What is vasectomy?
Vasectomy is a simple minor surgical procedure which prevents a man from fathering children. It prevents the sperm from being added to the fluid you ejaculate by sealing the sperm-carrying tubes. It does not affect sexual performance or general wellbeing and does not affect male hormone production. It is a very effective form of permanent male contraception and is a very safe and simple procedure when compared with female sterilisation.
How effective is vasectomy?
Vasectomy must be considered a permanent form of contraception, but it is not infallible. It remains the most effective form of male contraception. There is a very small failure rate when sperms find their way between the two ends of the tube. Early failure may occur within the first four months after vasectomy and would be detected by failure to achieve clearance of sperms on routine testing. Approximately 1 in 2000 men suffer a late failure after receiving the ‘all-clear’ as a result of the tubes (vas deferens) re-joining, which may occur years after having the procedure. Compared to female sterilisation, which has a failure rate of 1 in 2-300, vasectomy is between six and ten times more effective.
Is vasectomy safe?
Research shows that there are no known serious long-term health risks caused by having a vasectomy. Any surgical procedure carries some risk, but vasectomy is considered to be low-risk, and complications depend to a great extent on the experience and skill of the surgeon.
- Surgical wound infections (0.3%) occur from time to time and the small wound may be slow to heal. This may need to be re-checked by your doctor in case it requires antibiotics.
- Bleeding. In rare cases a small blood vessel in the scrotum can bleed causing a blood clot (haematoma). This occurs in about (0.5%) of cases and gives rise to pain and swelling and could take a few weeks to resolve. When this does occur, it is most likely to develop in the first 2-3 days after vasectomy and may be as a result of too much strenuous activity. It is advisable to follow the advice you receive at the clinic regarding rest after the procedure rest to reduce the risk of haematoma.
- Epididymitis or Epididymo/Orchitis occurs in about 0.5% and is a condition in which part of or the entire testicle may become inflamed. This can occur following a vasectomy, particularly if the man has had an untreated STI in the past such as Chlamydia. It can also occur in men who have not had a vasectomy. It usually responds very well to prompt treatment.
- Sperm Granulomas are not that uncommon. These are small lumps, which form at the end of the vas, particularly on the side still carrying sperm. These are harmless and may cause some initial tenderness and usually settle fairly quickly. They are more common when an ‘open-ended’ procedure has been performed.
- Another rare cause for prolonged post-operative discomfort includes a swelling of the lower end of the cut and sealed vas. This is when the end of the tube expands and may become tender. This very rarely requires treatment and is usually a temporary phenomenon.
- Very occasionally men suffer from persistent pain in the testicle or at the vasectomy site which does not have an obvious cause and occurs in 1% of vasectomised men. It is more common in men who have suffered testicular pain or infections prior to their vasectomy. Treatment of this condition can be difficult: In some of the cases it subsides with time, but on rare occasions it might require removal of a further section of the vas if the pain is high in the scrotum, removal of the epididymis or even reversal of the procedure if the pain involves the testicle.
- There is no firm evidence linking vasectomy to cancer of the prostate or testicles.
What happens to the sperm after a vasectomy?
The body normally absorbs unused sperm cells through a natural process - whether or not you have had a vasectomy. This process involves the production of anti-sperm antibodies. After the procedure, the testicles will continue to produce sperm, but they will not leave the body in the semen. The antibody level rises to help them dissolve and they are simply and naturally absorbed back into the body.
How popular is vasectomy?
Vasectomy is one of the most popular forms of contraception worldwide, and is regarded to be safe, simple and highly effective. It is the only permanent method of male contraception and is the method of choice for many British men.
Am I suitable for vasectomy?
There are no hard and fast rules to say which men are best suited for vasectomy because it is a personal decision. Vasectomy is really only suitable for those men who are certain, under any circumstances that they do not wish to father any more children. It is therefore essential to give serious thought to the implications of an operation that will render you sterile. This is because the vasectomy procedure must be seen as permanent.
Is it the right choice for me?
- Vasectomy is the right choice for you if you are comfortable with the thought of not having any more children and want to take the responsibility of contraception.
- You may choose vasectomy when other forms of contraception are not effective, safe enough or tolerable for yourself or your partner.
- Vasectomy is the right choice if you want to enjoy sex without the fear of unwanted pregnancy.
- Vasectomy may be the right choice for you, if pregnancy poses a risk to the health of your partner.
- Yes, if your family is complete and you want to save your partner from sterilisation which has a higher failure rate with the risk of more serious complications
Who should not consider having a vasectomy?
- Men who have not fully considered the implications of the operation and for whom other forms of contraception may be more suitable.
- Men who have been forced into this decision by others or by financial circumstances.
- Men who are suffering with unresolved personal or sexual problems.
- Men who hope vasectomy will solve a sexual or marital problem.
- Men who are counting on being able to reverse the vasectomy later.
- Men who are under the age of 25 except in exceptional circumstances such as passing on hereditary disease – see ‘Am I too young?’ above.
- Men in a relationship who have not discussed the issue with their partner.
- Men with a religious affiliation prohibiting vasectomy.
Do I need consent from my partner?
Before choosing vasectomy, we strongly encourage all our patients to discuss their decision to be sterilised with their partner. You need to be absolutely sure it is the right decision for you as it cannot be easily reversed. However, you do not need your partner’s agreement and as this service is completely confidential, we will not disclose any information to your partner without your permission.
Am I too young?
The decision whether or not to be permanently sterilised is a very personal one and very much depends on your circumstances and beliefs about whether you wish to father children. This is not necessarily an age-dependent decision although younger men, particularly without children are more likely to regret their decision than older men who have completed their family. At the Bristol Vasectomy Clinic we do not discriminate on the basis of age and we assess each man’s request for vasectomy on an individual basis. However, understandably, we encourage all men under the age of 25 years and those below 30 years without children to attend for a separate counselling session prior to their operation with an intervening ‘cooling-off’ period in order to fully consider their decision, taking into account alternative options such as long-acting reversible contraception.
The Vasectomy operation & its effects
How does it work?
This minor operation is performed by sealing and removing a section of the vas deferens, the small tubes which carry sperms from the testicles. This prevents the sperms from mixing with prostatic fluid to become part of the semen.
Does the operation hurt?
No more than any other minor operation that uses local anaesthetic. The injection of local anaesthetic into the skin may sting a little bit for a few seconds. It is put in just a small area of skin, so it is nothing to worry about. After this, there is a bit of an ache whilst the vas are numbed, but this is over very quickly after which the operation is usually painless. Most men feel some degree of discomfort during the first few days after the operation, which varies from one individual to another. This usually settles with simple treatment, such as Paracetamol.
What does the vasectomy procedure involve?
The procedure involves placing some local anaesthetic in the skin of the scrotum (which is surprisingly not very sensitive) and then alongside the right vas (uncomfortable - more of a pressure/ache sensation but easily bearable). A puncture is then made through the skin with the tip of the Hyfrecator (electrosurgical tool). The right vas is located and a loop is brought to the surface and a short segment is cauterised intra-luminally, then divided, a suture is placed for fascial inter positioning, the other end of the vas is lightly cauterised and a segment of the vas is excised. Then, anaesthetic is injected alongside the left vas, which is accessed through the same hole in the skin and subjected to the same procedure as the right.
How much pain can I expect after the operation?
Most men feel some degree of discomfort during the first few days after the operation, which varies from one individual to another. This usually settles with simple treatment, such as Paracetamol. Approximately 4 to 5 days after the operation, it is not unusual for men to experience some minor discomfort which coincides with the body’s healing process, trying to repair the vas. At this stage an anti-inflammatory drug such as Ibuprofen may be helpful (providing you have no tendency to ulcer-acid indigestion type problems).
What if I were to change my mind after the vasectomy?
Vasectomy should be considered a permanent procedure and vasectomy reversal is usually only funded on the NHS in exceptional circumstances. In the best of hands using microsurgical techniques, pregnancy success rates up to 67% can be achieved providing the reversal is not performed too long after the vasectomy. Vasectomy reversal is a particularly uncomfortable procedure contrasting with the ease and relatively minor discomfort of the vasectomy procedure itself.
What about Quality Assurance?
The vasectomy clinics based at St George Health Centre, Bristol and St George’s Medical Centre, Worle are approved locations for the provision of minor surgical services. We are fully compliant with local infection control policies and procedures, COSSH, health and safety and Medicines health regulatory advice.
Surgical instruments are sterilised by the Nuffield Hospitals central sterilisation service department (HSSU) in Taunton.
We constantly monitor and audit our results and patient feedback and the service has achieved outstanding results with regard to patient experience and exceedingly low complication rates.
Can I drive home after my vasectomy?
We recommend that you ask your partner, a friend or relative to drive you home after your vasectomy. However, many men attending the clinic feel well and choose to drive themselves home afterwards. The procedure is technically considered to be a minor operation and the local anaesthetic used should remain effective for one to two hours afterwards. Clearly, whether or not you choose to drive yourself home is a decision which you should make bearing in mind any previous tendency you may have to feel dizzy or faint such as after visits to your dentist. If you are in any doubt, then we would advise you to arrange for someone to give you a lift home.
How will vasectomy affect me?
Will it affect my sex life?
Your penis and testes are not altered in any way. The sex hormones made by the testes that make you a man continue to be passed into the bloodstream as before. The operation should have no impact on your sex drive or your ability to perform sexually. Vasectomy does not change your beard, your muscles, your erections or climaxes. The only thing that will change is that you will not be able to make your partner pregnant. In fact, many couples find having a vasectomy improves their sex life - With the security and peace of mind permanent contraception brings, sex can be more relaxed and spontaneous once they no longer have the worry of an accidental pregnancy.
Will I ejaculate normally?
Yes. 95% of what you ejaculate is seminal fluid. This will not be affected by vasectomy and you will be able to have normal ejaculations.
Will I be sterile right away?
No. After the operation, there will still be some sperm in the reservoirs above the site of the operation. It usually takes about 30 ejaculations to clear the sperm. It is therefore essential to continue using an alternative method of contraception until you are informed by us that your system is clear of sperm, depending on your semen test results.
We will ask you to provide us with samples of your semen at 16 weeks after your vasectomy. These are analysed in a fully accredited hospital laboratory to test for the presence of any remaining sperm. On occasion, several more tests may be required until the system is free of sperm. If this should happen, we will advise you if and when further samples are needed. Very occasionally the semen may be very slow to clear and on rare occasions, sperm can be present as much as a year after the operation.
Will it affect my long term health in any way?
A recent retrospective American study (July 2014) has suggested an association between vasectomy and prostate cancer. The study found a 1.6% increased risk of significant prostate cancer. However a number of other studies did not find any correlation between prostate cancer and vasectomy. More research is necessary to further explore and define this possible risk. Urologists worldwide do not consider this level of possible risk is sufficient to change vasectomy practice.
Recovery and Semen Testing
Recovery - What should I do when I go home after the procedure?
After the operation, the remainder of the day should be spent preferably lying down and it is also wise to rest as much as possible for the following 2 days. Most men feel some degree of discomfort during the first few days after the operation, which varies from one individual to another. This usually settles with simple treatment, such as Paracetamol. It is not unusual to notice a few spots of blood on the dressings for a couple of days or so. Some men may notice some superficial bruising around the testicles which usually fades after a week or two.
We advise you to wear tight fitting underpants to support your scrotum day and night for 1 week. Although normal activities can be resumed shortly after the operation, we advise all men to take things easy and to avoid any strenuous exercise or heavy lifting for about one or two weeks. Sexual activity can be resumed as soon as you feel it will be comfortable, however, we do advise you to wait a few days. Occasionally, a drop of blood may discolour the semen in the first couple of ejaculations after the procedure which settles spontaneously and is generally of no concern.
When can I go back to work?
It is better to rest for a couple of days. If your job is non-manual or involves only light duties you can then return to work. If you have a heavy job involving manual work, it is better to wait for a week.
When can I resume sex?
Usually after 7 days to allow for the soft tissues to heal and for you and your partner to feel comfortable.
When can I stop using other contraception?
The vasectomy procedure is not immediately effective as a form of contraception. Because there are still sperm in the vas deferens above the site of the operation it can take quite a number of ejaculations to clear the sperm, so it is essential to continue an alternative method of contraception until you are informed by us that your system is clear of sperm.
We encourage you to flush-out these sperms by having regular ejaculations after your operation. – At least twice or three times a week (aiming for a minimum of 30 ejaculations). We ask you to provide us with samples of your semen at 16 weeks post-operatively for testing. Once these tests confirm absence of sperm, we will inform you that it is safe to discontinue using other forms of contraception.
How and when do I send my semen samples?
Your specimens are due to be sent 16 weeks after the operation on the dates marked on the bottles. We ask you to wait until then because this is the period of time in which there is the greatest risk of the tubes re-joining. If you cannot send the specimens on the dates requested please change the date on the bottle so that the laboratory will know how old the specimen is. Please check to see that you are sending the bottles in the right order so as to avoid confusion.
Remember it takes at least 25 ejaculations to clear the sperm from the system (and in some cases many more), so if you have a period of sexual inactivity after your operation, you may need to postpone the dates for your test since you may not have "cleared" yet.
Specimens may be collected either directly into the bottle or by using a non-lubricated (dry) condom and emptying the semen into the bottle. DO NOT send the condom in the bottle as this contaminates the specimen. PLEASE securely tighten the top of the bottle.
Providing you live in the Bristol, South Gloucestershire or North Somerset areas you will be able to deliver the samples in the containers provided directly to your own GP’s surgery for analysis at the approved hospital laboratory.
How will I know the result of the specimen?
You should receive notification of your results within a fortnight of sending the second specimen. (Please note that results are not sent after the first specimen, but only after both have been tested). This is to maintain confidentiality and to avoid the risk of error. Please let us know if your address changes after your operation and before the results are due to be sent.
About 8 - 10% of men need more than two tests before clearance, and some need more than four, so please don't worry if you get a letter asking for further specimens. If at any stage we feel that your operation has not been successful, we will tell you at once, and, of course, we will perform a re-operation at no cost in the very rare cases where one of the tubes re-joins.
UNTIL YOU RECEIVE THE "ALL CLEAR" FROM US, WE STRONGLY ADVISE YOU TO CONTINUE TO USE AN ALTERNATIVE RELIABLE METHOD OF CONTRACEPTION.
What happens if I don’t submit the requested specimen?
We usually send you a reminder to submit your semen samples for testing. Despite this some men do not send a sample for post-operative testing to confirm the effectiveness of the operation. We very strongly encourage you to return the samples to ensure the effectiveness of the vasectomy and to continue to use another form of contraception until we are able to give you the ‘all-clear’.