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|Vasectomy is a method of permanent male
sterilization. Vasectomy is a surgical procedure in which the vas deferens of the man is
cut to prevent transport of sperm out of the testes. Vasectomy does not affect the man's
ability to achieve orgasm or ejaculate (potency). There will still be a fluid ejaculate,
but without sperm. Vasectomy is an effective, inexpensive, and easy-to-perform procedure,
which results in permanent sterility.
Vasectomy may be recommended for adult men who are certain that they wish to prevent
future pregnancies (permanent sterilization). Vasectomy is not recommended as a temporary
or reversible procedure. Vasectomy does not offer protection against sexually transmitted
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Physiology of Sperm Production:
The testis is
composed of coiled tubes called seminiferous tubules, in which the sperm is formed. The
sperm then empty into the epididymis, another densely coiled tube. This leads to the vas
deferens, which then enters the prostrate gland. (See figure). The sperm formed in the
seminiferous tubules matures in the epididymis and are stored in the vas deferens. During
ejaculation they travel to the ejaculatory duct. Right before ejaculation, fluid from the
prostate gland and seminal vesicles mix with the sperm in the ejaculatory ducts to form
semen, which is forced through the urethra during orgasm. In vasectomy the vas deferens is
cut and the sperm does not travel to the ejaculatory duct. Sperm make up only a
very small portion of semen. Most of the semen is made up of the fluid from seminal
vesicles (60%), and fluid from the prostrate gland (30%) and only 10% is the sperm from
the vas deferens. So vasectomised men will not find any difference in the amount of semen
ejaculated. Testosterone continues to be produced in the testes and delivered into the
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Sterilisation is an emotional
process. There may be negative feelings associated with the procedure Men with poor
self-images about their physical health or sexual ability may have difficulty adjusting
psychologically to vasectomy. Men who have the operation only for the sake of their
partner's health and not for voluntary reasons may face problems. . Some women think
vasectomy may encourage outside affairs. (Research (1970) indicates, that married men who
have been sterilized are no more likely to indulge in extramarital sex than fertile men
are)The couple should have a thorough discussion and may undergo counseling if needed,
before making a decision
Majority of the men who seek a vasectomy have been married for ten
years or more and have a stable relationship. The reasons for vasectomy may be
1) Having had enough children, to prevent future pregnancy,
2) Unable or unwillingness to use other methods of contraception,
3) A health problem in the woman that makes pregnancy unsafe,
4) A genetic disorder, or
5) A desire to enjoy sex without fear of unwanted pregnancy.
Vasectomies may not be right for those
1) Who are unsure of having children in the future.
2) Whose current relationships are unstable or going through a
3) Who are considering the operation just to please their partners,
4) Who have thoughts of reversal procedures to have children later on
either by storing sperm or surgical reversal of their vasectomies.
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How is Vasectomy Performed?
The patient has to sign a consent form stating that the patient is
aware of the risks involved. The patient should have no doubts regarding the operation and
get his queries answered if any, before signing the consent form.
Sperm Banking. Storing frozen sperm in a sperm bank before
vasectomy might enable the patient to have children later. Before vasectomy, the patient
collects sperm, which are frozen and stored until he wants to have a child. However the
procedure is expensive and the success rate is low.
Vasectomy is usually done in the surgeon's office using local
anesthesia. It is a minor operation that takes about 30 minutes and is usually performed
in a doctor's office or a family planning clinic. The patient's scrotum is shaved and
cleaned, and a local anesthetic is injected into it. The surgeon makes a tiny incision on
one side of the scrotum and locates one vas deferens. The vas deferens is isolated, drawn
through the incision, and clamped at two sites close to each other. The segment between
the clamps, which should be more than 15 mm, is then removed.
The surgeon then seals off (ligates) the tube with surgical clips or
sutures or cauterization using an electric needle, or some combination. The surgeon may
choose to close off either one (called an open-ended procedure) or two ends (closed-ended)
of the vas. In the open-ended procedure, the vas section connected to the testis is left
open and the one leading to the prostate is sealed; in the closed-end both are ligated.
The open-ended version has lower complication and failure rates than the closed-ended, and
results in fewer cases of chronic pain. After closing off the tube, the vas deferens is
gently placed back into the scrotum. The skin incision is stitched and closed. The
procedure is then repeated on the other side. After a short rest of an hour, the patient
can leave the doctor's office or clinic.
A small section of each vasdeferens (spermatic duct) is removed through small incisions on
either side of the scrotum.
C-Area to be removed
A method of vasectomy that does not require the use of a scalpel is now
used in one-third of vasectomies. The no-scalpel vasectomy (NSV) differs from a
conventional vasectomy in the method of accessing the vas deferentia. An improved method
of anesthesia that allows an injection under the skin instead of into the testicle makes
the procedure less painful.
In this operation, the doctor feels for the tubes under the skin and
holds them in place with a small clamp. Instead of making two incisions, the doctor makes
one tiny puncture with a special instrument, which is then used to gently
stretch the opening until the vas deferens can be pulled through it. The vas is
then blocked using the same methods as conventional vasectomy. As with standard vasectomy,
the closures can be open - or close - ended. There is very little bleeding with the
no-scalpel vasectomy. No stitches are needed to close the tiny opening, which heals
quickly and leaves no scar. The technique takes about 10 minutes and is performed in a
doctor's office or a family planning clinic.
The advantages of NSV are many. There is less injury to the tissues and
no stitches and so less discomfort to the patient. The procedure offers shorter operating
time, less pain, swelling and faster recovery than standard vasectomy. The risk of
hematoma and infections are lower. Postoperative care is similar to that for conventional
General Guidelines: Oral painkillers are used to alleviate the
pain. Most men return to work within 2 to 3 days. Postoperative care includes
1) Wearing a scrotal supporter,
2) Placing an ice pack over the dressings to prevent swelling, and
3) Staying in bed on his back to reduce postoperative pain.
Blood may ooze onto the gauze pads during the first day or two after
the operation. Nearly all men recover completely in a few days. The patient should not
perform any heavy physical labor for the next few days. Sports and heavy lifting may be
resumed two to three weeks after surgery.
Temporary Risk of Pregnancy:
Sexual intercourse can be resumed as soon as the patient feels ready
(usually about a week after the surgery. Initially, the patient may experience some
discomfort in the groin and testicles during ejaculation due to the contraction of the vas
deferens. This diminishes as the tissues heal. The couple must, however, continue to use
conventional birth control methods for few months. About fifteen to twenty ejaculations
are required to clear the viable sperm. The sperm count
gradually decreases after vasectomy. At 4 to 6 weeks sperms are no longer present in the
semen. A semen
specimen must be examined and should be totally free of sperm in a months
time. Continued use of contraception is recommended, until 2 to 3 sperm count tests are
negative, indicating that the patient is sterile.
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Most men recover quickly with no
problems. Vasectomy is a low-risk procedure, the complications occur in 10% of patients.
Immediate Postoperative Pain: Men experience acute pain
in the scrotum after the operation. Acetaminophen with or without codeine is the primary
choice for postoperative pain. Aspirin, ibuprofen or naproxen or other so-called NSAIDs
can cause bleeding and should be avoided. This pain generally disappears within two days,
although the patient may feel sore for a few more days.
Allergic Reaction. Some may be allergic to the local anesthesia
and develop itching and hives.
Bleeding. Frequently, blood may seep under the skin, so that the
scrotum and penis appear to be bruised. If the patient bleeds excessively require more
than two or three gauze changes per day, he should call his doctor.
Hematoma. In about 2% of cases, bleeding inside the scrotum can
cause a painful swelling known as a hematoma. In these cases, the scrotum swells up
shortly after vasectomy. The doctor should be called immediately. Risk for hematoma is
less in no-scalpel vasectomy.
Infection. Infections occur in about 4% of men after standard
vasectomy. The risk for infection is reduced with no-scalpel vasectomy. The incision
becomes infected, causing inflammation and swelling. Antibiotics, antimicrobial creams or
both, along with hot baths several times a day will usually clear the infection in a few
Sperm Granulomas. When the body fails to absorb the sperms and
they leak into the surrounding tissues, the body becomes allergic to its own sperms and
starts producing its own antibodies. It views sperm as foreign agents and attacks them.
The body forms pockets to trap the sperm in scar tissue and inflammatory cells. Firm balls
of tissue about one-half inch in diameter form, known as sperm granulomas. They occur in
about 60% of vasectomy patients. Sperm granulomas can generate pressure build-up in the
epididymis, causing its rupture. The testicles then become enlarged and painful. A damaged
epididymis can be repaired, but if the patient later wishes a reversal of the vasectomy,
disruption of this tiny tube makes success much less likely.
Chronic Orchialgia. In one percent of all vasectomies, the
epididymis becomes congested with dead sperm and fluid that the patient feels a dull ache
in his testicles. This condition, called chronic orchialgia, usually disappears within six
Epididymitis. The epididymis becomes inflamed and swollen. It
occurs within the first year and can be treated with heat and anti-inflammatory
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-Term Risks of Vasectomy:
Testicular Pain. A third of the men experience testicular pain that lasts longer than
three months. The source of the pain is not fully known. The cause may be because of the
scarring from the surgery or due to obstruction of the epididymis. Surgery, including
removal of the epididymis and surrounding tissue, may be required if more conservative
measures fail. A surgical procedure that blocks nerves in the sperm cord can bring relief
in severe cases. Surgery to reverse vasectomy also may relieve pain in men.
Prostate and Testicular Cancer. Because
testosterone levels remain higher for a longer period in men who had vasectomy, experts
have been concerned that such men have a greater chance for developing the cancer. The
relationship between vasectomy and prostate cancer is being studied and there is no
Immune System Changes. . Infections in the genital tract,
orchitis and sexually transmitted diseases, increase the risk of anti-sperm antibodies.
Changes in the immune system might cause damage in other parts of the body, including
hardening of the arteries, blood clotting, kidney disease, and arthritis. Most medical
experts, including special panels convened by the National Institute of Health and the
World Health Organization, have concluded that vasectomy is a safe procedure. The
anti-sperm response appears to be a problem only if a man wishes to reverse the procedure.
Kidney Stones. Studies are indicating that men younger than
their mid-forties who have vasectomies have twice the risk for kidney stones as their
peers who have not had vasectomies. The increased risk persists for up to 14 years after
the operation. Men who have had vasectomies should drink plenty of fluids to help prevent
Osteoporosis. There has been some concern that vasectomies
increase the risk for osteoporosis in men. One study, however, found no higher incidence
of bone loss in vasectomized men.
Heart Disease. Animal research has suggested that heart disease
accelerates after vasectomy, but one study on men who had vasectomies found no significant
increase in risk for angina even over the long term.
Psychologic Reactions and Long-Term Dissatisfaction. Most men
who have vasectomies feel relieved that the worry about pregnancy is over, and most
couples respond well to their newfound contraceptive freedom. About 30% of couples report
that they have sex more often following vasectomy, enjoy it more, consider their marriages
stronger, feel healthier and more relaxed, and have no regrets about the operation. No
recent comprehensive studies have been performed on long-term patient satisfaction
About half of vasectomy patients keep their operations a secret is
feeling emasculated, but they overcome this later on. However men with poor self-image
continue to face problems
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After a vasectomy, there is still
a 1.5-% chance of pregnancy usually due to either live residual sperm or operative
failure. Some reasons for failure of a vasectomy include incomplete sealing of the vas
deferentia and the development of openings in the tubes that allow sperm to pass through.
Residual Live Sperm. After the operation there are always some
active sperm left in the semen for several months, so it is essential that the patient and
his partner continue to use another method of birth control until his sperm count is zero.
Fifteen to 20 ejaculations are required to clear the viable sperm from the reproductive
system; usually it takes a few months before sterility is complete. A semen analysis is
done about six to twelve weeks after the surgery to ensure that no live sperm remain in
the semen. The semen is usually collected at home in a small jar and delivered to the
doctor's office where it is examined under a microscope. A second semen analysis is
usually performed again about four months after the vasectomy. The patient is considered
sterile only when there is no live sperm in his semen. The presence of non-motile sperm
presents no problem.
Recanalization. When the cut ends of the vas deferens reconnect
through a process known as spontaneous recanalization, vasectomy fails. This is very rare
but may occur if a sperm granuloma deforms. Recanalization has been known to occur as soon
as a man has achieved a zero sperm count and as late as 17 months after vasectomy. The
overall risk for recanalization is only .025% or one in 4,000 vasectomies. This natural
vasectomy reversal occurs regardless of the type of vasectomy surgery. Men should have a
follow-up examination a year after the procedure to be sure that there are no residual or
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Can Vasectomy be Reversed?
Vasectomy can be reversed by a
surgical procedure known as a vasovasostomy. This restores fertility. The main reasons for
requesting a reversal are remarriage, the death of a child, or an improvement in finances.
Reversal may also be performed to relieve postvasectomy pain, which occurs in a small
percentage of men.
Vasovasostomy (reversal surgery) procedure:
surgery the severed ends of the vas deferens are reconnected to reestablish the flow of
sperm. The reversal procedure is difficult; it involves sewing together the two ends of
both tubes, each with pinhead-sized openings. If the vas deferens is blocked, the surgeon
may try to connect the epididymis to an area in the vas that bypasses the blockage. Use of
an experimental special glue instead of sutures may help reduce operation time and
difficulty. Laser surgery is being investigated and may prove to require lesser skills,
reduce operating time, and result in fewer complications.
Reversal surgery is a major operation lasting one to two hours and
requiring several days in the hospital and two to three weeks for recovery at home. It is
far more expensive than vasectomy itself, and it is even costlier if the procedure
involves connecting the vas to the epididymis, which takes about three hours. One study
reported that even when pregnancy was achieved, successful conception took an average of
one year after the vasovasostomy.
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Causes of Vasovasostomy Failure
The chances for pregnancy
decrease the longer the duration between vasectomy and the reversal operation.
Epididymis Obstruction. If the sperm count does not recover
within a reasonable period after vasovasostomy, secondary blockage of the epididymis is
most often the cause, which may be corrected with a second procedure.
Autoantibodies. In the majority of cases, the reversal procedure
reopens the epididymis, but fertility is not necessarily automatic. Autoantibodies are
produced against the sperm, when they leak into the surrounding tissues. Antibodies bind
to specific parts of the sperm (e.g., the head or tail) and cause problems depending on
the site of attachment. Sperm may stick together (agglutinate), fail to interact with
cervical mucous, or fail to penetrate the egg.
Other Vasectomy-Induced Antifertility Factors. Among their other
harmful effects is the production of particles called oxygen-free radicals (also called
reactive oxygen metabolites), that are particularly injurious to sperm thereby impairing
Reoperations after a failed vasectomy:
A repeat operation of vasovasostomy may be performed for reverting
vaasectomy. Success rates depend on several factors, including the doctor's skill,
complications from the original operation, the effects of anti-sperm antibodies, and the
time elapsed since vasectomy. Pregnancy rate is only 30%. Damage to the epididymis occurs
in 75% of men who request a repeat operation after vasovasostomy failure. This requires an
operation called vasoepididymostomy, which creates a bypass around the obstruction. To
appreciate the difficulty, one should realize that the epididymis is 1/300 of an inch wide
with a wall thickness of 1/1000 of an inch. Microscopic techniques are critical for the
success of this procedure and require a surgeon who specializes in them.
Fertility treatments after vasectomy or after a failed
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|Assisted reproductive technologies (ART)
reproductive technologies (ART) or intrauterine insemination are available for
men who want to conceive children after a vasectomy. Intracytoplasmic Sperm Injection
(ICSI) is an effective fertilisation technique for vasectomisd men. In this procedure, as
single sperm, taken from the epididymis, is injected into an egg with the aid of powerful
microscopic and robotic instruments. The fertilized egg is then implanted in the woman.
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