The Big V – is Vasectomy for You?

Men who sit down with consultant urological surgeon always have a lot of questions about vasectomy. Chief among them is: ‘It’s reversible, right?’ Here, he addresses some of the myths and uncomfortable truths:

What vasectomy does and doesn’t do

Vasectomy, also known as male sterilization, is a reliable and permanent form of contraception for men who are sure that they don’t want to father any more children.

It doesn’t affect your sex drive or ability to enjoy sex. You’ll still have erections and produce the same amount of fluid when you ejaculate. The only difference is that the fluid will not contain sperm. The testes will still produce sperm, but they can't travel to the penis and are naturally reabsorbed.

Vasectomy doesn’t protect you from contracting or passing on sexually transmitted infections (STIs) or diseases (STDs), therefore you should continue to take appropriate precautions.

The golden rule: speak to your partner

If you’re in a relationship, you need to make this decision together. It goes both ways. You’d be surprised how many men speak with a consultant about vasectomy before they speak with their partner. On the other hand, there are some men who might feel pressured to have a vasectomy by their partner. You should take some time to talk it through long before stepping into a consultant’s office.

Consider it irreversible 

You cannot go into vasectomy with reversal as a fall back option. A vasectomy reversal is a complex procedure, and the success rates of the operation decrease the longer the period after the initial vasectomy.

In some cases it's possible to retrieve sperm surgically from the testicles if your circumstances change. Some men choose to freeze sperm before undergoing a vasectomy. If your future fertility is a central concern, then vasectomy is probably not for you.

I’m starting to have doubts - what are the alternatives?

There are many different types of effective contraception, but things like condoms and the contraceptive pill require constant thought and attention. Couples also have the option of female sterilisation, although this surgical procedure is not as simple to perform, has more risks than vasectomy and requires a general anaesthetic. It’s worth discussing all the options before deciding what to do next.

The awkward bits of the procedure

It’s not unnatural to feel a little vulnerable at the idea of having your testicles felt by a surgeon as they plan to make small cuts in your scrotum. This is a fear you will have to face.

For the surgeon to have unobstructed access, you may have to shave an area of your scrotum. If you prefer, you can do it yourself at home before the operation.

While you shouldn’t feel any pain under the local anaesthetic, you may feel a little exposed as the surgeon feels the testicles to find the vas deferens, tubes that carry sperm to the penis, and makes tiny cuts in both sides of the scrotum. Sometimes it’s just one central incision, or a small hole. The tubes are pulled out through the holes, cut, and sealed off. The tubes are then gently placed back into the scrotum and the cuts closed using dissolvable stitches or adhesive strips. Often there’s no need for a dressing.

After the deal is done

Recovery from the operation is often swift, with many men returning to work the next day. It’s best to avoid heavy lifting or vigorous exercise as this can place strain on the healing wounds.

There can be side-effects. If the surgeon has had trouble finding the tubes, there may be severe bruising around the scrotum. Most men will have some mild soreness after the local anaesthetic wears off.

As with any surgery, there can be complications. Complications arising from vasectomy are rare, but can include anything from bleeding inside the scrotum to infection. Very rarely, even when performed correctly, there is a minuscule risk the tubes can rejoin naturally making you fertile again (1 in 2000 men).

Getting back to sex – hold your horses!

Sex can be resumed as soon as it feels comfortable to do so, but another form of contraception must be used until the live sperm that remain in the tubes are gone. This can take a few months. Two semen tests will need to be performed to ensure that the tubes are clear of sperm. One semen sample should be taken to the hospital 12 -14 weeks after surgery and a second sample two weeks later.

When your semen has been shown to have no sperm at all, you’ll be given the all clear to stop using other methods of contraception.

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