Vasectomy at Loma Linda University Urology
Vasectomy is the most effective, safest, least expensive and easiest method of permanent
reproductive sterilization. There are no other effective forms of sterilization for men. Because the
vasectomy procedure is done through a puncture in the scrotal skin under local anestetic, it is
much safer than a tubal ligation for women - which is done inside the woman’s abdominal cavity,
under general anesthesia, requiring longer recovery time and is a more a expensive procedure.
We use the minimally invasive no scalpel technique where small skin punctures are used to
perform the procedure in the doctor’s office.
There are no known physiologic changes resulting from vasectomy. The man still has sex, has
orgasms and ejaculates normally like before the procedure. The vasectomy procedure
essentially caps off the duct the sperm goes through on the way to mix with the semen. The
semen remains unchanged, but is without sperm. All male sexual functions remain the same.
The only way to tell if there is any sperm in the semen is to look at a semen sample with a
microscope. The popular description of a man who has had a vasectomy is “shooting blanks,”
because the semen has no sperm. Though there has been much study of vasectomy, currently,
there are no known health risks associated with vasectomy. All men should perform periodic
testicular self-exam to look for testicular tumors and all men greater than 40 years old should talk
to their doctor about yearly prostate specific antigen (PSA) testing to detect early prostate cancer.
Vasectomy should be only be considered by men who are certain that they do not want to have
any more biological children. The vasectomy procedure must be considered permanent, though
in some circumstances it can be successfully reversed and pregnancy achieved. The failure rate
of vasectomy is about 1 in 1,000 and usually occurs when the vas deferens tube grows back
together. It does take about 3 months of normal ejaculations for the semen to clear from the
tubes. Before unprotected intercourse is undertaken the patient must have 2 negative semen
checks showing no sperm. Rarely it may take more time for the sperm to clear and that is the
reason for the confirmatory sperm checks. We also recommend a third check at 6 months to a
year to confirm that the vas deferens tube has not reconnected.
After the vasectomy it should be emphasized that the patient should have a low activity level for
at least 2 days. A small amount of swelling, bruising and firmness in the vasectomy site can be
expected. A high level of activity could result in more swelling or bruising in the scrotum, more
pain, and a delayed recovery. Scrotal compression with tight briefs or a jock strap can be helpful.
Using local ice for the first 2 or 3 hours can help decrease swelling. Pain medication is prescribed
and should be taken for at least the first day.
The problems and possible post-operative complications are generally confined to the scrotum.
To avoid complications it is imperative to explicitly follow the post-vasectomy instructions. It is
expected that there will be a small amount of scrotal swelling, bruising or oozing of blood from the
area of the puncture site. Less that 1% men develop an infection, a hydroceole (fluid around the
testicle) or have severe pain related to the procedure. Chronic discomfort can occur and is
usually relieved by anti-inflammatory agents. There is a <5% chance that small lumps, which can
be hematomas (blood spots) or sperm granulomas (the bodies reaction to sperm), will develop
and persist. In most circumstances these areas are pea sized and will be absorbed by the body
with no consequence. Very occasionally a minor surgery will be needed to remove these lesions.
Preparation for the Vasectomy
The patient should feel that his questions related to the vasectomy procedure have been
answered. The patient should not take any aspirin or other blood thinners for ten days before the
vasectomy is scheduled. In preparation for the vasectomy, while at home the patient shaves the
hair on his scrotum and the pubic hair around penis. He will also take a valium pill to relax him
and has someone drive him to and from his appointment. Bringing an iPod or other device to
listen to music can help with relaxation during the procedure.
The Vasectomy Procedure
The patient is comfortably positioned laying on his back and the surgical area prepared with an
antiseptic scrub to prevent infection. The doctor then grasps the vas deferens through the scrotal
wall and using a small needle places a local anesthetic in the skin. (clip 1) A small puncture is
then made in the scrotal skin (clip 2), the vas deferens identified and grasped with a specially
shaped instrument and brought to the skin (clip3). Next a ½ inch segment of vas deferens is
removed (clip 4), the ends are gently tied to stop the flow of sperm (clip 5), and tucked away from
each other (clip 6). A final check is done to assure there is no significant oozing of blood from the
vasectomy site and the procedure concluded (clip 7).
Healing is generally rapid. After one week it would be difficult to find the area where the puncture
was made. Normal activity is resumed after several days. It is very important to take it easy for a
few days and be aware of cues that the body is healing. Sexual activity may be resumed after
several days. Contraception should be used until two negative semen checks are done to confirm
that there is no more sperm in the semen. A third check at six months to one year is
recommended.
Vasectomy questions
Will vasectomy take away my manhood or sex life?
Vasectomy does not result in any changes related to sexual desire, sexual function, ejaculation or
orgasm. Any changes would be psychological. Many times when the threat of unwanted
pregnancy is removed, sexual satisfaction actually increases.
What are the pros of vasectomy?
Vasectomy is quick, easy and effective. It almost always works (999/1000), has no long-term
health risks and is cheaper and safer than female sterilization. Vasectomy removes the risks of
female contraception pills.
What are the cons of vasectomy?
Everyone will have some small degree of swelling and bruising. There is a small chance of postprocedure complications including bleeding (<1%), bruising, swelling, infection, chronic pain,
(<5%) sperm granuloma (10%) or need for further surgery (<1%). There will be a few days where
strenuous and sexual activity is not advised. The apprehension prior to a vasectomy can lead to
delays resulting in unintended pregnancy.
What do I have to do to get ready for a vasectomy?
Don’t take asprin, anti-inflammatory pain medications or blood thinners for 10 days prior to the
procedure. Within 3 days of the vasectomy the patient will shave the hair on the scrotum
extending to the base of the penis. This keeps the procedure field free of hair. The consent must
be signed 3 days prior to the procedure. Bringing an iPod to listen to music can help with
relaxation.
What can I do to speed the recovery and healing from the vasectomy procedure? Healing occurs
at a different rate for everyone. It is very important to have a light activity level for at least 2 days
following the procedure. During this time there should be no straining (i.e. heavy lifting or
exertions) as this can cause swelling. The patient should be aware of changes such as pain,
swelling, redness or warmth that occur in the puncture area and should report changes to their
doctor. Ice should be applied intermittently for the first 3 hours and then the patient should wear
tight briefs or a jock strap. No swimming, baths or soaking in a hot tub is advised for at least one
week and not until both punctures have healed. Being compliant with all of the post vasectomy
instructions, as well as using common sense, will speed the healing process.