What Is a Vasectomy?
Vasectomy is a surgical procedure performed to make a man sterile or unable to father a child. It is a permanent male birth control measure and a means of contraception used in many parts of the world.
Generally, vasectomy leaves the patient unchanged except that the vas deferens—the tubes leading to the testes—are blocked. The testes still produce sperm, but the sperm die and are absorbed by the body. The level of testosterone remains the same and all male sexual characteristics remain the same. For most men, the ability to have an erection is unchanged.
A total of nearly 50 million men have had vasectomies, a number equal to about five percent of all married couples of reproductive age. Approximately half a million vasectomies are performed in the United States each year. Nearly one out of six men over age 35 has had a vasectomy.
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How Common Are Vasectomies?
Vasectomy has become a widely-used form of male contraception, chosen by approximately 5–10 percent of US couples.
How Is It Done?
Although there are several techniques for performing vasectomy, the most common are variations on the no-scalpel technique. Each vas is grasped in such a way as to bring it to the surface of the skin. This may be done on both sides of the scrotum or both may vas may be brought to the same position so there is one incision. Your comfort is a high priority with us and we have developed several techniques to ensure that the vasectomy is neither scary nor painful.
Once the vas is fully dissected and isolated, it is divided. Many techniques may be used to ensure good separation of the vas. Based on the available studies, we feel that the best outcomes are achieved with a combination of 1) clipping the vas with permanent, small titanium clips, 2) sealing the inside (lumen) of the vas, and 3) interposition of tissue between the two ends of the vas.
Does It Work?
Vasectomy works very well, with an unwanted pregnancy rate well below 1%. However, some points are important to remember.
- The vas (where sperm are transported) is a very long tube. It requires time and ejaculations (at least 30) to clear the vas. The vasectomy does NOT work immediately. We CANNOT consider you sterile until you have two negative semen analyses (no sperm seen). These are typically done six and eight weeks after the procedure. If there are still sperm present, you may need to give additional samples.
- Although vasectomy is reversible, the reversal is expensive and not completely reliable. It is a bad idea to have a vasectomy if there is any thought that you might want to have additional children.
What Are the Risks?
Risks include bleeding, swelling, discomfort, recanalization (meaning the vas comes back together), infection, sperm granuloma (a swelling or lump where the vas was cut), and persistent non-moving sperm in the semen analyses. To minimize issues after the procedure, it is best to take it very easy for a couple of days after and be relatively inactive (no sports or intense exercise) for a couple weeks. We have developed a written post-vasectomy instruction sheet to help patients remember what to do.
Cardiovascular
An animal model in the early 1980s based on a small number of animals suggested that vasectomized monkeys develop a high cardiovascular plaque burden several years after their surgery, and this has led to concerns that anti-sperm antibodies that form after cutting the ends of the vasa promote endothelial injury. However, large population-based studies have shown no correlation between vasectomy history and either atherosclerosis or myocardial infarction.
Cancer
Retrospective and prospective studies have suggested a possible link between vasectomy and the development of prostate cancer. This was evaluated in population-based studies both in the US and abroad. While there is a small elevation of the relative risk of prostate cancer, all of the studies concluded that this is more likely due to introduced biases rather than a causal relationship. For example, men who have vasectomies by urologists are more likely to have follow-up later by urologists and thus have screening for prostate cancer.
A large Danish study looked at the relationship between vasectomy and testicular cancer and concluded that there was neither a causal relationship nor did vasectomy promote the growth of preexisting testicular lesions.
Bone Density & Autoimmune Disorders
Antisperm antibodies may develop after the blood-testis barrier is violated by dividing the vasa. However, even with long-term follow-up, no relationship has been found between vasectomy and a wide variety of immune-related conditions, and also no relationship between vasectomy and dementia (which was suggested in a case-controlled study). Additionally, although there may be alterations in the hypothalamic-pituitary-testis axis, vasectomy does not appear to cause decrease in bone density.
