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VASECTOMY -- Patient Education Handout Every man has a basic right to a vasectomy, a valuable medical procedure. Before you actually have a vasectomy, you should think about it carefully, because a vasectomy is designed to be permanent. Vasectomy is a small procedure, but a large decision. When children are definitely not wanted in the future, vasectomy relieves the man and woman from fear of pregnancy. In today’s world, it is important for men to have a responsible role in birth control.
How is the procedure performed? Usually the doctor gives an injection of local anesthetic into the skin of the scrotum (the sac holding the testicles). This may feel like a brief pinch. The anesthetic numbs the area. The doctor then makes one or two small, half-inch openings, gently pulls up each tube (vas deferens), cuts it, and burns or ties it shut. The procedure takes about 30-60 minutes to complete. What is the “no-scalpel” method of doing vasectomy? The “no-scalpel technique” is a method developed by Dr. Li, a Chinese physician. The doctor uses a special instrument instead of a scalpel to enter the scrotum. This instrument has a sharp point and spreads the skin instead of cutting it. This makes a smaller opening, and may cause less bleeding and less pain after the procedure. When can I go back to work? You should have a day or two of rest after the vasectomy. You should avoid heavy lifting or other strenuous activity for at least one week. Is there much pain after vasectomy? No. You may experience a few days of mild discomfort, like a pulling or aching feeling in the groin. This discomfort can usually be relieved with ibuprofen (Advil or Nuprin) and good support with tight underwear. Some bruising may occur, but this is perfectly normal. A very small number of men have more serious side effects, such as significant bleeding, infection, or painful sperm leakage (sperm granuloma). Will my sex life be affected? That depends: If a couple has been worried about pregnancy, their sex life could improve, especially as they come to trust the vasectomy. The procedure does not change anything, except that there will no longer be sperm in the semen. Sex, orgasm, and ejaculation are not affected, However, if you do not want a vasectomy and are having one because you think you should, or because your partner wants you to, then you may note some resentment. If you have been worried about other facets of your sex life before the procedure, chances are that a vasectomy will not improve those other conditions. When can I have sex again? You should wait one week until some healing has taken place. Use another form of birth control until your semen has been examined and no sperm is present. When is the vasectomy effective? It is effective when the semen has been tested and has been found to be free of sperm. A sperm count is usually done 6 weeks after the procedure, and after at least 15 ejaculations. What happens if my vasectomy is not successful? In the rare cases where the sperm can still get through, a repeat vasectomy may be required. When I have an orgasm, will I still ejaculate? Yes. The sperm are produced by the testicles, and they make up only 5% of the semen (the fluid that is produced with ejaculation). The other 95% of semen is produced by other glands that continue to function normally. Unless the semen is placed under a microscope, it is impossible to tell whether or not sperm are present. What happens to sperm after a vasectomy? The sperm continue to be produced by the testicles, but their passage to the penis is blocked. Therefore, the sperm cells break down in the body and their component parts are recycled. This process is normal and it occurs in men who have not had a vasectomy. What are the complications? In a few cases, a small blood vessel may continue to bleed inside the scrotum, causing bruising or even a larger accumulation of blood. Infection in the scrotum may also occur. Pain after a vasectomy is generally quite minimal; on a scale of 1 to 10, it is rated a 3. Failure rates vary between 1 per 200 and 1 per 1,500 vasectomies. Recently, there have been some concerns that having a vasectomy may increase the chances of prostate cancer. After careful review of all the data, several major organizations, including the American Cancer Society and the National Institute of Health, have concluded that there should be no change in vasectomy recommendations. Similarly, there do not appear to be any increased risks of any other diseases. Is vasectomy reversible? Vasectomy should always be considered permanent, so do not undergo a vasectomy if you feel there is any chance you will change your mind. 40-50% of the reversal operations are unsuccessful. What are the other options for contraception? There are many other temporary and reversible options for contraception: condoms, spermicides, diaphragm, IUD, Norplant, contraceptive sponge, and birth control pills. Is vasectomy anything like castration? No. Castration means removal of the testicles. Vasectomy does not touch the testicles and does not reduce the production of male sex hormones. Are there men who should not have vasectomies? Perhaps. Some examples are men who feel masculine only when they can cause a pregnancy; men or partners who change their minds a lot; men who may get divorced and then marry someone else who wants children; men who think they might want children later. We will consider performing a vasectomy for any man who has seriously thought about the implications of his decision and who feels quite sure he has had all the children he will ever want. This applies equally to men who are single, married, divorced, widowed, childless, or with families, regardless of age. Why do you offer only local anesthetic? There are certain well-established health risks associated with general anesthesia. Because vasectomy is such a simple and quick procedure, we feel that it is unwise to subject our patients to these unnecessary risks. While some doctors use general anesthesia, the vast majority of vasectomies in the United States are performed using local anesthesia. Do you need the consent of my partner? Only your written consent is required, although it is wise for you to discuss this decision with your partner. Her consent is not required by law. However, we prefer to have her present during counseling, if possible. What can I expect after vasectomy? After the procedure, you will need to remain in the office for a short time, and when you leave, you should take it easy for the rest of the day. It is a good idea to take another day or two off work. You may shower the next day. For adequate support, you should wear tight cotton briefs or an athletic supporter for the next 2-weeks. Some men get bruising that can be quite extensive. This is quite harmless and is caused by leakage of blood under the skin. It fades slowly. Some men ache about 6-hours after the procedure. Others may begin to ache about 5-days after the procedure. If swelling or pain persists, or if the incision looks infected, call your physician. If you can let the area heal for 7-days before having an ejaculation, you are more likely to have a successful result. What should I do to prepare for the day of surgery? · Do not take any aspirin for 2-weeks before surgery. You may use acetaminophen (Tylenol). · Clip the hair in front of the scrotum with a scissors. A razor can cut the skin and lead to infection. · Shower before coming into the office. Wash well with soap and water. · Take 3 or 4 ibuprofen 200 mg tablets (Advil or Nuprin) 2-hours before surgery. · Bring in your jock-strap or tight, snug-fitting underwear to the office with you. Bibliography: Pfenninger and Fowler, Procedures for Primary Care Physicians, c1994, Mosby.
VASECTOMY QUESTIONNAIRE After you have read the Vasectomy Patient Education Handout, please answer the following questions. It is simply to confirm that you understand the procedure. If you answer some of the questions incorrectly, the counselor or doctor will discuss them with you. Please circle the correct answer.
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