D. Brooke Johnson, MD
Western Wisconsin Urology
For most men just the idea of the procedure conjures up images of pain and singing soprano. In reality, it is a safe, simple and effective method of permanent birth control. It is successful 99.95% of the time and for the vast majority of men it is much less traumatic than imagined.
A vasectomy is done in an office setting under local anesthesia. For most men sedation is unnecessary, allowing them the independence to have the procedure performed around their own schedule. However, for men who desire it, sedation can be used to reduce the anxiety that sometimes accompanies medical procedures. In these cases men may remember little about the procedure, but a driver is necessary to provide safe transport home.
The procedure itself takes approximately 20 to 30 minutes, with a few minutes before and after for preparation and post-procedure care with the nursing staff. During the procedure the surgeon localizes the vas deferens and anesthetizes the overlying skin. A small opening is made in the skin and the vas deferens is isolated. At this point a small piece of the vas deferens is removed and each end cauterized to prevent the ends from healing back together. One end is also buried under tissue surrounding the vas deferens (a technique known as fascial interposition) to act as a barrier against the ends healing back together. The procedure is done on each side individually and the process is complete.
Two techniques are widely known, namely a traditional approach and a no scalpel approach. In the former, the skin is opened with a 1/4 inch incision in the scrotal skin. In the latter, the opening in the scrotal skin is made using a sharp clamp. In both, the opening is so small that no stitches are required. Another technique that uses a clip across the vas deferens is performed by some physicians as well.
After the procedure the scrotal skin is numb for a few hours. A prescription pain medication is given, and as the pain subsides patients can take over-the-counter pain relievers such as acetaminophen (Tylenol).
Once performed, recovery from vasectomy is relatively brief. Most men need only take a couple days before resuming normal activities. Because the body stores sperm it takes a few weeks to become sterile. This is confirmed by lab tests.
Risks of Vasectomy
- The vasectomy failure rate is about 1 in 2000
- 1–2% of men complain of lasting scrotal pain after a vasectomy
- As with any surgical procedure there are small risks of bleeding and infection
Benefits of Vasectomy
- Office-based procedure offering permanent sterility
- Simpler and less expensive than other surgical options for women
- Recovery is brief with quick return to full normal activities
In the end, vasectomy can reduce the worry about unwanted pregnancy without any effects on sexual drive or performance. It is much simpler, safer and less expensive than female surgical options.
As a surgeon, my goal is to make this procedure as minimally traumatic, both mentally and physically, for my patients.