So you thought you were shooting blanks all this time? Then you fertilized a partner? Oops. You don’t want that to happen again, so you’re thinking about getting a vasectomy.
Or… like most guys, your youngest child is out of diapers and your wife can’t stand the thought of going through this again. You asked if she wanted to get a tubal ligation, but she promptly informed you that no, it’s your turn to do something with your body. She’s asked you when you’re getting your vasectomy and you’ve been putting it off. Now, you are finally ready to get snipped.
But what does that mean?
About 500,000 men in the US, 6% of men, have one each year. (16% of women have tubal ligation, the female counterpart to vasectomy.) A vasectomy is done under local anesthesia, and a tubal ligation requires general anesthesia (i.e., more risk) so it’s a little surprising the numbers are so lopsided. Vasectomy makes economic sense, too; it’s less expensive than female sterilization or even the long-term cost of birth control pills.
To clarify how this works, there are two tubes, each one called a vas deferens, that carry sperm uphill from each testicle to the prostate. Within the prostate the sperm is mixed with seminal fluid and goes downhill through the urethra to the penis where it exits, cross country, during ejaculation. In surgery, the vas deferens is snipped (divided, cauterized, and tied) so sperm cells don’t travel from the testicles to and out the penis.
After vasectomy you can still get erections, still ejaculate, and your semen looks exactly the same. There is no difference in sex after vasectomy and no-one can tell who has had it done without the use of a microscope.
The best part? It is 99.3% effective in reducing the chance of unwanted pregnancy.
Alternative forms of birth control, besides abstinence, which we are not even considering here, are as follows:
- Condom, but there’s a high accidental rate of pregnancy, compared to vasectomy
- IUD for your partner, which is effective, but can be painful, has side effects and might need removing and replacing over time
- Birth control pills, which have a higher failure rate than vasectomies and cause unpleasant side effects for women
- Bilateral tubal ligation, which is major surgery for women with a much higher risk of complications than vasectomy for men. In fact, no death has been reported because of vasectomy, but about 20 women per year die after tubal ligation.
Before
Something you have to be completely sure about before you have a vasectomy is that you don’t want to father more children. Sure, vasectomy is theoretically reversible, but that surgery is not always successful. You should consider your vasectomy permanent. Please see “Reversing a vasectomy.”
Other tips for before the surgery:
- Don’t take aspirin or other NSAIDs or blood-thinners for a few days before surgery.
- The night before or the morning of the vasectomy, prepare the area for surgery. Using a single-blade disposable razor, shave all the hair from your scrotum, all the way to the top of your penis. (If you can’t or don’t want to do this, the nurse at the procedure will do it for you.)
- To reduce the risk of infection, thoroughly wash your scrotum and groin the day before and the morning of the surgery.
- Take an athletic supporter to your doctor’s appointment on the day of surgery because you’re going to need to wear it afterwards.
During
This surgery used to be performed with a scalpel making two incisions, one for each vas. This ensured that the surgeon didn’t accidentally tie off the same vas twice. Today, some surgeons use a single incision and other surgeons use the “no-scalpel technique.” This technique sounds cool because, hey, no scalpel! However, it’s mostly marketing because the tiny instrument is as sharp as a knife and it makes a hole through the skin (just like a scalpel…) There is no real difference between techniques. They all work the same and the recovery time is similar for all techniques. The most important part is finding a surgeon that is experienced doing vasectomies. See our page on Finding a Vasectomy Surgeon.
Vasectomies are usually performed under local anesthesia, unless you’re anxious and would like an anti-anxiety medication. After you are prepped for surgery, the doctor numbs the skin of the scrotum with an injection. This is often the most painful part of the procedure. Men who evaluate the pain level on a scale of 1-100 report their pain level at 15-20 for this part.
After you’re prepped for surgery, the doctor feels the two vasa deferentia under the skin and holds them in place with a special clamp while making one or two tiny incisions. The surgeon gently stretches the opening so the tubes can be pulled out, snipped, and sealed. Then the surgeon replaces the ends back into the scrotum. You may have a small stitch placed in the skin to help the skin heal faster. The entire procedure usually takes 30-45 minutes and your risk of infection is only about 1%.
After
Many men drive themselves home after the surgery, unless they have taken an anxiety medication. Recovery post-surgery takes six to twelve weeks. Recovery is just as important as the surgery, because you could undo it all if you get impatient.
First, limit your activity after surgery for a week: no travel, gym, running, biking, basketball, or sex. You are at risk for a hematoma if you get too active after surgery. That means you have knocked loose internal scabs inside the scrotum and venous blood has pooled in the scrotum to the size of a golf ball. It isn’t life-threatening; it is uncomfortable. It resolves eventually, but it sets you back a few months in your recovery.
The biggest risk is pregnancy. It takes six to twelve weeks or 15 to 20 ejaculations to become infertile after vasectomy. Live sperm are still in your vas deferens, downstream from where the tube was cut. These squirmy little soldiers need to get out before you are safe to have unprotected sex. Starting a week after surgery, you can help remove your sperm with frequent ejaculations. This can increase your chances of a sperm-free semen analysis later on.
On a side note, your testicle keeps making sperm. In fact, if you want to do in vitro fertilization, someone can take sperm right out of your testicle and inject them directly into an egg. What happens to the sperm after vasectomy – well they march down the vas deferens and stop at the road block. They are stuck there, and eventually your body reabsorbs them. Another potential side effect is getting a small knot in the scrotum smaller than a BB which is called a sperm granuloma. It is nontender and eventually goes away. This is totally normal and harmless.
You will have a follow-up visit with the urologist for a semen analysis and those frequent ejaculations help you produce a sperm-free sample. Usually two semen analyses with no live sperm are required before you get the green light. The guideline is <100 sperm per cc of ejaculate, with no sperm moving (meaning they’re dead) before you can stop using birth control. Continue to use birth control until you get the nod that you’re safe.
Life after vasectomy
- You will feel pain and swelling of the scrotum to which you should apply ice packs for the first two days. If you feel great after one day, DON’T do anything! It takes up to two days for the first healing stage to complete..
- Wear an athletic supporter after the surgery.
- When your dressing becomes stained or soiled, change it. You can remove it when it’s dry or stain-free. A small amount of oozing is normal and helpful.
- Don’t overdo it! If you do, you will likely have bleeding and bruising in the scrotum which can delay recovery.
- Take showers, not tub baths. Don’t go swimming for a couple of weeks. To dry your scrotum, pat, don’t rub, dry with a towel.
- Call your doctor right away if you have signs of infection: blood oozing from the surgery site; a temperature of more than 100.4 F; redness; or worsening pain or swelling.
- If your incision opens up a little, let your doctor know. However, don’t worry. It will close. If there is bleeding sometimes the skin opens up to allow the blood to drain out. The scrotum will heal.
- Remember: Vasectomy doesn’t protect you from sexually transmitted diseases.
Delayed complications
- Recanalization (a vas deferens tube regrows, rare)
- Pregnancy later in life (extremely rare)
- Chronic pain in the scrotum, 1-2%. This is usually caused by the surgeon rushing, and not removing all the tissue off the vas deferens before tying or dividing it. This results in nerves getting tied and causing pain. Tell your surgeon not to rush.
- Fluid builds up in the testicle, causing a dull ache especially during ejaculation. This usually goes away after a few months.
- Granuloma (Inflammation caused by leaking sperm. This is normal after a vasectomy and not actually a complication, but good to know about.)
- Spermatocele, an abnormal cyst that develops in the epididymis, a structure that collects and transports sperm -this is very common.
- Hydrocele, a fluid-filled sac surrounding a testicle that causes swelling in the scrotum – unusual after vasectomy.
You might hear about concerns of heart attack, stroke, dementia, and prostate cancer following vasectomy. The American Urological Association studied these concerns and reviewed all data. It determined that because of the quality (or lack of quality) of the studies about heart attack, stroke, and dementia, there is NO evidence of linkage of an increased risk of these conditions to vasectomy.
For the prostate cancer studies, the AUA pooled all the data and found no increased risk.
What they did discover is that men who get a vasectomy are more likely to go to a doctor in the future.
Another concern that some men fear is being sexually disadvantaged post-procedure. We have good news: vasectomies have no effect on sexual performance. They make it neither better nor worse than it was pre-vasectomy. You still ejaculate. You have the same amount of semen. Your testicles still produce sperm, but they don’t go anywhere. They are absorbed into your body. You are just as responsive to sexual stimulation. You just aren’t a wildcard anymore.
In fact, sexual activity can be surprisingly free of anxiety post-vasectomy. Many men report that their sex life improved. One man said with his wife no longer taking birth control pills, her libido increased and he didn’t have to fiddle around with condoms any more.
When to have a vasectomy
The most popular month for vasectomies is March, because of March Madness. You are already parked on the sofa to watch b-ball, and now your wife is grateful you have a distraction from your side-effects.
Or you could be like three friends in Los Angeles who got vasectomies, one after another, after their wives suggested it. They became known as “the three vascateers.”