Vasectomy: An effective form of male birth control

Vasectomy is a safe and effective birth control choice for men who are certain they don't want to father a child.

• Vasectomy is nearly 100 percent effective in preventing pregnancy.
• Vasectomy is an outpatient surgery with a low risk of complications or side effects.
• The cost of a vasectomy is far less than the cost of female sterilization (tubal ligation) or the long-term cost of birth control medications for women.
• You won't need to take birth control steps before sex, such as putting on a condom.

A potential concern with vasectomy is that you may later change your mind about wanting to father a child. Although it may be possible to reverse your vasectomy, there's no guarantee it will work. Reversal surgery is more complicated than vasectomy, can be expensive and is ineffective for many men. Before you get a vasectomy, you should be certain you don't want to father a child in the future.

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 your semen
• Bruising of your scrotum
• Infection of the surgery site
• Mild pain or discomfort
• Swelling

Delayed complications can include:

• Chronic pain (rare)
• 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 your vasectomy fails (rare)

Unfounded concerns

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

• Affect your sexual performance. A vasectomy won't affect your sex drive or your masculinity in any way other than preventing you from fathering a child.
• Permanently damage your sexual organs. There's very little risk that your testicles, penis or other parts of your reproductive system will be injured during surgery.
• Increase your risk of certain cancers. Although there have been some concerns about a possible link between vasectomy and prostate and testicular cancer in the past, there's no proven link.
• Increase your risk of heart disease. As with cancer fears, there doesn't appear to be any link between vasectomy and heart problems.
• Cause severe pain. You may feel minor pain and pulling or tugging during surgery, but severe pain is rare. Likewise, after surgery you may have some pain, but for most men it's minor and goes away after a few days.

Some family medicine or general practice doctors do vasectomies, but most are done by doctors who specialize in the male reproductive system (urologists).

Talking to your doctor

Deciding to get a vasectomy can be a tough decision, since you won't be able to father a child in the future. Before doing a vasectomy, your doctor will want to meet with you to be sure it's the right form of birth control for you.

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

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

Before surgery

Your doctor will give you instructions on how to prepare. You may need to:

• Stop taking aspirin or other blood-thinning medications several days before your surgery. These can include warfarin (Coumadin), heparin and aspirin and other over-the-counter pain medications such as ibuprofen (Advil, Motrin, others).
• The day of the surgery, use scissors to cut the hair around the surgery area. Then shower or bathe, being sure to wash your genital area thoroughly.
• Bring a pair of tightfitting underwear or an athletic supporter to wear after the procedure to support the scrotum and minimize swelling.
• Arrange for a ride home to avoid movement and pressure on the surgery area caused by driving.

A vasectomy is usually done at a doctor's office or surgery center under local anesthesia, which means you'll be awake and have medicine to numb the surgery area.

During surgery

Vasectomy surgery usually takes about 15 to 20 minutes. To perform a vasectomy, your doctor will likely follow these steps:

• Numb the surgery area by injecting a local anesthetic into the skin of your scrotum with a small needle.
• Make a small cut (incision) in the upper part of your scrotum once the surgery area is numb. Or with the "no-scalpel" technique, make a small puncture in the scrotum instead of an incision.
• Locate the tube that carries semen from your 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) or surgical clips. Then your doctor will return the ends of the vas deferens to the scrotum.
• Stitch up the incision at the surgery area. Stiches aren't necessary if your doctor has used the no-scalpel technique.

After surgery

Following a vasectomy, you'll have some bruising, swelling and pain. It usually gets better within a few days. Your doctor will give you instructions for recovery. Your doctor may tell you to:

• Call right away if you have signs of infection, such as blood oozing from the surgery site; a temperature of more than 100.4 F (38 C), or worsening pain or swelling.
• Support your scrotum with a bandage and tightfitting underwear for at least 48 hours after your vasectomy.
• Apply ice packs to the scrotum for the first two days.
• Limit activity after surgery. You'll need to rest for 24 hours after surgery. You can probably do light activity after two or three days, but you'll need to avoid sports, lifting and heavy work for a week or so. Overdoing it could cause pain or bleeding inside the scrotum.
• Refrain from bathing or swimming for at least 24 hours after surgery.

Avoid any sexual activity for a week or so. If you do ejaculate, you may feel pain or notice blood in your semen. If you have sexual intercourse, use another form of birth control until your doctor confirms that sperm are no longer present in your semen.

A vasectomy doesn't provide immediate protection against pregnancy. Use an alternative form of birth control until your doctor confirms there are no sperm in your semen. Before having unprotected sex, you'll need to wait up to three months or longer and ejaculate 20 times or more to clear any sperm from your semen.

Most doctors do a post-surgery check three months after surgery to be certain that no sperm are present. You'll need to give your doctor sperm samples to examine. To produce a sperm sample, your doctor will have you masturbate and ejaculate into a container. Your semen is then examined under a microscope to see whether sperm are present.

Vasectomy is an effective form of birth control, but it won't protect you or your partner from sexually transmitted infections, such as chlamydia or HIV/AIDS. For that reason, you should use condoms if you're not in a committed relationship — even after you have a vasectomy.