Vasectomy has become a widely used form of male contraception, chosen by approximately 10% of US couples.
HOW IS IT DONE?
Although there are several techniques for performing vasectomy, the most prevalent are variations on the “no-scalpel” technique developed by Li in 1974. Each vas is grasped in such a way as to bring it to a subcutaneous position. This may be done bilaterally or both may be brought to the same position such that there is one incision instead of two.
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) fascial interposition.
DOES IT WORK?
Vasectomy works very well, with an unwanted pregnancy rate well below 1%. However, some points are critical 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 (no sperm seen) semen analyses. These are typically done 6 and 8 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” (i.e. the vas comes back together), infection, sperm granuloma (a swelling or lump where the vas was cut), 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 the procedure 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. [link to vasectomy instruction sheet]
Vasectomy and other Men’s health issues
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.
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 U.S. 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 and 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.