Vasectomy is among the most reliable, and arguably, cost-effective method of contraception. In this common surgical procedure, a man gets his “tubes tied.” More technically, the tubes that deliver sperm from the testicles (called the vas deferens) are cut and closed off. This may be less scary than it sounds—it is performed under local anesthesia, it is fairly quick (about 10-60 minutes) and it has a low risk of complications. More importantly, vasectomy does not change sexual function or libido. You can still get an erection, orgasm and ejaculate.

Close to half a million vasectomies are performed annually in the United States. Most are performed in patients who want a form of effective and permanent contraception. Vasectomy is almost 100% effective as a contraceptive, which is similar to the more than 97% efficacy of reversible methods of birth control, such as intrauterine devices (IUDs) and birth control pills, shots or rings. However, the effects of a vasectomy are not immediate, and there are times when vasectomies do fail, although rare. It usually takes about several weeks before the vasectomy can be considered effective as a contraceptive. A lab analysis of the semen must be done to confirm that the procedure has worked and that there is no sperm in the seminal fluid. Until that time, another form of birth control should be used.

How Does It Work?

When a typical man who has not had a vasectomy ejaculates, the semen that comes out of the penis is actually a mixture of sperm and seminal fluid. These are two different things. Sperm are the male reproductive cells that are made in the testes. When a sperm fertilizes an egg during intercourse, pregnancy can occur. Seminal fluid is secreted by the prostate and other glands. Once the vas deferens is closed by the vasectomy procedure, the sperm is blocked from mixing with the seminal fluid that is being ejaculated. Instead of being ejaculated, the sperm is absorbed by the body. Since no sperm is released, pregnancy is prevented.

Scalpel?!

There are a few different vasectomy techniques, all of which are considered permanent methods of birth control. All current methods involve an anesthetic, but not all require that a scalpel be used.

Done as an outpatient procedure (patient gets to go home afterwards), a vasectomy is performed by an urologist or other medical professional. Before the procedure, the groin and scrotum are cleansed and a local anesthetic is injected into the area using a small needle.

1. In the conventional procedure requiring a scalpel, one or two small incisions are made in the scrotum and the vas deferens is cut and then tied off, cauterized or blocked with surgical clips. The incision is closed with stitches and the procedure is repeated on the other side of the scrotum.

2. No-scalpel vasectomy is exactly as it sounds—no incision is made with a scalpel. Rather, the vas deferens is accessed through a small puncture hole, cut and closed off. No sutures are needed. Compared to a conventional vasectomy, this procedure is quicker, lessens discomfort after surgery, decreases the risk of bleeding, bruising and infection, and doesn’t cause scarring.

3. A newer option is the use of a device called the Vasclip ® , small clips that can be implanted via an incision or no-scalpel technique to clamp the vas deferens and block the sperm. Because there is no cutting or cauterization of the vas deferens, the Vasclip® is associated with a shorter recovery time and fewer complications (e.g., swelling, inflammation, infection) than other vasectomy techniques. Some reports have suggested that a vasectomy using the Vasclip ® is easier to reverse compared to the other surgical techniques, but there is not yet any solid data.

Serious complications after vasectomy are rare. As with most surgical procedures, there is some risk for infection, bleeding and bruising, tenderness, pain, and swelling. Sometimes the pain may be chronic (long-term) and severe.

A Cancer Connection?

Despite a few studies suggesting that vasectomy is linked to an increased risk of prostate cancer, numerous subsequent studies and examination of the available data by groups including U.S. National Institutes of Health (NIH) and the American Urological Association (AUA) have not upheld that link. In addition, no strong link between vasectomy and testicular cancer has been demonstrated. Overall, vasectomy is considered safe.

Major Considerations

Vasectomy should be considered a permanent, irreversible procedure. This is an extremely important point. Anyone who may want a child in the future, or who is uncertain about his desire for a child, should not undergo this procedure. Reversal is difficult, expensive, and often unsuccessful, with only about a 30-50% success rate. Another important point, already discussed, is that there is a period of time after the procedure during which a man can still impregnate his sexual partner. Also, vasectomy clearly does not protect against sexually transmitted diseases.

Various physicians and groups such as Planned Parenthood suggest that men who are thinking about vasectomy should consider the following:

Reasons for vasectomy:

• You and your partner have all of the children you want and desire a permanent form of birth control.
• You or your partner don’t want to or are unable to use another form of birth control.
• Pregnancy is unsafe for the female partner.
• One or both partners in the relationship have a hereditary condition that they do not want to transmit.
• You want to spare your partner from the more complicated and costly procedure of getting her tubes tied.

Vasectomy may not be a good choice if:

1. You want to biologically have a child in the future, or you and your partner are unsure whether you want any children in the future.
2. You are young. In one study of patients treated at the Cleveland Clinic Foundation, patients who underwent vasectomy at a younger age were much more likely to later request a vasectomy reversal.
3. You are having temporary problems that are relationship and sex-oriented, illness or unemployment-related and think vasectomy might help.
4. You are considering vasectomy just to please your partner or because of pressure from others, not because you really want to do it.
5. You haven’t considered possible life changes (e.g., divorce, remarriage, death of a child, improvement in financial situation) or discussed vasectomy with your partner.
6. You intend to rely on sperm banking or a surgical reversal of vasectomy to have children at a later date.

Conclusion

Vasectomy is a highly effective form of contraception, but it is not for everyone. Men should consider and discuss the pros and cons with their female partners (if any) and their physicians before deciding on this permanent procedure.