ask you to give a sample of your semen at your follow-up appointment, which will be 3 months after your operation.
The sample will be tested to find out if there are any sperm left. Use another method of contraception until Dr Vasudevan tells you that you are sperm-free.
Sometimes the sperm can take many months to clear from the semen (risk: 1 in 50). However, the number of sperm can fall to such a low level that Dr Vasudevan may tell you that you no longer need to use contraception.
A vasectomy is meant to be a permanent method of contraception. Although it is possible to have an operation to re-join the tubes, this does not work for everyone. You should assume that you will not be able to have children again.

Summary

A vasectomy is an operation to cut the tubes that carry sperm from your testicles. It is a permanent and effective method of male contraception. Surgery is usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.