What is a Vasectomy?

I'm think of getting snipped, let's get right to it--How is this done?

You’ve made the decision and you’re ready to go. Well, let’s talk about what is the most common procedure done on a male in the United States–THE VASECTOMY.

So, a vasectomy is an office-based procedure. You’ll come in and be set up in the procedure room. The urologist will groom you and “prep” or clean your scrotum.

Now, let’s understand the lay of the land. A vasectomy is the medical term for excising, or cutting out, the vas deferens. Now God gave you two, so in reality it’s called a bilateral vasectomy. The vas deferens is the tube that connects the epididymis (the hard lump that you feel next the to the testicle where sperm hang out) and carries the sperm all the way to the ejaculatory ducts as it enters the urethra in the prostate. So, this is the tube that helps bring the sperm from the testicle into the urethra for when you ejaculate.

So if we block this route then no more kids, YAY!!! It is essentially a permanent form of contraception or sterilization.

Just like being at the dentist, you are awake when this is being done. I give my patient’s the example of getting a root canal or a filling. You will feel the poke and burn when the numbing medicine goes in, but the rest of the time you will just be laying down there wondering what is going on and how things are going down there. But the sounds during a vasectomy are thankfully definitely less scary than being at the dentist.

After you are numbed up, the urologist will feel around for where the vas deferens is. The skin will be opened and the vas deferens will be pulled out from this tiny skin opening. There is a layer of tissue around the vas which will be teased away and then a 1-2 cm portion of the tube will be removed. Now, on each cut end of the vas, there is the opening for the tube and this will be burned or cauterized to really seal it off. These steps are essentially the same for all urologists that do this procedure.

Afterwards, there is some variability. Some docs will just be done at this point. Some will put a stitch on the vas others will place a clip. Some will close the skin with a stitch and others don’t. The rest is just dealer’s choice. The main key components to this procedure is to have the vas properly cut and have the two ends burned off.

All in all, this procedure typically takes between 20-30 minutes and you are done.

Here is an old but good video walking through the steps of a vasectomy (don't click if you don't wanna watch)

Medical terms you may hear during your appointment

Sterilization

This is a fancy word for term used to make it so that someone can’t have kids anymore.

Vas deferens

The tube in the scrotum that carries sperm from the epididymis to the ejaculatory duct

Vasectomy

Term for the procedure to remove a segment of the vas deferens

Semen

Term used to describe all the contents in your ejaculate.

When can I resume normal activity, have sex, or exercise?

This is very person dependent. You should be able to walk up and down stairs immediately after the procedure. There are no restrictions in terms of what you eat.

You can shower the next day but typically don’t soak in a tub till the sutures have healed which is about a week on average.

Now you got to remember, we are operating in the scrotum. So you will be sore and walking slow those first couple days. I recommend ice packs especially the first 24 hours and to take round the clock NSAIDS (Motrin, Ibuprofen, etc) for the first 2-3 days to help limit swelling and pain.

The scrotum will typically look like you have been in a bar fight and lost. You will notice some bruising and swelling. It’s also normal to feel a hard lump in the scrotum where the vasectomy was done and this lump can sometimes take weeks to months to go down. Usually after the first couple days, you will feel sore but in general the pain is really manageable.

I tell most of my patients that they will be ready to go back to work after 2-3 days.

You are ready to have sex and exercise when you feel ready. For most people this is around 7-10 days. Listen to your body, if it’s still sore and uncomfortable then take it easy. Your body will let you know when you are ready, trust me.

Will I notice a difference in how much I ejaculate?

No. Sperm is not the biggest component of semen.

Even though there are no sperm in your ejaculate, most guys aren’t able to tell a difference in how much they ejaculate. Sometimes I get a phone call, “Dr. Jafri, OMG this didn’t work I don’t see a difference”. I then have to remind my patients that typically the amount that you ejaculate usually isn’t that much different after a vasectomy.

Again you gotta remember that sperm is not the biggest component of semen.

How will I know if this has worked?

As with any procedure, there is a risk of failure. For a vasectomy, the typical risk that the procedure fails is quoted as less than one in two to three thousand. So even though the risk is super duper low, we definitely want to have your semen checked at some interval after the vasectomy to make sure there are no sperm.

I will usually do this at the 6-8 week mark. Now remember, there are still swimmers in the pipes until we confirm with the follow-up testing. So you can still get your girl pregnant in the first couple months after the vasectomy until we have proven that you are sterile.

Some urologists will have you drop the sample to the office and he/she will personally look at them under the microscope to make sure no sperm. Others will have you drop it to a lab to have it analyzed.

Do not use home fertility kits. They are not accurate enough.

What results may occur when my semen is analyzed after the vasectomy

There are three results for the ‘post-vasectomy semen analysis’.

No sperm: Awesome. We are good to go. Some urologists are cautious and will get another test to confirm. For me, the AUA guidelines say that this is enough and I say great we are good to go.
Non-motile sperm: Another result is that there are sperm that we see under the microscope but they aren’t moving. We call this non-motile sperm. When we see this, we haven’t really called this a failure yet and will tell you to clean the pipes a bit more and will recheck a sample in another month or so
Motile sperm: Worst case scenario, we see sperm on the slide and they are moving. This means the tube(s) have reconnected, the procedure failed and we need to repeat it. The odds of this again are very low as mentioned above but this result is the whole reason that we do a post-vasectomy check to confirm that the coast is clear.

What are the risks with this procedure?

There are many risks which are typical to any procedure and those include, but are not limited to, bleeding, infection, and bruising. As described above this procedure can fail, which is why you should use some form of contraception until it is confirmed that you are sterile. If you get bleeding, it kinda stinks for a couple weeks. There will be a heaviness and discomfort in the scrotum because a collection of blood forms called a hematoma. This will just delay the time it takes for you to feel back to normal but doesn’t affect the success of the procedure.

There is a condition called post-vasectomy pain syndrome. This is rare but unpredictable as to who can get it. I can’t look at you and say oh your white or black or this age or that or have this medical problem. It’s really random as to who can develop this and thankfully it is really uncommon. Typically, if a patients gets this they will have a noticeable but low level discomfort in the scrotum that can last for several years.

Is a vasectomy permanent?

I tell patients to think of this as permanent.

Can it be reversed? Yes.

Is reversal covered by insurance? No and it can be expensive.

Will reversal guarantee future pregnancy? No. So only do this procedure if you are confident that you want to be sterile and avoid using other forms of birth control methods.

Does this affect my sex drive or erections?

The Dr. Jafri Wrapup

Look you got this. Guys do great with this procedure and will frequently improve your sex life with your partner as you aren’t dealing with the anxiety of having another kid.

If you have further questions or want a little more information about this procedure, you can check out the American Urologic Association website and its guidelines statement at this link https://www.auanet.org/guidelines/vasectomy-guideline