A vasectomy is a procedure that permanently sterilizes a man and takes away his ability to impregnate a woman. The procedure involves making small incisions into two long ducts known separately as the vas deferens. These are the pathways that normally allow sperm (the male reproductive cell) to mix with semen before it is ejaculated through the penis.

In the United States, 500,000 vasectomies are performed each year, and about one in six men over age 35 has had the procedure, according to the National Institute of Child Health and Human Development.

Vasectomies are among the most effective methods of birth control available. However, men should carefully consider whether or not a vasectomy is right for them. Men who later change their minds and decide to have children can often have the procedure reversed. However, reversal surgery is expensive and not always successful. In many cases, men are able to ejaculate sperm, but the sperm are unable to fertilize an egg. Health experts recommend that men who are opting for vasectomy surgery have their sperm frozen and stored at a sperm bank prior to the procedure in case they change their mind about having children in the future.

A vasectomy is an operation that permanently sterilizes a man, making him unable to get a woman pregnant. During the procedure, the physician makes a small incision into two long ducts known as vasa deferentia. Each of these ducts is called a vas deferens, and they are located on either side of the scrotum (the external sac of skin that holds the testicles). This prevents sperm from entering the semen that a man ejaculates during sexual intercourse.

Sperm are the male reproductive cells. They are produced in the testicles before moving into a long, narrow tube called the epididymis that is located on the surface of the testicle. Here, the sperm are stored and combined with seminal fluid. When a man ejaculates, the seminal fluid and sperm move through the vas deferens and are expelled from the penis.

About 50 million men have had a vasectomy, which corresponds to about 5 percent of all married couples of reproductive age, according to the National Institute of Child Health and Human Development. In the United States, approximately 500,000 vasectomies are performed each year, and about one in six men over age 35 has had the procedure.

Most men choose to undergo a vasectomy as a means of achieving permanent birth control. The procedure is quick and easy to perform, and the patient usually recovers with only minor discomfort within two weeks. In addition, vasectomies are much less complicated, have fewer side effects and cost only about one-quarter of the price of a tubal ligation, the surgery typically performed to sterilize women.

Vasectomies do not affect a man’s production of the male sex hormone testosterone. As a result, the procedure will have no adverse effect on a man’s level of sexual desire or ability to maintain an erection. In addition, a vasectomy does not affect other male characteristics (e.g., muscle mass, facial hair, voice tone) and should not noticeably reduce the volume of a man’s ejaculate, which is produced by the prostate and other glands.

In 2003, the Food and Drug Administration (FDA) approved an alternative to the traditional vasectomy called a Vasclip. This is a plastic device the size of a rice grain that locks around the end of each vas deferens to prevent the flow of sperm. Early studies indicate that this technique causes fewer complications than standard vasectomy and may be more easily reversed.

Men should not enter into this procedure lightly. Patients who later wish to reverse a vasectomy can often do so through a second surgery. However, if a man plans to reverse the vasectomy at some later date, exploring other birth control options is beneficial. Reversal surgery is expensive, is not covered by insurance and is not always successful. In many cases, men who have had reversal surgery are able to ejaculate sperm, but the sperm are unable to fertilize an egg.

In addition, recent research suggests that vasectomy reversals may put men at greater risk of having genetically defective sperm, which can increase the likelihood of birth defects in their offspring. Health experts generally recommend that men who are opting for vasectomy surgery have their sperm frozen and stored at a sperm bank prior to the procedure in case they change their mind about having children in the future.

Prior to a vasectomy, patients will be asked to weigh the consequences of their decision. Although vasectomies can often be reversed, the results are not always successful. As a result, no man should have a vasectomy unless he is relatively sure that he never intends to father children.

Patients who have an infection on or around the genitals or who have a bleeding disorder may have to postpone a vasectomy, or may not be eligible for the procedure at all. In addition, all patients are advised not to take aspirin, ibuprofen, ketoprofen or naproxen for two weeks after the operation. These pain relievers can thin the blood and cause bleeding. Instead, patients should take acetaminophen to reduce pain. Patients may also be asked to refrain from eating or drinking for a certain period of time before the surgery.

In most cases, a vasectomy is performed in a physician’s office or an outpatient surgical center. The patient receives a local anesthetic that numbs the scrotum. Once the area is numb, the physician makes a small incision on one side of the scrotum and pulls out a portion of the vas deferens. During this process, patients may feel a little tugging or pulling, but should not experience any pain.

Two clamps are then placed on the vas deferens about a half-inch apart. The small section of the vas deferens between the clamps is then removed, and the ends of the vas deferens are sealed by stitching, clamping or cauterizing (with heat from an electric needle) them shut. The physician then repeats the procedure on the other side of the scrotum.

This procedure usually takes about 30 minutes. Once it is finished, the physician uses stitches to close the two openings. Within three to 10 days, the stitches disappear by themselves.

In some cases, a physician will perform a “no-scalpel” vasectomy. In this procedure, the vas deferentia are located under the skin and held in place with a small, ring-shaped clamp. The physician then makes a very small puncture in the scrotum and gently stretches the opening until the vasa deferentia can be pulled out. The rest of the procedure follows the standard method, and may take as little as 10 minutes. After the procedure has been completed, the patient will not require stitches to seal the tiny opening, which will close on its own.

Immediately following the procedure, bandages will be placed over the incisions, and the patient will be asked to wear an athletic supporter to keep the bandages in place and apply pressure to the area. The patient also will be instructed to rest for a couple of hours with an ice pack placed on the scrotum.

Patients are likely to experience some pain and cramping after the procedure. Generally, patients are advised to take acetaminophen to reduce pain. In some cases, a physician may also prescribe codeine for pain relief. Patients should not take nonsteroidal anti-inflammatories (e.g. aspirin, ibuprofen, naproxen) for two weeks after the operation. These pain relievers can thin the blood and cause bleeding. Patients should not take any medication without first consulting their physician.

Bathing and swimming are usually prohibited for two days after surgery. Men who work at a desk job can return to work within a day or two. However, those who engage in physical labor or extensive walking or driving may have to delay their return to work. Stitches in the scrotum should dissolve within seven to 10 days. It is normal to have some bruising in the scrotal area, which will slowly fade over two weeks. At the end of that time, the patient will have made a full recovery.

Sexual intercourse can be resumed about three days after the procedure. However, the sterilization process will not take effect immediately after the vasectomy. In most cases, patients will need to ejaculate between 15 and 20 times before sperm is cleared from the vas deferens. For this reason, couples should continue to use birth control until a physician advises otherwise. Usually, a physician will ask the patient to bring in samples of ejaculate after surgery. Patients who have two sperm-free samples – in most cases, one at six weeks after surgery, the other at eight weeks after surgery – will be considered sterile. This can take up to three months or even longer.

The testicles will begin making fewer sperm once they no longer can travel through the vas deferens. The body absorbs any sperm that are made. Even after a man is considered sterile, partial failure of the vasectomy can still allow him to impregnate a woman in rare circumstances.

It is also important to note that a vasectomy does not provide protection against sexually transmitted diseases (STDs), such as chlamydia, gonorrhea and human immunodeficiency virus (HIV). Men at risk of contracting STDs, such as those with multiple partners, and those diagnosed with an STD should use a condom to prevent transmission.

Vasectomies are among the most effective forms of birth control, preventing more than 99 percent of possible pregnancies. The procedure itself also has a high success rate. According to the Centers for Disease Control and Prevention, the probability of failure is 11 per 1,000 procedures over a two-year period. Half of these failures occur in the first three months following the procedure, and none occur after 72 weeks. 

Complications that are sometimes associated with vasectomies include:

• Bleeding. Blood can collect (hematoma) inside the scrotum, causing painful swelling.
  
  
• Infection. The incision site can become infected, causing redness and swelling. Antibiotics and hot baths can help relieve these symptoms.
  
  
• Mild inflammatory reaction to sperm that has leaked into the scrotum. The immune system can react to this situation by forming an inflammatory mass known as a sperm granuloma. In most cases, this can be treated with pain medications. However, occasionally sperm granulomas must be surgically removed.
  
  
• Pain in the scrotum. Some patients may experience scrotal pain for longer than three months. In most cases, this can be treated with over-the-counter pain medications.
  
  
• Formation of kidney stones. Men in their mid-40s or younger have a two in 10 risk of developing kidney stones, compared to a one in 10 risk factor for men of that age group in the general population. The risk persists for about 14 years after a vasectomy. Drinking plenty of fluids can help reduce the risk.

In very rare cases, the ends of the vas deferens may spontaneously reconnect to one another. In such cases, the man’s sterility will be reversed.

Patients should call a physician if they experience any of the following symptoms:

• Fever
• Swelling that does not subside or gets worse
• Urinary difficulties
• Formation of a marble-sized lump in the scrotum
• Bleeding from an incision that does not cease despite pinching the site between two gauze pads for 10 minutes

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions regarding vasectomy:

1. How effective are vasectomies as a method of birth control?
   
   
2. Is the procedure painful?
   
   
3. How should I prepare for the procedure?
   
   
4. How long is the recovery period?
   
   
5. What are the restrictions following the procedure?
   
   
6. What are the potential risks associated with a vasectomy?
   
   
7. Will a vasectomy decrease my sex drive?
   
   
8. Can a vasectomy be reversed?
   
   
9. How effective are vasectomy reversals? Are there any risks associated with the procedure?
   
   
10. What are my options if reversal surgery is unsuccessful and I want to father children?