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Vasectomy is a minor surgical procedure which prevents sperm from moving from the testicle into the semen, and therefore makes men sterile and unable to father a pregnancy. Sperm are produced in the testis, and swim through the vas deferens into the body where they mix with fluid from the prostate to produce semen. Semen is stored in the seminal vesicals, and during ejaculation the semen from the seminal vesicals and fluid from the prostate are forced into the urethra and out of the penis. During vasectomy the vas deferens is divided on both sides, blocking the sperm from getting into the semen. The testes continue to make sperm for a man's entire life, but they are reabsorbed from the vas deferens after several weeks. The prostate and seminal vesicles continue to make fluid, and the semen appears no different to the patient after vasectomy. The procedure is performed in the office, and usually takes 10-15 minutes to complete. Monterey Bay Urology Associates have performed over 1000 vasectomies using a technique called no-scalpel vasectomy (see below) which makes the procedure very quick and virtually painless.
The no-scalpel vasectomy is very simple and causes very little pain during or after the procedure. We use lots of local anesthesia on the front of the scrotum, similar to what is given at a dentists office, and after an initial sting there is no sharp pain. We also put music on the stereo and talk during the procedure, and most patients have very little discomfort. If you know that you will be very nervous and someone can drive you home afterwards, then we can give you oral sedation before the procedure (Valium and Vicodin tablets). This is very effective at relieving anxiety and helping you to relax during the procedure. After vasectomy there is usually very little pain, and tylenol or ibuprofen is usually strong enough pain relief. We will give you a stronger pain reliever (hydrocodone) to take home in case you have more pain, but most patients don't need to use very many of these pain pills.
Very little preparation is necessary for vasectomy. Please shower the day of the procedure. We would like to have the front of the scrotum shaved prior to the procedure, and you shave at home if you wish, or we can shave the scrotum when you come for the procedure. Some patients may be advised to take antibiotic tablets prior to the procedure (see below in Risk of Vasectomy). If you shave at home please use an electric clipper to prevent nicks of the scrotal skin. Please bring an athletic supporter (jock strap) or tight briefs to wear after the procedure.
No-Scalpel vasectomy is a technique that was developed in China, and is now used by most urologists around the world. A small puncture is made in the midline in the front of the scrotum, and a special clamp is used to grap the vas deferens. The tissue around the vas deferens is separated from it, and a loop of the vas deferens is pulled out through the small punture hole. We use titanium metal clips to close the vas deferens, and then a short piece of the vas deferens is excised. When the vas deferens is returned to the scrotum the ends separate from each other, lowering the chance that the ends could stick back together. The vas deferens on the other side is grasped, clipped, and divided through the same puncture hole. The small puncture hole does not need stiches and heals very quickly with less pain or risk of infection or bruising and swelling.
Please go home after the vasectomy and relax. An ice pack should be applied to the front of the scrotum for the first few hours after you get home, 20 minutes on, 20 minutes off. Frozen peas or corn make a good, re-usable ice pack. The next day most men feel very little discomfort and can shower. We are most concerned that men will over do it the next day, so please relax as much as possible. Two days after the procedure you can use "common sense" to guide your activity. If you feel discomfort during any kind of activity then you should stop and relax, otherwise you can use "common sense" and do whatever activity or exercise feels comfortable. Common sense can also help guide when you resume sexual intercourse. After vasectomy sex will look and feel exactly the same as it did before vasectomy, and you can resume intercourse after a few days if it feels safe.
Vasectomy is very safe, but all procedures have some risks. The main risks of vasectomy are as follows:
There are no long-term medical risks known from vasectomy. In the early 1990s there was talk about increased risk of prostate cancer in men who had vasectomy, but this has been proven to be not true in the U.S., Europe, and New Zealand and should not be a reason to avoid vasectomy.
Vasectomy reversal is possible after vasectomy. In our practice the surgery to reverse a vasectomy has a 90% chance of being successful with return of sperm to the semen. The chances for successful reversal are higher for younger men and if it has been less than 5 years since the vasectomy. However, the surgery to reverse the vasectomy is much more difficult than the vasectomy itself. Men must be put completely to sleep and we use a high-powered operating microscope to sew the vas deferens back together. The procedure is not covered by insurance and costs approximately $8000. Men should not have vasectomy until they are sure that they no longer want children, but there is hope if your life changes and you want a vasectomy reversal.