medical information

Vasectomy | Definition | Description | Causes and symptoms | Treatment

Definition

A vasectomy is a surgical procedure performed on adult males in which the vasa deferentia (tubes that carry sperm from the testicles to the seminal

vesicles) are cut, tied, cauterized (burned or seared), or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but the sperm die and are absorbed by the body.

Purpose

The purpose of the vasectomy is to provide reliable contraception. Research indicates that the level of effectiveness is 99.6%. Vasectomy is the most reliable method of contraception and has fewer complications

KEY TERMS

Ejaculation— The act of expelling the sperm through the penis during orgasm. The fluid that is released is called the ejaculate.

Epididymitis— Inflammation of the small tube that rests on top of the testicle and is part of the system that carries sperm from the testicle to the penis. The condition can be successfully treated with antibiotics, if necessary.

Scrotum— The sac that contains the testicles.

Sperm granuloma— A collection of fluid that leaks from an improperly sealed or tied vas deferens. The fluid usually disappears on its own, but can be drained, if necessary.

Testicles— The two egg-shaped organs found in the scrotum that produce sperm.

Tubal ligation— A female sterilization surgical procedure in which the fallopian tubes are tied in two places and cut between. This prevents eggs from moving from the ovary to the uterus.

Vas deferens (plural, vasa deferentia)— The Latin name for the duct that carries sperm from the testicle to the epididymis. In a vasectomy, a portion of each vas deferens is removed to prevent the sperm from entering the seminal fluid.

Vasovasostomy— A surgical procedure that is done to reverse a vasectomy by reconnecting the ends of the severed vasa deferentia.

and a faster recovery time than female sterilization methods. Some insurance plans will cover the cost of the procedure.

Demographics

Approximately 500,000 vasectomies are performed annually in the United States. About one out of every six men over the age of 35 has had a vasectomy. Higher vasectomy rates are associated with higher levels of education and income.

Description

Vasectomies are usually performed in the doctor’s office or an outpatient clinic using local anesthesia. The area around the patient’s scrotum (the sac containing the testicles that produce sperm) is shaved and cleaned with an antiseptic solution to reduce the chance of infection. A small incision is made in the scrotum. Each vas deferens (one from each testicle) is tied in two places with nonabsorbent (permanent) sutures and the tube is severed between the ties. The ends may be cauterized (burned or seared) to decrease the chance that they will leak or grow back together.

“No-scalpel” vasectomies are gaining in popularity. Instead of an incision, a small puncture is made into the scrotum. The vasa deferentia are cut and sealed in a manner similar to that described above. No stitches are necessary and the patient has less pain. Other advantages include less damage to the tissues, less bleeding, less risk of infection, and less discomfort after the procedure. The no-scalpel method was developed in China in the mid-1970s and has been used in the United States since 1988. About one-third of vasectomies in the United States are performed with this technique.

The patient is not sterile immediately following the procedure. Men must use other methods of contraception until two consecutive semen analyses confirm that there are no sperm present in the ejaculate. It takes about four to six weeks, or 15–20 ejaculations, to clear all of the sperm from the tubes.

In some cases, vasectomies may be reversed by a procedure known as a vasovasostomy. In this procedure, the surgeon reconnects the ends of the severed vasa deferentia. A vasectomy should be considered permanent, however, as there is no guarantee of successful reversal. Vasovasostomies are successful in approximately 40–50% of men, although the success rate varies considerably with the individual surgeon. In the mid 2000s between 6% and 12% of American men were requesting reversals of their vasectomies. The cost of the procedure in the United States can be considerable, ranging from $5,000–20,000.

Diagnosis/Preparation

No special physical preparation is required for a vasectomy. The physician will first assess the patient’s general health in order to identify any potential problems that could occur. The doctor will then explain the possible risks and side effects of the procedure. The patient is asked to sign aconsent form that indicates that he understands the information he has received, and gives the doctor permission to perform the operation.

Aftercare

Following the surgery, ice packs are often applied to the scrotum to decrease pain and swelling. Adressing (or athletic supporter) that supports the scrotum can also reduce pain. Mild over-the-counter (OTC) pain medication such as aspirin or acetaminophen

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Vasectomy is a minor procedure that can be performed in a clinic or doctor’s office on an outpatient basis. The procedure is generally performed by a urologist, who is a medical doctor that has completed specialized training in the diagnosis and treatment of diseases of the urinary tract and genital organs.

(Tylenol) should be able to control any discomfort. Activities may be restricted for one or two days, and no sexual intercourse for three or four days.

Risks

There are very few risks associated with vasectomy other than infection, bruising, epididymitis (inflammation of the tube that carries the sperm from the testicle to the penis), and sperm granulomas (collections of fluid that leaks from a poorly sealed or tied vas deferens). These complications are easily treated if they do occur. Patients do not experience difficulty achieving an erection, maintaining an erection, or ejaculating. There is no decrease in the production of the male hormone (testosterone), and the patient’s sex drive and sexual performance are not altered.Vasectomy is safer and less expensive than tubal ligation (sterilization of a female by cutting the fallopian tubes to prevent conception).

According to both the World Health Organization (WHO) and the National Institutes of Health (NIH), there is no evidence that a vasectomy will increase a man’s long-term risk of testicular cancer, prostate cancer, or heart disease.

Normal results

Vasectomies are more than 99% successful in preventing conception. As such, male sterilization is one of the most effective methods of contraception available.

Morbidity and mortality rates

Complications occur in approximately 5% of vasectomies. The rates of incidence of some of the more common complications include:

· mild bleeding into the scrotum: one in 400

· major bleeding into the scrotum: one in 1,000

QUESTIONS TO ASK THE DOCTOR

· How often do you perform vasectomies?

· What is your rate of complications?

· How long will the procedure take?

· What will the procedure cost?

· Will my insurance cover the cost?

· Do you perform vasectomy reversal? If so, what is your success rate?

· infection: one in 100

· epididymitis: one in 100

· sperm granuloma: one in 500

· persistent pain: one in 1,000

Fournier gangrene is a very rare but possible complication of vasectomy in which the lining of tissue underneath the skin of the scrotum becomes infected (a condition called fasciitis). Fournier gangrene progresses very rapidly and is treated with aggressive antibiotic therapy and surgery to remove necrotic (dead) tissue. Despite treatment, a mortality rate of 45% has been reported for this condition.

Alternatives

There are numerous options available to couples who are interested in preventing pregnancy. The most common methods are female sterilization, oral contraceptives, and the male condom. Female sterilization has a success rate of 99.5%; oral contraceptives, 95–99.5%; and the male condom, 86–97%.

Resources

ORGANIZATIONS

Alan Guttmacher Institute. 1302 Connecticut Ave., NW, Suite 700, Washington, DC 20036. (202) 296-4012 or toll free (877) 823-0262. http://www.guttmacher.org (accessed April 16, 2008).

Planned Parenthood Federation of America. 434 West 33rd Street, New York, NY 10001. 212-541-7800. http://www.plannedparenthood.org (accessed April 16, 2008).

OTHER

“Facts About Vasectomy Safety.” National Institute of Child Health and Human Development,August 17, 2006 [cited January 5, 2008].http://www.nichd.nih.gov/publications/pubs/vasectomy_safety.cfm (accessed April 16, 2008).

“Vasectomy.” Planned Parenthood Federation of America, [cited January 5, 2008].http://www.plannedparenthood.org/midsouthmi/vasectomy.htm (accessed April 16, 2008).