Vasectomy: An effective form of male birth control

If a person is certain that he does not want to become a father in the future, vasectomy is the best birth control procedure available because it is very safe and effective. This procedure is one of the best birth control procedures for men due to following reasons:

• It is almost 100% effective in preventing pregnancy
• It can be done as an outpatient procedure that eliminates the need for hospital stay
• It has very less side-effects and very low risk of complications in the future
• Vasectomy is a very cost-effective process and it costs far less than the cost of a female sterilization (Tubal Ligation) or birth-control pills for a long time
• As this procedure controls pregnancy, condoms are not required before sex for birth control. However, to prevent sexually transmitted diseases, condom is still necessary
• The failure rate is very low and the procedure has a successful track record for many years now as a safe and effective contraceptive method
• It does not change the ejaculation feeling nor does the patient feel any difference while having sex with female partners

The main concern with this procedure is that if a man changes his mind to become a father, the possibility of reversal of the procedure is very low. Although reverse vasectomy is possible but there is no assurance that it will work. The reverse vasectomy is much more complicated as compared to vasectomy. It is more expensive and has various risks.

After vasectomy procedure, there are other methods, such as in vitro fertilization, through which a man can increase the possibility of becoming a father. However, usually, these processes are very expensive and are less effective. Thus, before undergo the process, the person should be sure about the decision of not becoming a father of a child in the future.

If the person has a chronic testicular pain or testicular disease, then he is not a good candidate for a vasectomy. For most men, a vasectomy doesn't cause any noticeable side effects, and serious complications are rare.

Side effects right after surgery can include:

• Bleeding or a blood clot (hematoma) inside the scrotum
• Blood in the semen
• Bruising of the scrotum
• Infection of the surgery site
• Mild pain or discomfort
• Swelling

Delayed complications can include:

• Chronic pain, which can happen to 1 to 2 percent of those undergoing surgery
• Fluid buildup in the testicle, which can cause a dull ache that gets worse with ejaculation
• Inflammation caused by leaking sperm (granuloma)
• Pregnancy, in the event that the vasectomy fails, which is rare.
• An abnormal cyst (spermatocele) that develops in the small, coiled tube located on the upper testicle that collects and transports sperm (epididymis)
• A fluid-filled sac (hydrocele) surrounding a testicle that causes swelling in the scrotum

Unfounded concerns

Many men worry that a vasectomy can cause serious problems — but these fears are unfounded. For example, a vasectomy won't:

• Affect the sexual performance. A vasectomy won't affect the sex drive or the masculinity in any way other than preventing you from fathering a child. Men have even reported higher sexual satisfaction after a vasectomy.
• Permanently damage to the sexual organs. There is a very little risk that the testicles, penis or other parts of the reproductive system will be injured during surgery. In extremely rare cases, injury to the blood supply can lead to the loss of a testicle, however, that is unlikely to happen if the surgeon is skilled.
• Increased risk of certain cancers. Although there have been some concerns about a possible link between vasectomy and testicular or prostate cancer in the past, there's no proven link.
• Increase the risk of heart disease. Similar to cancer fears, there is no link between vasectomy and heart problems.
• Cause severe pain. The patient might feel minor pain and pulling or tugging during surgery, however, severe pain is rare. Likewise, after surgery, the patient might feel some pain, but for most men the pain is minor and goes away after a few days.

• Food and medications- The doctor will probably ask the patient to stop taking aspirin, nonsteroidal anti-inflammatory drugs or other blood-thinning medications several days before the surgery. The drugs not recommended by the physician, before the surgery, include warfarin (Coumadin, Jantoven, others), heparin and over-the-counter pain medications such as ibuprofen (Advil, Motrin IB, others).
• Clothing and personal items- The patient is recommended to bring a pair of tightfitting underwear or an athletic supporter to wear after the procedure to support the scrotum and minimize swelling.
• The patient is asked to shower or bathe on the day of the surgery. The patient is asked to wash the genital area thoroughly and also to trim the hair.
• The patient is asked to arrange for a ride home after the surgery to avoid movement and pressure on the surgery area caused by driving.

What to expect during the procedure:

Before the procedure

Before doing a vasectomy, the doctor will meet the patient and explain the procedure, along with its benefits and side effects, in detail to the patient.

At the initial appointment (consultative visit), the patient should be prepared to discuss:

• The understanding that vasectomy is permanent, and that it isn't a good choice if there's any chance the patient might want to father a child in the future
• Whether the patient has children and how the partner feels about the decision
• Other methods of birth control available
• What vasectomy surgery and recovery involves, and possible complications

Some family medicine or general practice doctors also perform vasectomies, however, in most cases the procedure is performed by the doctors, specialized in the male reproductive system (urologists).

A vasectomy is usually done at a doctor's office or surgery center under local anesthesia, which means the patient would be awake and only the surgery area would be made numb for the patient.

During the procedure

Vasectomy surgery usually takes about 10 to 30 minutes. To perform a vasectomy, the doctor will likely follow the following steps:

• Numb the surgery area by injecting a local anesthetic into the skin of the scrotum with a small needle.
• Make a small cut (incision) in the upper part of the scrotum once the surgery area is numb. Else, the doctor, with the "no-scalpel" technique, can make a small puncture in the scrotum instead of an incision.
• Locate the tube that carries semen from the testicle (vas deferens).
• Withdraw part of the vas deferens through the incision or puncture.
• Cut the vas deferens where it has been pulled out of the scrotum.
• Seal the vas deferens by tying it, using heat (cauterizing), surgical clips or a combination of methods. Then the doctor will return the ends of the vas deferens to the scrotum.
• Close the incision at the surgery area. Stitches or glue may be used. In some cases, the wound may be left to close on its own over time.

After the procedure

Following a vasectomy, the patient would have some bruising, swelling and pain. However, these usually get better within a few days. The doctor will give some instructions for recovery, to the patient, as highlighted below.

• The patient would be recommended to call the doctor, if they have signs of infection, such as blood oozing from the surgery site; a temperature of more than 100.4 F (38 C); redness; or worsening pain or swelling.
• The patient would be asked to support the scrotum with a bandage and tightfitting underwear for at least 48 hours after the vasectomy.
• The patient would be recommended to apply ice packs to the scrotum for the first two days.
• The patient would be asked to limit activity after surgery. He is needed to rest for 24 hours after surgery. The patient can probably do light activity after two or three days, but is asked to avoid sports, lifting and heavy work for a week or so. Overdoing it could cause pain or bleeding inside the scrotum.
• The patient is asked to avoid any sexual activity for a week or so. In case of ejaculation, the patient may feel pain or notice blood in the semen. In case of sexual intercourse, the patient is advised to use another form of birth control until the doctor confirms that sperm are no longer present in the semen.

A vasectomy doesn't provide immediate protection against pregnancy. The patient should use an alternative form of birth control until the doctor confirms that there are no sperm in the semen. Before having unprotected sex, the patient will need to wait several months or longer and ejaculate 15 to 20 times or more to clear any sperm from the semen.

Most doctors do a follow-up semen analysis six to 12 weeks after surgery to be certain that no sperm are present. The person would need to give the doctor sperm samples to examine. To produce a sperm sample, the doctor will have the patient masturbate and ejaculate into a container or use a special condom without lubrication or spermicide to collect semen during intercourse. The semen would be then examined under a microscope to see whether sperm are present.

Vasectomy is an effective form of birth control, but it won't protect the person of the partner from sexually transmitted infections, such as chlamydia or HIV/AIDS. Hence, the person is advised to use other forms of protections such as condoms if the person is at the risk of acquiring a sexually transmitted infection — even after the vasectomy.

How long does it take to recover after a vasectomy?

Most men recover completely in less than a week. Everyday activities can be resumed, the day after surgery unless the activities are unusually vigorous. Men surveyed after percutaneous vasectomy report full recovery in an average of 8-9 days.

When is it safe to have sex?

Sexual activity can be resumed within a few days after a vasectomy, but precautions should be taken against pregnancy until sperm counts show that the semen is free of sperm. In general, a semen analysis is completed about 3 months after a vasectomy.

After a vasectomy, can I stop using other birth control methods right away?

No. Sperm can remain in the vas deferens above the area of the procedure for weeks or even months after a vasectomy. A semen test is done three to four months after the procedure. If the results meet American Urological Association guidelines, you are considered sterile. If the sperm is seen, the semen test is repeated. Until then, you must continue to use other birth control to prevent pregnancy.

Can I have a vasectomy reversed later if I choose?

While vasectomy reversal is an option after vasectomy, in case the fertility restoration is desired, vasectomy should be considered a permanent means of birth control. Men who are married or in a serious relationship should also discuss this issue with their partners.