Frequently Asked Questions About Vasectomy

Why is "Open-Ended Vasectomy" Preferable?

Open-ended vasectomy with Fascial InterpositionIn a standard vasectomy, the vas is cut and both ends are cauterized and/or tied.  Because the fluid produced by the testicle cannot escape the obstructed end, there may develop increased pressure within the testicle and epididymis.  The resulting "congestive epididymitis" is thought to be one of the main causes of post-vasectomy pain syndrome.  

"Open-ended" refers to the method of leaving the testicular end of the cut vas unobstructed.  The benefit is the reduced risk of post-vasectomy pain syndrome.  Unlike the traditional vasectomy, the unobstructed vas is less likely to result in pressure increase within the testicle and epididymis. The key step is thoroughly securing the abdominal end of the vas, ensuring the two cut ends never come in contact after the procedure. 

A more complete discussion of the value of "Open-Ended Vasectomy" can be read HERE, including literature references.

What is the expected recovery after vasectomy?

frozen-peas (the perfect ice pack)

jock-strapAfter your vasectomy, go home and relax.  Most men can return to their normal routine after a few days. You can do desk work the day after the procedure, but should avoid sexual activity and lifting anything over 20 pounds for at least 5 days. A scrotal support (snug briefs or jock strap) for the first 48 hours after the procedure can alleviate tension on the scrotum and minimize bruising.  An ice pack (or bag bag of frozen peas) applied to the scrotum may help minimize swelling and bruising.  

Avoid situations where scrotal trauma is likely. For example, don't ride  a bike for a while and watch out for young children who might jump in your lap!

What are the risks of vasectomy?

All procedures, medications, and even contraceptives carry some risk.  With that in mind, No-Scalpel Vasectomy (NSV) is quite safe. The rates of the most common complications are significantly lower than the rates of problems after conventional vasectomy. The following statistics have been compiled from several large series:

  • risk of hematoma formation (bleeding into the scrotum) is 0.4%
  • risk of scrotal infection is less than 0.1%
  • risk of vasectomy failure (sperm still present in ejaculate) is less than 1 in 500. Despite the low risk, the downside of an unanticipated pregnancy is potentially devastating.   For this reason, vasectomy patients must use another reliable form of contraception until a semen analysis 6-8 weeks after the procedure which shows he is "shooting blanks." Until this test is performed, each patient must consider himself fertile.
  • post-vasectomy chronic testis or epididymal pain occurs rarely and usually resolves spontaneously within a month or so.  Ibuprofen and scrotal elevation with snug briefs or a jock strap during the day and a rolled towel between the legs at night are often helpful. Very rarely (3 in 1000), a man will experience a chronic testicular symptoms that leads him to seek additional treatment.
What is the advantage of No-Needle Anesthesia?

No needles required

Needles have several downsides:

  • Many people are afraid of needles, leading to anxiety before and during the procedure.  Some men who would benefit from vasectomy avoid the procedure just to avoid the needle
  • Trauma to the tissue from a needle results in higher incidence of bleeding complications (hematoma)
  • Most of the medicine from a needle is deposited in the same tissue plane, reducing effectiveness
  • Risk of needle-stick injuries

No-Needle Anesthesia improves vasectomy in significant ways:

MadaJet - pressurized spray device for no-needle anesthesia

  • The spray's numbing effect is nearly instantaneous, with almost no discomfort
  • The anesthetic spray spreads through multiple tissue layers, numbing more completely with less drug
  • Multiple studies have shown higher satisfaction from patients having No-Needle anesthesia for their vasectomy
  • Risk of bleeding during vasectomy or scrotal hematoma afterward are significantly reduced
  • Fear of needles is eliminated, so patients can relax and be more comfortable during their procedure
Does Dr. Golden accept my health insurance?
Is No-Scalpel Vasectomy Painful?

tyelenol

Most men experience no pain during vasectomy, but there is often minor discomfort during and after no-scalpel vasectomy.  Some men feel a vague pulling sensation while there is tension on the vas deferens.

Most men only need 2 doses of tylenol after their vasectomy.  Dr. Golden reports that after he did his own vasectomy (yes, he did his own procedure), he took only one dose of 2 Extra Strength Tylenol.   

To hear patients describe no-needle no-scalpel vasectomy with Dr. Golden, Listen to these Audio Recordings.

 

Is there anything to help with my anxiety about the procedure?

Don't Stress!

 

It is normal to be nervous about any procedure, but the vast majority of men handle the brief vasectomy procedure without difficulty. The mood in the room is relaxed and we'll even listen to music during the procedure.  Rarely, a patient may be so anxious that he is unable to physically relax, which can make the procedure more difficult.  If severe anxiety is suspected ahead of time, a relaxing medication can be prescribed**, purchased at your pharmacy, and taken before the procedure. The downside of taking an anti-anxiety medication is that someone else must be available to drive home after the procedure.

                                                           ** The prescription must be requested at least a week before the procedure.

Will sex or my erections be different after vasectomy?

male-symbol-blue

 

No. Vasectomy does not alter sex drive, erections, or sexual function in any way.  There is no change in the production of testosterone, the male sexual hormone.  Similarly, sexual pleasure, orgasm, and ejaculation are unchanged.  Sex for most couples is better after vasectomy, once the anxiety around unintended pregnancy is gone.

 

After vasectomy, will my semen be any different?

azoo

 

Without a microscope, there is no perceptible change in the semen after vasectomy.  The ejaculate is comprised mainly of prostate and seminal vesical fluids which support and transport sperm.  Since sperm cells only makes up 2-4% of the total semen volume, removing the sperm from the semen does not change the volume, appearance, or consistency.

 

Will I be sterile immediately after vasectomy?

Don't let this happen to you!

 

No. Sperm are still present in the tubes beyond the point where the tubes are cut.  

About 6 weeks after the vasectomy, a confirmatory test is necessary to confirm absence of sperm.  Examination of a semen sample under a microscope is the standard test.  Another option is home use of a home test kit, SpermCheck Vasectomy.  Use another form of contraception until you have proof.

Is anything permanent left in the scrotum?

Some doctors leave metal clips in the scrotum.  In the vasectomy procedure by Dr. Golden, nothing permanent is left in the scrotum.  The only material left behind is a single absorbable knot on each side, separating the two ends of each cut vas.  This part of the procedure (fascial interposition) is the best way to minimize the risk of vasectomy failure.

Does vasectomy increase the risk of any health problems such as prostate cancer?

 

In the 1980s and 1990s, some doctors thought there was a correlation between vasectomy and prostate cancer, but this has since been disproved.  There is no established association between vasectomy and cancer or any other medical problems.  Interestingly, a well-respected journal published a study that shows men who have undergone vasectomy have a lower risk of mortality from any cause.  It must be recognized this is a statistical relationship and does not demonstrate causality. 

  • Giovannucci E, Tosteson TD, Speizer FE, Vessey MP, Colditz GA. A long-term study of mortality in men who have undergone vasectomy.
    N Engl J Med 1992;326:1392– 8.

Can I still get sexually transmitted infections after vasectomy?

Vasectomy does nothing to alter susceptibility to any infections including HIV. Condoms are the best protection from STDs besides abstinence.

Should I bank my sperm for future use... just in case?

Test tube of frozen sperm

 

Maybe. Cryopreserving sperm is a reasonable option to consider.  But this question is a bit of a red flag.  If you think there is a reasonable chance you will desire future reproduction, then vasectomy probably isn't the best form of contraception for you at this time.  Make sure you are certain that your family is complete before having your vasectomy.

Can I have my initial consultation and procedure on the same day?

Unfortunately, California has a law that mandates a 3-day waiting period between the day the decision is made to have a vasectomy and the day it is done.

How difficult is it to reverse a vasectomy?

Vasectomy Reversal

 

This question is another red flag. While vasectomy is an easy procedure and inexpensive as long-term contraception, vasectomy reversal (vasovasostomy) is a much more complex and expensive undertaking. Vas reconstruction is typically a 2-3 hour microsurgical procedure, requiring general anesthesia.  Vasectomy reversal costs around 5-8 thousand dollars, is not covered by insurance, and is not always successful.  If you are not certain you are finished having children, then another form of contraception should be used until reproduction is no longer desired.

Can vasectomy success be confirmed without bringing a semen sample to the lab?

spermcheck

 

Yes. A home test kit, SpermCheck Vasectomy, allows the confirmatory test to be performed in the privacy of your home. The test works by detecting specific proteins found only in sperm. The test is available by mail-order directly from the manufacturer.

What happens to sperm that are produced after a vasectomy?

Sperm with nowhere to go

 

The testicles continue to produce the same things after vasectomy as before, namely testosterone and sperm. The testosterone is released into the bloodstream just as before vasectomy.  Sperm, however, come to the cut end of the vas and have no place to go.  After a short time, sperm cells break down into their components (proteins, lipids, DNA...), which are recycled by the body.

 

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