Vasectomy is an effective and permanent form of contraception. The operation is quicker, easier and more effective than female sterilisation. There is a very small failure rate. Sterilisation is only for people who have decided they do not want children, or further children in the future. It is considered a permanent method of contraception, as reversal is a complicated operation which is not always successful. In addition, reversal is not usually available on the NHS.
What is vasectomy?
Vasectomy is a small operation to cut the vas deferens. This is the tube that takes sperm from the testes to the penis. Sperm are made in the testes. Once the vas deferens is cut, sperm can no longer get into the semen that is ejaculated (comes) during sex.
How reliable is vasectomy?
Vasectomy is very reliable - but not quite 100%. Even after a successful operation about 1 in 1,000 men who have had a vasectomy will become fertile again at some point in the future. This is because, rarely, the two ends of the cut vas deferens re-unite over time. (When no contraception is used more than 800 in 1000 sexually active women will become pregnant within one year.) About 1 in 1,000 operations are not successful and tests show sperm are still present in semen after the operation.
How is a vasectomy done?
Vasectomy is usually done under a local anaesthetic. Sometimes it is done under a general anaesthetic.Local anaesthetic is injected into a small area of skin on either side of the scrotum above the testes. A small cut is then made to these numbed areas of skin.
The vas deferens can be seen quite easily under the cut skin. It can be cut with a scalpel (surgical knife) or using diathermy. Diathermy is electrical current that cuts the skin and stops bleeding at the same time. This is now more common. The small cuts to the skin are then stitched or stuck back together with tape. Dissolvable stitches are used if the cut is stitched. The operation takes about 15 minutes.
There is usually some discomfort and bruising for a few days afterwards. This normally goes away quickly. The discomfort can be helped by wearing tight-fitting underpants day and night for a week or so after the operation. It is also best not to do heavy work, exercise or lifting for a week or so after the operation.
Are there any risks to the operation?
Most men have no problems after a vasectomy. Problems are uncommon but include the following:
- As with any operation or cut to the skin, there is a small risk of a wound infection.
- The bruising around the operation site is sometimes quite marked, but will go in a week or so.
- Rarely, sperm may leak into the scrotum and form a swelling which may need treatment.
- A small number of men have a dull ache in the scrotum for a few months after the operation. This usually settles over time.
- Between 1 and 3 men out of 10 develop congestive epididymitis which may cause chronic testicular pain. This may not settle over time.
- If you have a general anaesthetic, as with any operation, there is a small risk associated with the anaesthetic.
How do I know it has been successful?
Some sperm survive in the upstream part of the vas deferens for several weeks after vasectomy. These can get into the semen for a while after the operation. About eight weeks after the operation you will need to produce two semen tests about 3-6 weeks apart. These are looked at under the microscope to check for sperm. If these have no sperm in them, you will be given the all clear.
You still need to use additional contraception, such as condoms, until you get the all clear.
What are the advantages of vasectomy?
What are the disadvantages of vasectomy?
It may take a few months before the semen is free from sperm. As it is permanent, some people regret having a vasectomy, especially if their circumstances change.
Will it affect my sex drive?
No. The sex hormones made by the testes (for example testosterone) continue to be passed into the bloodstream as before. Also, vasectomy does not reduce the amount of semen when you ejaculate (come) during sex. Sperm only contributes a tiny amount to semen. Semen is made in the seminal vesicles and prostate higher upstream.
Sex may even be more enjoyable, as the worry or inconvenience of other forms of contraception are removed.
What happens to the sperm?
Sperm are still made as before in the testes. The sperm cannot get past the blocked vas deferens and are absorbed by the body.
Some other points about vasectomy
Don't consider having the operation unless you and your partner are sure you do not want children, or further children. It is wise not to make the decision at times of crisis or change, such as after a new baby or termination of pregnancy. It is best not to make the decision if there are any major problems in your relationship with your partner. It will not solve any sexual problems.
Doctors normally like to be sure that both partners are happy with the decision before doing a vasectomy. However, it is not a legal requirement to get your partner's permission.
Some common questions about vasectomy
Is vasectomy done on the NHS? Yes most men have a vasectomy done on the NHS. However, waiting lists may vary throughout the country. Some men prefer to have it done at a private clinic or hospital.
Does the operation hurt? No more than any other minor operation that uses local anaesthetic. The injection of local anaesthetic may sting a bit for a few seconds. It is put in just a small area of skin, so it is nothing to worry about. After this, the operation is usually painless. After the operation, when the local anaesthetic wears off, the top part of the scrotum is normally mildly sore for a few days. Ignore any scare stories that seem to be a favourite joke topic for some men.
What if I change my mind? Vasectomy is considered permanent. There is an operation to re-unite the two cut ends of the vas deferens. It is a difficult operation and not always successful. It is also not available on the NHS, so you would have to pay for this yourself.
How soon after the operation can I have sex? You can resume sex as soon as it is comfortable to do so. However, remember you will have to use other methods of contraception (such as condoms) until you provide two semen specimens which are clear of sperm. Some sperm will survive upstream from the cut vas deferens for a few weeks.
I have heard that there is an increase in the risk of prostate cancer after vasectomy. Is this true? No. A few years ago there was a scare about a possible link. Since then several surveys have been done and have shown that there is no link between vasectomy and an increased risk of any cancer.
Further help & information
Dr Tim Kenny
Dr Hayley Willacy
Dr John Cox