Once the family is complete, long-term contraception is an important issue. Female sterilization options are widely available, but are quite invasive. This is quite simply because a woman's reproductive parts are all inside her body. Tubal ligation (abdominal surgery) requires general anesthesia, which confers a small risk of significant complications and much higher cost. Essure is relatively expensive, metal coils containing nickel are implanted in the fallopian tubes, and proving success requires an invasive confirmatory test (hysterosalpingogram) that is often painful. By comparison, vasectomy is a quick and easy office procedure done under local anesthesia, in which no permanent foreign material needs to be left in the patient. Vasectomy by an experienced urologist also has the lowest failure rate and is more cost-effective. For all these reasons, vasectomy is generally viewed as the preferred form of permanent contraception.
Before minimally invasive methods were developed, vasectomies were performed by using a scalpel to make a separate incision over each vas deferens. Each vas was then pulled out the incision, then cut and tied with permanent suture. Due to the amount of tissue disruption, pain was more common, along with a higher risk of bleeding and infection. More significantly, the cut ends of the vas were left in the same tissue plane, resulting in a relatively high risk of failure due to the vasal ends growing back together (recanalization). Ask your vasectomy surgeon if fascial interposition is utilized to minimize the risk of failure. (See the FAQ for more information about fascial interposition.)
Open-Ended No-Scalpel Vasectomy: A Better Procedure
No-Scalpel Vasectomy (NSV) utilizes a single small skin puncture in the midline of the scrotum. Both vasa deferentia are treated through this single skin opening in the upper scroutm. This puncture is so small that it does need to be sutured at the end of the procedure. The puncture heals very quickly, often without a visible scar. "Open-ended" describes the treatment of the testicular end of the vas, which is not obstructed in any way, in order to minimize the risk of pressure build-up leading to pain in the epididymis or testicle. For complete details read the First FAQ topic or watch Dr. Golden's 8 minute video of a complete vasectomy procedure.
Other Benefits of No-Scalpel Vasectomy:
- reduced procedure time (typically takes between 8 and 15 minutes)
- reduced pain both during and after the procedure
- lowest risk of bleeding
- lowest risk of infection
- "fascial interposition" minimizes risk of procedure failure
- besides condoms, vasectomy is the only option that allows a man to be in control of his own reproduction