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131: The Vasectomy Episode

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131: The Vasectomy Episode

Feb 14, 2023

A vasectomy is one of the most successful ways to prevent pregnancy and is a way for men to remove the fear of a new kid from sex and even take the responsibility of birth control off of their partner. But when it comes to any sort of procedure below the belt, men may have some concerns. Urologist Dr. John Smith explains the ins and outs of the procedure and answer the question the guys have about getting "the snip."

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Welcome to a very special Valentine's edition of "Who Cares About Men's Health." Did you hear that, Troy? Did you hear what . . .

Troy: That wasn't me. That was Mitch.

Dr. Smith: That was Mitch 100%.

Mitch: All of our very special episodes give me such anxiety. What is the topic today, Scot? Let us hear. What's Valentine's Day going to be about?

Scot: Yeah, you guess what our topic for Valentine's episode is going to be?

Mitch: I don't know. Emotional openness or . . . I don't know. What is it?

Scot: Vasectomies.

Mitch: You know what? I'll give it a solid B-plus. I think this is a good thing. Yeah, love this. Okay, great.

Troy: It works for Valentine's Day.

Scot: Does it? Did you get the tie-in? I was afraid you wouldn't get the tie-in.

Mitch: No, I feel it.

Troy: V-Day has a whole new meaning.

Scot: Actually, a vasectomy could be an amazing gift because women have traditionally borne the responsibility of birth control, right? And sometimes it impacts their hormones, and some of it is uncomfortable, and some of it is a daily grind, it's a responsibility, or all of the above, right? So what if you could take that weight off of your wife and put it on you?

From what I understand, a vasectomy is one of the most effective forms of birth control, and it can remove a lot of stress when you're having sex. But there are some crazy things on the internet about vasectomy side effects, and there are also some legit concerns. And we're going to find out what's legit, what's not, plus also how to figure out if vasectomy is right for you and your partner and what to expect.

This is a Men's Health Essentials episode about vasectomy for the vasectomy curious of "Who Cares About Men's Health," providing information, inspiration, and a different interpretation of men's health.

My name is Scot Singpiel. I bring the BS and I'm on Team V. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I just want to know did you give your wife a vasectomy for Valentine's Day? Is that how this kind of all came up?

Scot: No, I got it a couple of years ago.

Troy: But not on Valentine's Day.

Scot: But not on Valentine's Day.

Troy: I just wanted to know how many men have actually done that.

Mitch: What do you put in a box or card for that?

Troy: Yeah, exactly.

Scot: Always with his unique perspective, Mitch Sears.

Mitch: Hey. Hello. I'm not concerned about this, but I am curious to learn more about it.

Scot: All right. And the most manly guy on the planet because, get this, he performed his own vasectomy on himself.

Troy: This is amazing. This actually blew my mind when I heard this, so I hope you're going to describe this in detail for us.

Scot: It's urologist Dr. John Smith on the show.

Dr. Smith: Man, I thought my wife was the only person who loved to start conversations with that story.

Troy: That is seriously the manliest thing I've heard.

Scot: I know.

Troy: I have sutured myself up and I tell people that, and they're like, "Whoa, are you serious?" But to tell someone I did my own vasectomy, that would just be next level. I've never heard of that before.

Scot: Yeah, on a scale of one to awesome, how do you feel about that, Mitch? That John did . . .

Mitch: I just can't even imagine. Did you have to? Were you in an emergency vasectomy situation, or what was going on?

Dr. Smith: I mean, all of that is up for interpretation. My wife and I had surprise twins during the beginning of the pandemic, and that was a shocker. And so once we had the twins, she literally looked at me and said, "When are you getting your vasectomy?"

Scot: And going to another provider never was something you considered?

Dr. Smith: I mean, I considered it. I probably should have done it. I mean, probably not the brightest move I've ever made in my life, but it's worked out just fine. I mean, it was one of those where someone no-showed their vasectomy. I wasn't going to throw that stuff away, so I made the executive decision to just do it.

Mitch: You just sat down and did it?

Dr. Smith: Yeah.

Troy: And just to clarify for any listeners who are thinking of doing this, this is a . . .

Dr. Smith: Don't.

Troy: . . . procedure you do on a regular basis.

Dr. Smith: Oh, yeah. I mean, volume-wise, I'm one of the highest-volume vasectomy folks at the University of Utah.

Troy: So this is not an unfamiliar procedure. But you did it on yourself. That's amazing.

Scot: This is a "don't do it at home" sort of . . .

Troy:Yeah, don't do this at home.

Dr. Smith: I would not take what I did and make it something that's the smartest thing I've ever done.

Scot: So, as a guy who had the procedure, I had a misconception. I thought that I was going to show up and there was going to be an operating room full of people, right? I thought there was going to be just a ton of people, but there wasn't. There was one guy. That's one of the things we're going to talk about, one of the misconceptions people have.

But before we get into that, John, what are some of the crazy things that men hear about vasectomy on the internet that they ask you about?

Dr. Smith: I mean, a lot of them will come in and they'll be like, "I'm going to be able to have an erection? I'm going to be able to . . . I'll still ejaculate? This won't impact my testosterone levels? I'll still feel and have testosterone?" Pretty much anything that you can think of when it comes to your genitals being in the crosshairs. There's a lot of misconception out there.

Scot: And it's not true. All those things you said . . . I'm not going to all of a sudden have the desire to start watching Hallmark Channel movies or something, right? My voice isn't going to get higher.

Dr. Smith: No, not at all. And so yeah, a lot of the misconceptions are there. It doesn't change erectile quality. It doesn't even change the amount of ejaculate. The sperm themselves make up about 5% of the ejaculate. And so there's not even a really noticeable decrease in the amount of ejaculation. Your testicles make the testosterone and sperm. They don't stop making testosterone because you got a vasectomy. All those things are all misconceptions.

Scot: Mitch, Troy, have you heard about any kind of crazy things about vasectomy that you've wondered about? I've got one here that I saw on the internet.

Mitch: Yeah. The big one that I've ever heard and when I've talked to people before, they're like, "Ew, no, I'm not going to do that," is the sexual dysfunction stuff. It's the, "I won't be able to ejaculate again," or, "It won't be the same," or, "I won't have . . ."

Scot: Or the pleasure, right? It's going to be less pleasurable.

Mitch: Yeah. And I guess none of that is true.

Dr. Smith: It'll be less pleasurable if you had another kid that was screaming in the background. I'm just kidding. That was terrible of me. But consequence-less intercourse does have its appeal.

Scot: Yeah. And on the other hand, it's really almost freeing. It can make sex better because it's one of the most effective forms of birth control, if I understand correctly, right?

Dr. Smith: Yeah. It's very effective. The pregnancy risk after a vasectomy is 1 in 2,000. And that's not 1 in 2,000 ejaculations, by the way.

Scot: Sure. Okay. I mean, it kind of just makes things freer. And then knowing that I took the responsibility on and my wife doesn't have to go through the stuff she used to have to go through anymore, I think it's cool. I mean, that's my take.

I've seen on the internet that sperm will build up and that could be a problem. Is that true?

Dr. Smith: Very rarely is that a problem. There's a 1% risk of chronic testicular pain after the procedure, which that is one of the possible reasons you could have the chronic testicular pain. But oftentimes, that is not the case. The sperm have a life cycle, they die, and then they're absorbed by the body, so it doesn't really hold true.

But some people do notice chronic testicular pain and they get a vasectomy reversal and the pain goes away. So there is some thought that there may be some truth to that, but it's not a common thing.

Scot: I will admit that was the one potential side effect that I was concerned about, because that could impact your life for the rest of your life. But it's a very, very low chance.

Dr. Smith: You've got a 1% chance of chronic testicular pain is what most of the literature will say. That chronic testicular pain, often there are ways to mitigate that. It sometimes will involve another procedure or another surgical intervention to get rid of that pain. It is a rare occurrence. But when it happens, it's definitely not something that you're going to be like, "Man, I'm so glad that happened to me."

Scot: Troy, any misconceptions you want to clear up?

Troy: I don't know if it's a misconception. I know some people have talked about some of the pain they've experienced after a vasectomy and . . .

Scot: Like just procedural pain? Pain from the procedure itself?

Troy: Yeah, procedural pain. And I know it's a common procedure to have around the Super Bowl. I think some places make a big push then because the idea being that you're going to just sit on the couch all weekend and have an ice pack on your groin to ease the pain.

Scot: Or March Madness, right? You've got an excuse to sit around and do nothing.

Dr. Smith: We've done a Vas Madness a few years.

Troy: Vas madness, yeah.

Dr. Smith: Where you get them in and do it before the tournament.

Troy: And is that common? Are people typically saying, "Hey, I'm just going to have to sit on the couch for two or three days because it hurts too much to walk"? Or is that more of an excuse to watch a lot of basketball?

Dr. Smith: I'm not going to sell anybody out here. Most of the time, we recommend after the procedure to take it easy for a couple of days, about 48 hours after the procedure. Some folks are a little bit more aggressive. Some folks are a little bit more conservative as far as telling you to take it easy for four or five days.

I usually tell my patients ice 20 minutes on, 20 minutes off, for the first couple days and then get back to your routine as it feels okay. No heavy lifting for about five days after the procedure. You can't get in a pool or hot tub or submerge it in water for about 10 to 14 days while the small incision heals. Other than that . . .

I mean, some people will tell you that you can have sex within a couple of days. Some people say wait a week to have sex. It varies between who does your procedure.

Some people will say you can shower the night of the procedure. Some people say to wait to shower a couple of days after the procedure. Again, there's not a huge variety of people that are getting infections or anything from this.

Troy: No running?

Dr. Smith: I usually tell people they can go running when things feel better. I can tell you that I know a couple folks who went golfing the day after they did their vasectomy. Not that they did their own, but after they had their vasectomy done. And they said they were fine. There were no problems.

The big thing that you worry about when you are too active too soon is a small blood clot in the scrotum. Not the kind that goes to your heart or lungs, but a hematoma is what they'll call it. Just a collection of blood in the scrotum. And it makes things a lot more sensitive and painful during the recovery and makes the recovery a little bit more miserable for a couple of weeks.

Scot: Also, I've read that some people are concerned it can cause prostate cancer or it's been linked to cardiovascular disease. Talk about that. That's not true, though, is it?

Dr. Smith: No. A lot of that has been debunked. I mean, there's a lot of literature out there about other things as well that say that. But there's no clear link to getting a vasectomy and then having prostate cancer. There were some articles that came out and most of that has all been debunked, and it's not true.

Scot: And then I didn't know this. There's a no-scalpel vasectomy. Is that kind of the common way now, or what?

Dr. Smith: Well, it's all a gimmick, right? You've got to open up the scrotum to get where you've got to get to start. So it's one of those where you've got to make a hole in the scrotum at some point, whether you poke a hole with a sharp instrument, whether you use a scalpel, you've got to open it up anyway. There's no magic to just the vas deferens just coming out without making some kind of an opening in the skin.

Scot: Do I need to be concerned about, first of all, the way they're making the hole? I mean, is one way any better than the other really?

Dr. Smith: Honestly, no. I mean, the scrotum is very robust as far as its healing capacity it's going to be fine. In three to four weeks, you're not even going to know that somebody was there regardless of how they got in.

Scot: All right. And then as far as how they're actually going to . . . if they're tying or if they're cauterizing the vas deferens, does that make a difference? Should you request one over the other?

Dr. Smith: Well, most people will cauterize and then do something else, or just cauterize. And so the cautery is the one thing that the American Urologic Association says is best practice, is to have mucosal cautery of the lumen of the vas deferens. And so that's something that I'm pretty sure everybody does.

And then on top of that, some people will put clips. Some people will do something called fascial interposition. And that's pretty much where there's an opening in the fascia of the scrotum, and sometimes you'll tuck one end of the vas deferens underneath and put a clip or a stitch over the top of it.

So it's kind of like putting one of them in the basement and one of them in the upstairs so that they can never meet again, is kind of a way to think of it. They call it fascial interposition.

Some people will just tie a ligation stitch around both ends. I mean, there are different variations. You could talk to 50 different urologists and have 50 different ways to do it.

Mitch: What's the thinking behind that? Is it just if the two somehow accidentally meet up again it will heal?

Dr. Smith: Right. So the thought is that you can have someone who's . . . I call them super healers because I don't know of any other way that this happens. But where you can have those mucosal ends grow back together and just recanulate and make a tube again.

I mean, that happens. Very rarely does it happen. I have a friend of mine who actually had it happen where he had a vasectomy done, and he told me he actually had a second vasectomy done. I haven't confirmed that in his medical records, and he still says he has active sperm.

Mitch: Is he Wolverine?

Dr. Smith: He has to be, man. I checked for adamantium, but I did not see any on first glance. I'm not sure.

Troy: Did he know it had reconnected because he had another kid, or what? How did he find out?

Dr. Smith: Usually, we have folks get a semen analysis in 8 to 10 weeks. Some people say six to eight weeks. Again, it varies between folks that are doing this. You get to a semen analysis that looks to see if there are any mobile sperm, how much sperm there are if there are any, and if they're moving. And that gives you a good idea of whether you should lose the protection or not.

Troy: Well, speaking of reconnecting . . . I'm going to put this out there as a misconception, and maybe it's not. But the misconception being that it's very easy to reverse a vasectomy. If you get it done and you want to have it reversed in five years, it's a simple thing to do and you can go on and feel confident you're going to have kids at that point. Is that a misconception?

Dr. Smith: So a lot of it depends on time. The vasectomy reversal can be done. The longer that things are scarred down, the less successful the reversal is. But the reversals are pretty successful. I mean, a high number, we're talking three-quarters or more of them, are able to have sperm there after the reversal procedure. Also, individual doctors have different kinds of success rates that they'll quote you.

The thing that you've got to realize with that, though, is insurance is not going to cover that. So you're going to hit that on your own. It's going to cost you $6,000, $8,000, $10,000, depending on where you get it done, cash to do that.

Obviously, insurance paid for you to get a vasectomy so that they wouldn't have to pay for another kid. And so a lot of that becomes out-of-pocket expense for the person who gets the reversal.

Scot: So I think a lot of guys want to know what the procedure is like. It was almost a non-event. I was a little intimidated going into it. Like I said, I thought it was going to be this big procedure. I think it was done in like 15 minutes. The pain wasn't super bad. I went and bought a couple bags of peas and iced like I was told to and took it easy for two or three days, and everything was great.

I'd read some of the crazy stuff, that it was going to decrease your sexual pleasure, and yadda, yadda, yadda, and none of that happened. And it just feels great not having to worry about it. Is that pretty accurate? Did I describe the procedure pretty well? I mean, just kind of the overview, John?

Dr. Smith: Yeah. I mean, it's a simple procedure that's done in the office. And I don't want to simplify anything because surgery is never a big deal until it's on you. And then obviously, when it's on your genitals, it's an even bigger deal. But it's a very commonly done procedure. It takes 15 to 20 minutes, maybe 30 minutes, in the office. It's minimally invasive. I do mine through a single incision that's about a centimeter to a centimeter and a half long. Numb things up with lidocaine and just take care of it.

Scot: Don't even feel it. Don't even know. It is kind of weird though because you're sitting there in a chair, and you're kind of watching the doctor do it, but you're not seeing what the doctor is doing, because you've got some blankets or something up there. So you know something is going on and you're actually kind of seeing that something is going on, but I didn't feel a thing.

Dr. Smith: Yeah, once you're numb . . . I mean, the worst part is the numbing. When I did mine, that was the worst part, was getting numb. And most men when they're done, they're like, "Oh, the numbing was the worst part. After I realized I was numb, I could just relax and hang out."

Scot: I don't even think the numbing was that bad, really. I don't remember it.

Dr. Smith: Listen to this guy. What a tough guy. "It didn't even bother me, man. My name is Scot."

Scot: I still don't measure up to you, but . . .

Troy: Yeah, I think you're trying to outdo John on this one, Scot.

Dr. Smith: It hurt, man. I did not like numbing it up. I'm not going to lie to you. That was the worst part by far. But again, once it's done, that is the part that people say is the worst.

And then you had a great recovery. Most people do have a good recovery like that. I was very similar to that. I had some minimal discomfort for a few days. Bruising for 7 to 10 days in and around the scrotum.

I did not get a hematoma, thank goodness. I mean, they happen about 1 in 20 to 1 in 30 vasectomies. So they're not super common, but they're the most common "complication" that you have after the procedure. If you do get one of those, your recovery is not quite as fun. I tell you guys it gives you the man flu for a couple of weeks. You're not going to want to do much. But that's kind of what to expect for it.

A lot of guys come in they're like, "Man, I was really worried and scared about this and it wasn't as bad as I thought." I hear that quite a bit.

Troy: And you mentioned insurance coverage earlier too, John. It sounds like this is covered by insurance.

Dr. Smith: So a lot of insurances will consider this preventative care. You need to check, obviously, with your insurance company. But if you think about it, it makes sense for them to pay for a vasectomy. Then you don't have to worry about taking care of another kid on the insurance for 18 years, or 26 years. And so a lot of them will have that.

So we'll have a mad rush at the end of the year where people think that they've met their deductible and they need to go get their vasectomy. But then a lot of times, if you look at your insurance coverage, you could have done it into March, April, May, it didn't matter because it was considered preventative care.

Now, not every insurance is that way, but a lot of them are because it's advantageous for them to obviously have that done to decrease another kid coming on to the policy.

Troy: Yeah, a calculated decision on their part.

Dr. Smith: Yeah, exactly.

Scot: As we get ready to wrap this up, what type of guy would be a good candidate for a vasectomy? Are there some people that are better candidates than others?

Dr. Smith: Almost everybody is a good candidate. Oftentimes, if there is a difficult exam or something where we think it needs to be done in the operating room, it can be. Most everyone is able to be done in the office.

Obviously, a good candidate would be someone who's not interested in fertility any longer and does not want to have any more children. And so those folks would want to come in.

We have them have a consultation to go over all the risks/benefits before they have the actual procedure, and then come back for a second visit for the actual procedure. That way, they have the ability to do that.

Also of note, when we talked about insurances, government insurance makes you wait 30 days from a consultation to have the procedure done so that you have time to think about it.

I was told when I did my training that that was because some places were doing the vasectomies on people who were in mental hospitals, things like that, without consent. And so the government changed it to where they had to have consent and wait 30 days, and yadda, yadda, yadda.

But all of the government insurance does require a 30-day wait period and a form to be filled out. So Medicaid and other government insurance, you have to do that.

Scot: Something I remember, I had my consult and they asked me the same thing. They asked me how many kids I have. Zero. "Are you positive that you don't want to have kids?" Well, I'm to the age and my wife's to the age where that's probably not even a smart thing from a health standpoint, and we've decided that that's the case. And they did ask if I talked to my wife about it. You would recommend that as well? This is a conversation that should be had between both partners. You shouldn't just go out and surprise . . . do the Valentine's Day vasectomy surprise.

Dr. Smith: Right. If you've already had that conversation with your partner, and you guys have decided that's not what you're going to do, then I think you're pretty safe. But I think it is a wise thing to talk to your partner. If you don't have a partner, then obviously it doesn't apply.

Troy: And I have to ask this too, John. Let's say someone out there is thinking they're not married, but they don't want to worry about the issues with possible pregnancy with partners, and so they decide to have a vasectomy. How effective is a vasectomy at preventing STDs?

Dr. Smith: It's not at all.

Troy: So you're still using a condom for those guys.

Dr. Smith: Yeah, absolutely. I mean, that's not going to stop an STD in their tracks at all. That's just going to make it so you're not going to get someone pregnant, but it's not going to stop transmission of any of that stuff.

Scot: By the way, I think Troy knew the answer to that question.

Troy: I had to ask it.

Dr. Smith: Was Troy baiting me in?

Troy: I was baiting you. I had to ask it. I think that maybe potentially that could be a misconception, that you think, "Hey, I had a vasectomy. Great. I don't have to worry about pregnancy."

Scot:Yeah. Woohoo.

Troy:You're right. Not a big concern. Far more effective at preventing pregnancy than condoms or oral contraceptives, but doesn't do anything for STDs.

Dr. Smith:Absolutely.

Scot: Yeah. You might forget that. I could definitely see that.

Well, if you're considering having a vasectomy, of course, if you have any concerns or questions, if you've seen something crazy on the internet that we didn't address today, then definitely talk to a urologist.

If you have other concerns, like what it's like, for some reason other guys that have had them, it's been my experience, love to talk about them. I don't have any qualms about it.

I don't know if there are some people that think it makes you less manly or anything like that, but from my personal experience, I'm really glad that I got one.

I will admit it was a little strange thinking that this is it. I've made the decision that under no circumstance . . .

You do consult men that this is not a reversible procedure, even though there is potential to reverse it if you've got the cash and if you do it soon enough?

Dr. Smith: Correct. I usually tell people that this is reversible, but I don't do it to be reversible.

Scot: Yeah. Right. Your job is to do it so it works and those things don't grow back together. But beyond that, I mean, it's been great. So I would highly recommend it if you are done having children and you don't want to have to worry about birth control anymore.

Dr. Smith: I concur.

Scot: If you have any questions, you can email us. The email address is And we've just given you a Valentine's Day gift idea, so you're welcome. Just don't make it a last-minute gift. Have that conversation.

Troy: Last-minute gift. Yeah, it sounds like maybe the gift would be proposing the idea rather than coming home and showing the incision on your scrotum.

Scot: Yeah, that's a good idea. Thank you for listening, and thank you for caring about men's health.

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