What you need to know if you are thinking of having a vasectomy

What is a vasectomy?

A vasectomy is a procedure that cuts or blocks the tubes connecting the testes to the penis (called the vas deferens). Sperm are produced in the testes, and blocking these tubes prevents the sperm from being ejaculated during sex. Vasectomy is often known as male sterilisation and it is an effective method of preventing pregnancy.

How is a vasectomy performed?

The procedure is commonly performed under local anaesthetic, meaning you will be awake but unable to feel any pain. The benefit of this is that you will usually be able to leave hospital on the same day as the operation. Sometimes the operation will be done under a general anaesthetic where you will be asleep, but this is less common.

There are two types of vasectomy, and your doctor will be able to discuss which is the best option for you:

• Conventional vasectomy involves numbing the scrotum with local anaesthetic and making two small incisions in the skin to access the vas deferens. Each tube is cut, and a small section removed, with the remaining ends being tied or sealed. Dissolvable stitches will be used to close the incisions
• No-scalpel vasectomy is similar to a conventional vasectomy but involves a small puncture in the scrotum rather than small cuts. The tubes are closed off in the same way as a conventional vasectomy. The advantages of the no-scalpel technique are that stitches are not needed, there is usually less bleeding and there are fewer complications

Having a vasectomy is a big decision, as it will affect your fertility for the rest of your life. It is important that you think it over carefully. Listed below are the essential things you need to know if you are thinking about having a vasectomy:

Who can have a vasectomy?

A vasectomy is considered a permanent form of contraception. A successful operation will make you infertile, so you should only have a vasectomy if you are certain that you will not want to have children in the future.

Advantages and disadvantages

Advantages

Vasectomies are safe and quick to perform, with minimal effects on long term health. They are also easier and more effective than female sterilisation.

Disadvantages

A vasectomy doesn’t protect against sexually transmitted illnesses, so you will need to use condoms as well. You will also need to continue using contraception until tests after the operation show that there are no sperm in your semen. A vasectomy is difficult to reverse, and it may not be possible to have children after reversal, so you should be certain about your decision to have one.

Risks

Problems with a vasectomy are uncommon, but as with any surgical procedure, it does carry some risks:

• Wound infection
• Bleeding or bruising, which will usually resolve after a few days
• Rarely, sperm can leak into the scrotum and cause swelling, requiring treatment
• A small number of men will experience aching in the scrotum for a few weeks after the operation. This will usually settle by around 3 months
• Sometimes, pain in the scrotum, testicles, penis or lower tummy will not settle over time. Troublesome chronic pain occurs in about 15% of cases, and in 5% of cases, it is severe enough to limit daily activities. This pain can be treated but it is not always successful

Success rate

A vasectomy is very reliable – it is more than 99% effective. However, in less than 1% of cases, tests will show that sperm are still present in the semen after the operation. Even after a successful vasectomy, roughly 1 in 2000 men will regain their fertility in the future due to the tubes reattaching by themselves.

Recovery

A small amount of discomfort, swelling or bruising around the scrotum is normal for a few days after the procedure. Painkillers can help to ease your symptoms, but you should see your doctor if the pain does not settle. You can have sex again once it is comfortable to do so. It is common to see some blood in your semen for the first few ejaculations after a vasectomy

Does it work immediately?

A vasectomy is not effective immediately. Sperm can remain in the tubes even after they have been closed, so you will need to use extra contraception for the first 8-12 weeks. Your semen will need to be tested for sperm to confirm that the vasectomy has been a success, and this can be done around 12 weeks after the procedure. Until it has been confirmed that your semen is free of sperm, you should continue using another form of contraception.

Can I have children after a vasectomy?

Reversal of a vasectomy is a difficult procedure and isn’t always successful. A reversal done within 10 years of a vasectomy has around a 55% success rate, and this drops to 25% if it is done after 10 years⁴.

It is possible to have children through IVF after a vasectomy, but this is also difficult and has a low rate of success. Sperm previously stored in a sperm bank is another possible way of having a child after vasectomy, but this too is not always successful.

Will it affect my sex drive?

No. Your sex drive is controlled through testosterone released by the testicles. The release of this testosterone is unaffected by a vasectomy and as such your sex drive, sensation and ability to have an erection will be unaffected.

What happens to the sperm?

Sperm continues to be made as before in the testicles, but they cannot get through the blocked tubes and so they are broken down and absorbed by the body.

Will it increase my risk of cancer?

No. A recent study of over 1 million men who had vasectomies has shown that there is no evidence that a vasectomy causes prostate cancer. This is supported by the Faculty of Sexual and Reproductive Healthcare in the UK.

In summary

There are a number of things you need to consider if you are thinking of having a vasectomy. If you think that a vasectomy is right for you then speak to your doctor. Your doctor will be able to answer any further questions you might have about vasectomy or other forms of contraception and they can discuss the best available options with you.