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Vasectomy

This factsheet is for men who are considering having a vasectomy operation or for people who would like information about vasectomy.

A vasectomy is an operation to cut and seal off the tubes (each called the vas deferens) that carry sperm from each of your testicles to your penis. This means that you are no longer able to have children.

What is a vasectomy?

A vasectomy involves cutting the two tubes (vas deferens) that carry sperm from your testicles to your penis.

A vasectomy will not affect your sex drive or ability to enjoy sex. You will still have erections and produce the same amount of fluid when you ejaculate. The only difference is that the fluid will not contain sperm. Your body will still produce sperm, but they can't travel out through your penis and are naturally reabsorbed by the body.

It is important to note that a vasectomy does not protect you from getting sexual transmitted infections (STIs). 'Safer sex' methods involve using condoms.

Illustration showing the male reproductive system

Does a vasectomy work?

Research shows that vasectomy is a very reliable form of contraception. It's estimated that over a lifetime a pregnancy results for 1 in 2,000 men who have had a vasectomy.

Can a vasectomy be reversed?

A vasectomy should be considered a permanent operation.

However, some men come to regret the operation and want it reversed. A vasectomy reversal operation rejoins each of the tubes that carry sperm from the testicles to the penis, which were cut during a vasectomy. However, this doesn't guarantee that your fertility will be restored. For more information, please see the separate BUPA factsheet, Vasectomy reversal.

What are the alternatives?

The alternatives to vasectomy include long-term contraceptive options for women such as the following.

Long-term irreversible option

Female sterilisation (female tubal ligation) is an operation to block, seal or cut the fallopian tubes. Eggs can then no longer be fertilised by sperm. This has a lower success rate and a higher risk of complications than a vasectomy. It should be considered a permanent operation.

Long-term reversible option

The levonorgestrel intra-uterine system (IUS) is a device that is a placed in the uterus (womb) and slowly releases a hormone called levonorgestrel. For more information, please see the separate BUPA factsheet, The IUS.

For more information on alternative contraception, please see the separate BUPA factsheets, Hormonal contraception and Non-hormonal contraception. Before deciding on vasectomy, it is worth discussing the options with your GP or family planning nurse.

What happens before vasectomy?

Your surgeon will discuss how to prepare for your operation. For example, you may be asked to give up smoking as it slows the healing of wounds.

What should I expect before the operation?

A vasectomy may be performed in a hospital, GP practice or private clinic.

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

The operation

The operation usually lasts about 15-30 minutes and is performed as a day case, which means that you can have the operation and go home the same day. The procedure is usually performed under local anaesthesia that numbs the area but you will be awake. Less commonly a general anaesthetic is used, in which you are asleep throughout the procedure and feel no pain.

Once the anaesthetic has taken effect, your surgeon will feel your testicles to find the vas deferens. He or she will then use one of two techniques.

• In the scapel technique he or she will make tiny cuts (about 1cm) in both sides of your scrotum or one cut in the centre of your scrotum.
• In the 'no-scapel' technique, he or she will use a special instrument to make a small opening in the skin. This will be stretched to create a small opening in the scrotum. The opening in the skin is so small that it does not require stitches.

A section of the vas deferens will be carefully pulled out through the cut or small opening. Each tube will be cut and a small section will be removed. The ends of the tubes will then be closed off by either tying them or sealed off using diathermy (an instrument that heats to a high temperature).

The vas deferens will then be gently placed back into your scrotum and the cuts will be closed using dissolvable stitches or adhesive strips (eg Steristrips). The dissolvable stitches will disappear after about a week. Often a dressing is not required.

The sections of the tubes that are removed are usually examined in a lab to confirm they are each vas deferens.

After the operation

Before discharge your doctor or nurse will give you advice about caring for your wounds. You will usually be provided with supportive disposable underwear to help relieve any discomfort from your testicles, which will be sore for a few days. This discomfort can be relieved by taking painkillers that you would normally take for a headache.

You will need to arrange for someone to drive you home and then stay with you for the first 24 hours.

Recovering from vasectomy

It's sensible to take it easy for a couple of days, but you can drive and go back to work as soon as you feel able.

For as long as you need, wear close-fitting underwear, such as a jock strap, day and night. This will support your scrotum and help to ease any discomfort and swelling.

Don't do any heavy lifting or vigorous exercise during the first week after the operation.

You can bathe and shower but you should dry the area gently and thoroughly.

Sex and contraception

You can have sex as soon as you feel comfortable but you should use another form of contraception until the live sperm that remain in the tubes have gone.

You will need to have two semen tests to ensure that your tubes are clear of sperm. The first semen sample should be taken 8 to 12 weeks after surgery and a second sample about two weeks later.

When tests show that your semen is clear of sperm, you will no longer need to use other methods of contraception.

Deciding on treatment

A vasectomy operation is a commonly performed and generally safe surgical procedure. For most men, the potential benefit is greater than the disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. Anyone having a vasectomy can expect a sore and tender scrotum for a few days. You may also have some bruising and swelling.

Complications are unexpected problems that can occur during or after the procedure. Most men are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic.

Specific complications of vasectomy are rare but include those below.

• Bleeding inside the scrotum can make it swollen and painful. This is called a haematoma and may require further surgery.
• It is possible for sperm to leak out of the cut tubes and collect in surrounding tissues. If this happens, hard lumps, called sperm granulomas, can form. Sperm granulomas are not harmful, and can be treated with anti-inflammatory medicines. However, occasionally they can be painful and need to be removed.
• A small proportion of men develop long-term testicular pain. This may be due to pinched nerves or scarring, and may require further surgery.
• Some men develop a full feeling in their testicles. This is caused by the epididymis (sperm sacks near the surface of each testicle) filling with stored sperm. This usually goes away after a few weeks.
• Very rarely, even when performed correctly, there is a very small risk (about 1 in 2000) the tubes can rejoin naturally and you will become fertile again.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Your surgeon will explain how the risks apply to you.

Further information

• Fpa (Family Planning Association)
  020 7608 5240
  www.fpa.org.uk

Sources

• Male and Female Sterilisation, Royal College of Obstetricians and Gynaecologists. January 2004, Evidence-based Clinical Guideline Number 4
  www.rcog.org.uk
• Your guide to contraception. UK Department of Health. PRODIGY.
  www.prodigy.nhs.uk
  accessed 19 May 2006
• Collier J, Longmore M, Scally P. Oxford Handbook of Clinical Specialities. 6th edition. Oxford: Oxford University Press, 2003
• Smoking and wound healing. Am J Med. 1992 Jul 15;93(1A):22S-24S

Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre and Mr Raj Persad, MB, BS, ChM, FRCS, FRCS (Urol), FEBU, Urology consultant at BUPA Hospital Bristol.

Published by BUPA's health information team, healthinfo@bupa.com, October 2006.

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