So you are considering a no-scalpel vasectomy

You’ve expressed an interest in having a vasectomy as a permanent form of birth control. Naturally, there are questions you’d like answered. We’ll try to tackle the common ones and then explain the operation itself.

First, you’re not alone in your choice of this method of family planning. In fact, more than half a million North American men have vasectomies every year. It is of utmost importance that you realize that vasectomy is intended to render you permanently infertile. And like any other decision that will affect you for the rest of your life, your choice to have the surgery must be made for the right reasons, and only after you understand all the facts. If you’re under stress for whatever reason, and particularly if you’ve recently divorced or separated, now isn’t the time to make up your mind.

The choice of this method of birth control must ultimately be yours. Although your partner should be as well informed as you are, you must not feel pressured to proceed. Think twice if you’ve decided to have the operation simply to spare your partner the dangers of pregnancy or to remove the burden of birth control from her. After all, the day may come when she may no longer respect you for your sacrifice. All of this means that your relationship should be stable, for while it is true that a vasectomy is likely to improve a good relationship by removing the fears of possible pregnancy, no operation will fix a poor relationship.

If you’re wondering about banking some sperm in the deep freeze before the surgery, you’re having second thoughts. Anyway, banking is not all that successful, and pregnancy rates for banked sperm are poor. You should also realize that although a vasectomy can be reversed, it’s a complicated procedure with only a 40%-60% chance of success.

In making your decision you should be aware that a vasectomy will simply render you incapable of fathering a child. It will not affect your virility or manhood. You won’t become a capon.

Now for some anatomy. In your scrotum you have two testes which, among other functions, produce sperm. The sperm are stored in what’s known as the epididymis. On their journey to the outside world they travel up your vas deferens to the urethra. On the way, they pick up lubricating and nourishing fluid from your seminal vesicles and prostate. When you ejaculate, the known mixture of semen is about 98% fluid and only 2% sperm.

The surgery itself takes only about half an hour and is done under local anesthetic. Most vasectomies are done in doctors’ offices or in outpatient departments of hospitals. Since a vasectomy is a relatively minor operation, there’s no need for you to spend the night in hospital however,  you should plan to have someone other than yourself drive home.

In preparation for the surgery you may be asked not to take any ASA (aspirin) during the week before the operation, as drugs like this may interfere with the ability of your blood to clot. Unless your surgeon gives permission, you shouldn’t “booze it up” the night before surgery or take any tranquilizers. A light breakfast is recommended.  We ask that you shave your scrotum a week prior to the vasectomy and scrub the area the morning of the procedure with a disinfectant soap containing chlorhexadine.

To freeze the area, the surgeon will inject local anesthetic. There’s no point lying; it will hurt momentarily. Once the freezing has taken, the remainder of the procedure should be pain free. I use the “No Scalpel Technique” to gain access to your tubes or vas deferens.  You may  feel  some minor pulling or stretching. Through the aperture I  will isolate each vas deferens, clean off its sheath and then cut it. To block the vas deferens I cauterize the top end and to ensure that the sperms’ journey is halted at that point  I sew some of the sheath over it for good measure.

When the surgery is done, the skin wound is self closing and does not need a stitch. A dressing will be applied.  You can use an ice pack intermittently over the next 12 hours to keep swelling down . Tight underwear such as briefs are recommended over boxers and certainly more advisable than going commando.

Don’t be surprised if you hurt for the next couple of days. You may be told not to get the incision wet for a day or so. You can return to work when you feel able, usually in a day or two, although you might avoid heavy lifting and strenuous exercise for a week or two.

You may have intercourse when you feel capable but most recommend waiting a week.  Your scrotum may ache a bit, and the ejaculate may be a bit blood tinged the first few times. But – and its a big “but”- remember that you won’t be infertile. It usually takes six to eight weeks or somewhere between 12 to 15 ejaculations before your semen is spermless, in some men the washout period is longer. So, to be sure that your ejaculation is sperm free, you’ll be asked to bring in samples for examination, and only when you’ve been given the green light, is it safe to abandon other methods of birth control.

Naturally, complications may arise. You should expect some post- operative discomfort, but acetaminophen (Tylenol) will likely be all you’ll need to control it.  You can expect some bruising and swelling. While rare, excessive post operative bleeding may result in significant swelling and pain. Wound infections are rare. Symptoms include redness, excessive swelling, pain, fever or pus.

Pain that begins a week to years post-operatively is likely caused by the formation of a lump called a “sperm granuloma” which in about one-third of men will be small and will not produce any discomfort at all. Anti-inflammatory drugs are often all that’s needed if your testes do ache, but occasionally, surgical drainage becomes necessary.

Sometimes a sperm granuloma is a good sign, as it helps to absorb the sperm that your testes are continuing to manufacture. At other times, it may mean that there’s a possibility that the vasectomy is reversing itself. This can be checked by a semen analysis. But be assured: fewer than one per cent of vasectomies reverse themselves, and if they do, the likelihood is that the process will occur within the first three months after surgery. Pregnancy rates in the partners of men who’ve had two ejaculates checked and found negative for sperm run between one in 2,300 and one in 7,000.

There will be no change in your voice, your pubic hair won’t fall out, you’ll still have to shave, and if your desire for sex changes, you’ll likely want it more, since you will no longer be concerned about impregnating your mate. Once you’ve recovered from the surgery, the only visible reminder (and you’ll have to hunt for it) will be the small scar(s) on your scrotum or sac. You won’t even notice any change in the volume of your ejaculate.

There were conflicting reports concerning vasectomy hastening the development of arteriosclerosis, or hardening of the arteries in monkeys. No similar risks have been demonstrated in human males.

One final question remains: What happens to all the sperm that the testes procedure now that they have no place to go? I suppose you could say that they die of loneliness and are absorbed by your body.

In summary, vasectomy is a generally safe, minor operative procedure intended to render a man permanently sterile. The failure rate is low. Serious complications are uncommon and no significant bodily changes occur as a result. The decision to proceed with the operation should be one that you consider very seriously. Naturally, you’ll want to discuss what you’ve just read further with your doctor before finally making up your mind. If the decision to go ahead is made correctly, your sex life will, if anything, be better, since you’ll no longer have to worry about impregnating your mate.