Perhaps the exhausting days and sleepless nights of raising kids have worn on you. Or, as a single man, you may realize that you never want to have children at all. You may be one of a growing group of men who view vasectomy as an environmentally conscious decision -- by refusing to bear children, some believe that they're helping to preserve the Earth's resources, eliminating their role in global overpopulation. No matter the reason, you want to be absolutely, positively certain that your days worrying about getting your partner pregnant are over.
While the results are appealing to many men, the vasectomy surgery itself can provoke fear. Thoughts about genital pain, health risks and sexual dysfunction worry many of the men who even contemplate this procedure. But are these fears supported by science? Do men experience faulty erections or chronic pain after vasectomy surgery? Can it cause cancer? And what happens if you change your mind? Can your vasectomy be reversed?
Vasectomy is a safe and largely effective birth control method that allows men to enjoy a healthy sex life without worrying about unintended pregnancies. Many couples praise its benefits, but vasectomy is somewhat permanent, and it is not a procedure to undergo on a whim. In this article, we'll explain how vasectomy works and where it came from, and we'll summarize the latest medical research on vasectomy side effects, risks and complications.
Vasectomy: History and Modern Times
Sterilization of males and females is the most common form of birth control around the globe, says the World Health Organization. More than 200 million people have been sterilized worldwide, and each country's government regulates the surgery according to different customs and standards. In some countries, your marriage status and family size determine whether you are eligible to receive the surgery [source: CDC]. But where did vasectomy begin?
As with most medical procedures, doctors experimented with vasectomy on animals before trying it on a human. The first known vasectomy was performed on a dog in 1823. We're not sure where the first human vasectomy took place, or who did it, but its appeal and desirability may have arisen when men realized that castration was no longer necessary as a treatment for certain prostate problems. With the advent of vasectomy, a man was able to keep his testicles, even with certain health conditions [source: Drake et al.].
Starting around 1900, during an infamous historical movement known as eugenic sterilization, vasectomy spread throughout Europe. Politicians and influential members of society campaigned for the sterilization of socially undesirable individuals in Germany, Switzerland and other countries. These leaders considered vasectomy to be a suitable option to prevent certain ethnic groups from procreating. Other groups that were sterilized at this time included the mentally ill and the criminally insane. Around the world in places like London, Cuba and the United States, prisoners and patients were forcibly sterilized. Around 65,000 men were sterilized in the United States during this "Vasectomania," and inmates were locked in confinement until their surgeries were complete. Later, in the early 1900s, vasectomy was thought to benefit men in several ways, including reversing senility and improving sexual health. One man was sterilized twice to reduce his excessive masturbation habit, with reported success [source: Drake et al.].
After World War II, vasectomies became widely used as a form of birth control, and they remain so today. During the 1970s, the Indian government offered cash incentives to hundreds of thousands of Indian men willing to receive vasectomies. Leaders were eager to increase birth control opportunities to the public, in order to reduce drastic population growth. Different regions in India competed to see who could sterilize the largest numbers of men [source: Leavesley]. Vasectomy grew in popularity around the globe during the last few decades of the 20th century, and most urologists in the United States started performing vasectomy reversals in the 1970s. Vasectomy and vasectomy reversal remain popular and safe around the world today [source: Kim].
Worldwide, only 5 percent of married men have had vasectomies, although one in six men in the United States over the age of 35 has had the surgery [source: U.S. Dept. of Health and Human Services]. In a 1999 study, researchers looked at the characteristics of men who were getting vasectomies in the United States. About 80 to 90 percent of the men who had received a vasectomy were white, non-Latino and married or in a long-term partnership. More than 80 percent had at least a high school education, and about half of the men had completed college [source: Barone et al.]. According to the CDC, vasectomy was the most common form of birth control used by American men in 2002, with a range of vasectomy rates across the country. Only 2 percent of men in Washington, D.C. were sterilized by the year 2000, compared to more than 30 percent of men in Oregon [source: Bensyl et al.].
The Science of Vasectomy
During sexual reproduction, a man's body ejaculates, or discharges, sperm into a woman's body in an attempt to create a pregnancy. To understand how vasectomy works you'll first need to understand the mechanics of ejaculation.
- Two testicles, which are housed in the scrota, produce millions of sperm.
- Sperm then wait in two nearby tubes, known as the epididymides, where they develop and mature.
- Once they have reached maturity, the sperm are carried from each epididymis into two longer tubes called the vas deferens, which connect to the prostate.
- The vas deferens and seminal vesicles work together to carry millions of mature sperm out through the head of the penis via a lubricative, sugary liquid called semen.
- Before and during sexual intercourse, the penis fills with blood, stiffens and typically remains hard until a man climaxes and has an orgasm.
- During orgasm, the semen, carrying the sperm, is ejaculated out of the penis through the urethra.
When a man has a vasectomy, both of the vas deferens are cut, blocked or tied to prevent his sperm from traveling out through the urethra during sex. However, a vasectomy does not work immediately. Because sperm are continuously being created in the testicles, housed in the epididymides and carried towards the urethra, it can take several months for existing sperm to completely clean out of the reproductive system. During this time another form of birth control must be used to prevent pregnancy [source: Davis]. After vasectomy, there should be no noticeable change in semen quality or quantity. The testicles will continue to produce sperm after vasectomy, where they are absorbed by the body and vanish over time [source: National Library of Medicine].
Getting Ready for the Big Day
Before your vasectomy, you will need to choose a doctor for the surgery, which might take a little research. Some ideas to help you choose the appropriate doctor include:
- Get personal insights from friends and relatives who have had vasectomies.
- Consider whether you would prefer a male or female surgeon, and get a referral to a urologist from your primary care doctor.
- Request that your wife or partner talk to her friends to get recommendations of urologists, family practice doctors or general surgeons.
- Ask each doctor about the types of vasectomy he or she performs, and get an idea of the one you feel most comfortable with.
Once you choose your doctor, you will need to set up an initial consultation several weeks or months before your scheduled surgery. It might be valuable to bring your spouse or partner along for this visit. Your doctor will take a thorough health history and discuss all of the risks and benefits of vasectomy. He or she may ask questions about your family size and your personal reasons for seeking a vasectomy. You will need to disclose details about any medications that you take regularly, including prescription and over-the-counter drugs. Some drugs, like blood thinners, affect your blood's ability to clot, so you may need to stop taking them or take a lower dose at least 10 days before surgery. This includes medicines like aspirin and ibuprofen [source: Zieve et al.]. Your doctor may also do a physical examination to rule out any anatomical issues that would interfere with the surgery [source: Clenney].
What to Expect During Your Vasectomy
The big moment has arrived. Many men may find themselves nervous on the big day. While women are more often accustomed to having their genitals examined at their annual OB/GYN visit, men tend to have their private parts touched and scrutinized by a doctor less often.
On the day of your surgery, you will need to bathe and shave your testicles. If you do not shave them, an assistant will probably do it for you. You will also need to bring a scrotal supporter, like tight, brief-style underwear or a jockstrap, to wear home. The room will be warm to help you relax, and soft music might be playing. In a quick procedure that takes only 15-30 minutes, the vasectomy will be performed. You will probably be awake during the vasectomy, relaxing with the aid of a mild sedative, which can be given orally or through an IV [source: Davis]. Rarely, general anesthesia is used to put you to sleep [source: Zieve et al.].
Before the surgery, your scrotum will be numbed with local anesthetic [source: Davis]. During the procedure, you may feel tugging on the scrotum, which will often feel uncomfortable but should not be painful. In order to access the vas deferens, a doctor will cut or puncture one or two holes into each side of the scrotum with a scalpel. Each of the two vas deferens tubes will be severed [source: National Library of Medicine]. At this point, the tubes will either be clamped or tied securely (closed-ended vasectomy), or simply cut and left open (open-ended vasectomy) [source: Christiansen]. Many urologists then perform a thermal cauterization of the vas, using heat to sear the vas deferens tube shut. After the surgery, your doctor may or may not choose to stitch the incision site back up, depending on the size of the incision and any resultant bleeding [source: CDC].
Your doctor may choose to use another vasectomy technique that is done with no incision and no scalpel. Known as the Li technique, this procedure started in China in the early 1970s and remains very popular today. The no-scalpel vasectomy promises less discomfort, quicker healing and reduced surgical time [source: Clenney]. During this process, the urologist feels for the vas deferens in the scrotum, and clamps it securely. He or she punctures the scrotal skin slightly with sharp forceps, and then stretches the skin to lift the vas deferens out through a tiny hole. The vas is cut, then cauterized or tied, and placed back into the scrotum [source: American Urological Association Foundation]. With this technique, stitches are not needed, as bleeding is minimal [source: CDC].
The Vasectomy Is Over - Now What?
Immediately after your vasectomy, you will need to rest for a short while until you're stable and lucid again, and then you may go home. That day, your scrotum will be quite numb, and you can expect some soreness, swelling, discharge or bruising, possibly lasting up to several days. Rest and ice packs will help to reduce any discomfort that you feel.
Some men are able to return to work the following day, with most men returning to work after several days of healing [source: National Library of Medicine]. You will need to avoid heavy lifting for several days until all swelling and pain cease. Make sure to follow your doctor's recommendations about wearing your jock strap or tight briefs to support your scrotum. Most likely, you can resume sex and your normal routine within a week after the surgery [source: Zieve et al.].
You may wonder, now that your vasectomy is complete, whether you can immediately begin to enjoy sex without worrying about an unwanted pregnancy. For several months after your vasectomy, you will still be fertile. For two to three months, sperm will still be circulating in your reproductive system, allowing you to impregnate your partner. To confirm that your semen is clear of all sperm, you will need to visit your doctor and provide a sperm sample several months after your vasectomy. Some doctors may even recommend that you return several times to confirm that the vasectomy was a success. As we will discuss later, one of the most important aspects contributing to your vasectomy success is avoiding unprotected sex during these first few months after surgery. Most pregnancies that occur after vasectomy occur within the first six months after surgery. For this reason, abstinence or a backup method of birth control must be used to prevent pregnancy.
What if Something Goes Wrong?
While vasectomy is regarded as a very safe surgery, with few to no serious side effects, on rare occasions, some men do face problems after the procedure. After all, vasectomy is an invasive surgery, which can possibly result in surgical complications like infection, excessive bleeding, medication allergy or scarring. However, claims that vasectomy causes men to develop anti-sperm antibodies, which supposedly lead to problems like heart disease, arthritis and other disorders, have all been unfounded [source: U.S. Dept. of Health and Human Services].
To discover trends in post-vasectomy side effects, researchers followed more than 10,000 men for eight to 10 years after their vasectomy surgeries. The only common side effects shared by the men were swelling and pain in the testis or epididymis, which usually occurred within the first year after vasectomy. For most men, this condition was easily cured within a week by applying heat to the area [source: U.S. Dept. of Health and Human Services]. Testicular pain can be caused by sperm granulomas, which are miniscule lumps that appear in the testes after vasectomy. Sperm granulomas form when sperm leak out of the severed vas, causing inflammation. Sometimes these granulomas grow large or become painful, and surgery can become necessary for their removal [source: National Library of Medicine].
You may be concerned about the effects that vasectomy might have on your sex life. Will it affect your ability to maintain an erection? Will you still be able to ejaculate? To answer these questions, researchers in Australia surveyed more than 3,000 Australian men about their sex lives after their vasectomies. No significant differences were observed between men who had had a vasectomy and those who hadn't. Other studies have confirmed this as well [sources: U.S. Dept. of Health and Human Services, Smith et al].
Post-vasectomy pain syndrome (PVPS) is a rare side effect of vasectomy. Symptoms of PVPS can include swelling, soreness, pain during sex and ejaculation, or pain during physical activity. Lasting for months or years, the definite cause of PVPS is unknown. One theory is that closed-ended vasectomies cause a build up of pressure, resulting in inflammation, swelling, pressure and pain. Open-ended vasectomy techniques may reduce the risk of PVPS. Some forms of treatment for PVPS include medication, psychiatric treatment and nerve blocks to reduce the pain [source: Christiansen]. Doctors have tried to treat PVPS with vasectomy reversal surgery, but some men have needed two vasectomy reversals before they felt relief from their pain [source: Myers et al.]
Yes, Sometimes Vasectomies Fail
Many of us have heard the sometimes sad and sometimes humorous stories of couples who became pregnant after a man had had a vasectomy. While vasectomy is a highly effective birth control method, it is not fail-proof. Rarely, men that have had vasectomies father children after the surgery.
Possible reasons for failed vasectomy include:
- Not using a backup method of birth control for the first few months after the surgery.
- Using a backup method of birth control that fails.
- The vas deferens reconnects itself after surgery.
When scientists observed pregnancy rates of women after their partner's vasectomy, the risk of vasectomy failure appeared to be about 10 in 1,000, or a 1 percent chance of getting pregnant within several years after vasectomy. Most of these accidental pregnancies occurred within six months after vasectomy, and half of the pregnancies occurred within three months of the procedure, during the fertile window [source: Jamieson, et al.]. Remember: It takes several months for sperm to completely clean out of a man's system after vasectomy. This reiterates the importance of being cautious and using a second method of birth control for several months after your vasectomy.
This still leaves a number of unexplained post-vasectomy pregnancies. How can a vasectomy fail if a couple avoids sex during the fertile window? One explanation is a phenomenon called recanalization, which can occur after a vasectomy. During recanalization, a mass of cells starts to grow between the two cut ends of the vas, and the vas deferens is able to reconnect itself, allowing sperm to travel through the vas once again. Often, a man doesn't know this has happened until a pregnancy occurs. At times, recanalization is diagnosed when a routine post-vasectomy semen analysis fails, but other times it occurs years after the vasectomy [source: Xiaozhang]. Sometimes, doctors will cut and remove a small section of the vas deferens during the vasectomy to prevent this rare complication [source: American Urological Association Foundation].
Is Vasectomy Right for You?
After reading this piece, you may feel ready for vasectomy. After all, if you change your mind later, you can always have vasectomy reversal surgery, right? Or maybe you'll just have some sperm frozen at a sperm bank in case you decide that you want more children one day. While these safety measures sound appealing, most doctors would advise you to reflect further about vasectomy's permanence.
While some men are able to father children after vasectomy reversal, many vasectomy reversals do not work. Banked sperm is not always viable, and sperm banks have been known to lose men's specimens on occasion. Experts recommend that men consider vasectomy as a birth control option only if they are 100 percent positive that they are done having children. Before going through with the procedure, you may want to consider your future. Many men divorce and remarry after vasectomy and then want more children with a new partner. This can lead to frustration and disappointment when vasectomy reversal surgery does not work.
If your partner is the one pushing for vasectomy because she doesn't want to get pregnant, you may want to talk to her about tubal ligation, or getting her tubes tied. This surgery is a longer, more intensive and expensive surgery, and it has more risks and side effects. For these reasons, and because vasectomy and tubal ligation success rates are similar, many couples opt for vasectomy as their preferred method of sterilization. The decision to have sterilization surgery is highly personal and should be thoroughly discussed with your partner and healthcare practitioners.
For more information on vasectomies and reproductive health, check out the links on the next page.
More Great Links
- American Urological Association Foundation. "Vasectomy Reversal." April 2010. (7/28/10) http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=153
- Barone, et al. "Characteristics of men receiving vasectomies in the United States, 1998-1999." Perspectives on Sexual and Reproductive Health. Vol. 36, No.1. 2004. http://www.guttmacher.org/pubs/psrh/full/3602704.pdf
- Barone, et al. "Vasectomy in the United States, 2002." The Journal of Urology. Vol. 176, No. 1. 232-6. 2006. http://www.jurology.com/article/S0022-5347(06)00507-6/abstract
- Bensyl, et al. "Contraceptive Use -- United States and Territories, Behavioral Risk Factor Surveillance System, 2002." Morbidity and Mortality Weekly Report. Vol. 54, No. SS06. 1-72. 2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5406a1.htm
- CDC. "Tubal Sterilization and Vasectomy." Family Planning Methods and Practice; Africa. 2000. http://www.cdc.gov/reproductivehealth/ProductsPubs/Africa/Africa_bk.pdf
- Christiansen, C.G. and Sandlow, J.I. "Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome." Journal of Andrology. Vol. 24, No. 3. 293-298. May/June 2003. http://www.andrologyjournal.org/cgi/content/full/24/3/293
- Clenney, T.L. and Higgins, J.C. "Vasectomy Techniques." American Family Physician. 1999. http://www.aafp.org/afp/990700ap/137.html
- Cook, L., Pun, A., Gallo, M.F., Lopez, L.M., and Van Vliet, H. "Scalpel versus no-scalpel incision for vasectomy." Cochrane Database of Systematic Reviews. Vol. 2. 2007. http://apps.who.int/rhl/reviews/CD004112.pdf
- Cox, et al. "Vasectomy and Risk of Prostate Cancer." Journal of the American Medical Association. Vol. 287, No. 23. 3110-3115. 2002. http://jama.ama-assn.org/cgi/content/full/287/23/3110
- Davis, B. "Vasectomy." WebMD Birth Control Health Center. May 2008. (Aug. 1, 2010) http://www.webmd.com/sex/birth-control/vasectomy-14387
- Drake, M.J., Mills, I.W., and Cranston, D. "On the chequered history of vasectomy." British Journal of Urology International. Vol. 84, No. 4. 475-481. 1999. http://www3.interscience.wiley.com/cgi-bin/fulltext/119091539/PDFSTART?CRETRY=1&SRETRY=0
- Huh, B.K. and Zieve, D. "Conscious sedation for surgical procedures." MedlinePlus. March 2009. (July 28, 2010) http://www.nlm.nih.gov/medlineplus/ency/article/007409.htm
- Jamieson, et al. "The Risk of Pregnancy After Vasectomy." Obstetrics & Gynecology. Vol. 103, No. 5. 848-50. 2004. http://journals.lww.com/greenjournal/Fulltext/2004/05000/The_Risk_of_Pregnancy_After_Vasectomy.5.aspx
- Kim, H.H. and Goldstein, M. "History of vasectomy reversal." Urologic Clinics of North America. Vol. 36, No. 3. 359-73. 2009. http://www.ncbi.nlm.nih.gov/pubmed/19643238
- Leavesley, J.H. "Brief history of vasectomy." Family Planning Information Services. Vol. 1, No. 5. 2-3. 1980. http://www.ncbi.nlm.nih.gov/pubmed/12336890
- Myers, S.A., Mershon, C.E., and Fuchs, E.F. "Vasectomy reversal for treatment of the post-vasectomy pain syndrome." Journal of Urology. Vol. 157, No. 2. 518-20. Feb 1997. http://www.ncbi.nlm.nih.gov/pubmed/8996346
- National Library of Medicine Patient Education Institute. "Vasectomy." May 2008. (July 28, 2010) http://www.nlm.nih.gov/medlineplus/tutorials/vasectomy/ur039104.pdf
- Planned Parenthood. "Vasectomy." 2010. (July 28, 2010) http://www.plannedparenthood.org/health-topics/birth-control/vasectomy-4249.htm
- Scott, A. and Glasier, A. "Contraceptive sterilization: global issues and trends." Bulletin of the World Health Organization. Vol. 81, No. 2. 146. 2003. http://www.scielosp.org/scielo.php?pid=S0042-96862003000200013&script=sci_arttext
- Smith, et al. "Are sexual problems more common in men who have had a vasectomy? A population-based study of Australian men." Journal of Sexual Medicine. Vol. 7, No. 2 pt.1. 736-742. 2009. http://www3.interscience.wiley.com/journal/122667385/abstract/
- Sokal, D., et al. "A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition." BioMed Central Urology. Vol. 4, No. 12. 2004. (Oct. 11, 2010) http://www.biomedcentral.com/1471-2490/4/12
- U.S. Department of Health and Human Services. "Facts about vasectomy safety." October 2009. (July 28, 2010) http://www.nichd.nih.gov/publications/pubs/vasectomy_safety.cfm
- WebMD. "The Male Reproductive System." 2010. (Aug. 1, 2010) http://www.webmd.com/sex-relationships/guide/male-reproductive-system
- Xiaozhang L. Vasectomy occlusion techniques for male sterilization: RHL commentary September 2008. The WHO Reproductive Health Library; Geneva: World Health Organization. Sept. 1, 2008. (Oct. 11, 2010) http://apps.who.int/rhl/fertility/contraception/CD003991_xiaozhangl_com/en/
- Zieve, D. and Miller, S. "Vasectomy." MedlinePlus. March 2010. (July 28, 2010) http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm