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Vasectomy: Everything You Need to know Before Getting One

by Dr. Jed Kaminetsky

Dr. Jed Kaminetsky
Dr. Jed Kaminetsky

Dr. Jed Kaminetsky M.D. is an American Board Certified Urologist and earned his Medical...

Board Certified Urologist, expert in male sexual dysfunction

What is a Vasectomy?

vasectomy is a simple operation performed on an adult male to prevent impregnation of a female partner during vaginal intercourse.

The operation stops sperm from entering the semen during ejaculation. Without sperm present, even a healthy egg cannot become fertilized in a woman's reproductive organs and the woman will not become pregnant.

Vasectomy does not affect erections, orgasm or ejaculation. It blocks the flow of sperm which makes up only 1-2% of ejaculate volume so patients or partners won’t notice any difference. For this reason, it is sometimes referred to as "male sterilization."

Before we jump in further, let's cover the most frequently asked questions about vasectomies. 

Quick FAQs

Vasectomies range in cost from $300 to $3,000, including follow-up appointments. The cost of a vasectomy depends on where it is performed, what methods are used, and how much is covered by your insurance.

Vasectomies can be reversed but are designed to be permanent. Vasectomy reversals are less likely to be covered by insurance. Expect to fork up anywhere from $3,500 to $15,000 for full vasectomy reversal.

A vasectomy has no effect on sexual arousal, orgasm, or ejaculation. A vasectomy will neither cause premature ejaculation nor will it eliminate premature ejaculation.

No, a vasectomy affects none of your hormone levels, including testosterone. It merely prevents your testicles from supplying sperm to the seminal vesicles.

How is a Vasectomy Performed

vasectomy is performed by a doctor in his or her office or clinic. The doctor makes small cuts in the scrotum to access the vas deferens, tubes that connect the testicles to the seminal vesicles and supply sperm to the seminal mixture. How a Vasectomy Procedure is Performed

The doctor will cut the vas deferens so that semen can no longer be delivered to the seminal vesicles. The doctor might accomplish this by:

  •    Removing a small segment of the vas deferens, leaving a gap that sperm cannot cross.

 

  •    Cauterizing (searing) the cut portion of the vas deferens, creating a blockage that semen cannot circumvent.

The procedure may be accomplished with one cut, or with two. Doctors have two options for the cutting method:

No-Scalpel Method

The aptly-named "no-scalpel" method of vasectomy uses no scalpel for the incision.

Instead, the doctor makes a single small opening in the scrotum, spreads it open, removes a small segment of the vas deferens through the small opening, clamps it, and completes the procedure with the vas deferens outside the body.

The doctor then seals or cauterizes the cut ends of the vas deferens and replaces them in the scrotum. This procedure is usually faster than the incision method and requires no stitches.

Incision Method

The incision method of vasectomy involves two small cuts made with a scalpel on either side of the scrotum.

The doctor can then remove a portion of the vas deferens and seal the cut ends by tying them, sealing them, or cauterizing them with a minor electrical current. The incisions in the scrotum are then sealed with stitches. The procedure usually takes about 10 - 20 minutes under local anesthetic or conscious sedation ("twilight anesthesia").

gif-example-vasectomy-surgery

Which One is Better?

Because it is faster and requires no stitches, the no-scalpel method is becoming more common.

In addition to these benefits, no-scalpel vasectomies have shown to carry less than 5% the risk of blood clots, infection, and other complications.

Talk to your doctor about which method is best for you.

Both methods are outpatient procedures that do not require a general anesthetic.

How Effective is a Vasectomy?

As a method of birth control, a vasectomy is close to 100% effective. The separated or blocked vas deferens rarely reconnect on their own.

Note; sperm may still be present in the seminal vesicles up to three months or longer after the procedure.

Continue using your current method of birth control until your doctor confirms on a follow-up appointment that your semen is free of sperm.

Success Rate and What That Would Look Like

Less than 1% of vasectomies fail.

They are designed to be a permanent, reliable procedure to sterilize the semen of an adult male. After the vasectomy has been confirmed to be effective, a man can expect to have vaginal intercourse as often as desired, with no other form of birth control, and never fertilize the eggs of his partner.

Note; that vasectomy does not guard against sexually transmitted diseases or infections.

Failure Rate—What Could Go Wrong and What Should You Do

  •        The best calculations put the chances of a spontaneous rejoining of the vas deferens at 0.15%.
  •        Impregnation after a vasectomy usually occurs within the first three months after the procedure, when is still present in the seminal vesicle.
  •        Wait to stop other birth control methods until the doctor confirms your semen is sterile on follow-up.

Are Vasectomies Reversible?

Vasectomies are designed to be permanent but can be reversed with a second procedure.

However, vasectomies are only recommended for men who are very confident that they no longer want to father biological children via fertilization through vaginal intercourse.

Even in that circumstance, the vasectomy does not prevent the transmission of many sexually transmitted infections, so condom use is still recommended under a variety of circumstances.

In practice, vasectomies can often be reversed through a second procedure to re-attach the vas deferens.

Be advised, that the procedure to reverse a vasectomy is much more complicated than the vasectomy itself—longer, more invasive, with a more disruptive and uncomfortable recovery process.

How Common Are Vasectomy Reversals?

Vasectomy Advantages

  •    With a 99.85% success rate, a vasectomy is one of the most effective forms of birth control, and one of the few under the control of a man.

 

  •    Long-term side-effects are very uncommon. The procedure almost never has any long-term impact on your sex drive, hormone levels, or sexual enjoyment.

 

  •    The procedure is also much more safe, less invasive, and simpler than female sterilization operations.

 

  •    A vasectomy may be the best alternative for couples who prefer sex without condoms, but one or the other partner cannot tolerate other forms of birth control for various reasons.

 

  •    The procedure is quick, does not require a general anesthetic, and can be performed as an outpatient procedure.

Vasectomy Disadvantages

  •    Vasectomies do not prevent the spread of sexually-transmitted infections (STI) or sexually transmitted diseases.

 

  •    Vasectomies are designed to be permanent and hard to reverse. Vasectomy reversals are less likely to be covered by insurance.

 

  •    You must continue to use alternate forms of birth control up to three months or longer after the procedure, as live sperm may still be present in the seminal vesicles and could induce fertilization and pregnancy.

 

  •    The vas deferens can spontaneously reconnect on very rare occasions, replenishing the semen with sperm that could cause pregnancy without warning.

 

  •    While minor, a vasectomy is an invasive surgery with some pain and discomfort associated with recovery.

Complications With The Procedure

vasectomy is relatively safe. Complications are rare, but could include:

  •    Hematoma: a blood clot in the scrotum, resulting in pain and swelling, possibly requiring surgical removal.

 

  •    Sperm Granuloma: an accumulation of sperm leaking from the vas deferens, causing hard clumps of sperm to form around the tissue. Although small, these lumps can become very uncomfortable and require surgical removal.

 

  •  Infection: bacteria could enter the scrotum through the incision, or the incision could become infected. Symptoms include redness, tenderness, and fever. Infection at the site of the vasectomy requires immediate medical attention and treatment with antibiotics.

 

  •    Testicular Pain: this could be incisional pain or a pinched nerve and can occur weeks after the surgery. The duration of the pain is unpredictable and may indicate the need for further surgery.

 

  •    Feeling of "Fullness" in the Testicles: caused by an overproduction of sperm with nowhere for it to go. As the body adjusts, it will produce less sperm, and the sensation should abate within a few weeks.

What is the Cost of a Vasectomy?

 Vasectomies range in cost from $300 to $3,000, including follow-up appointments. The cost of a vasectomy depends on where it is performed, what methods are used, and how much is covered by insurance.

Does Insurance Cover Vasectomies?

Most health insurance plans will cover some or part of an outpatient vasectomy procedure.

Note; deductibles, co-insurance, and out-of-pocket maximums may apply, so you may still owe money even if your insurance technically covers the procedure.

If you don't have health insurance, your state's Medicaid programs may cover some of the costs.

Health insurance may not cover any of the costs of reversing a vasectomy. Expect to fork up anywhere from $3,500 to $15,000 for full vasectomy reversal.

Also, keep in mind that your fertility success rate will vary greatly.

Will Getting a Vasectomy Affect my Testosterone Levels?

No, a vasectomy affects none of your hormone levels, including testosterone. It merely prevents your testicles from supplying sperm to the seminal vesicles.

Testosterone is supplied to the body through a different mechanism.

Vasectomies and Sexual Performance

Reports of a vasectomy negatively affecting a man's sexual performance are rare.

In fact, studies performed in 2015 by Stanford University indicate that men who have vasectomies tend to have more sex than men who have not had vasectomies.

A study performed in 2017 by Frankfurt University found that test subjects reported increased sex drives after undergoing a vasectomy.

The vas deferens plays no role in erection, orgasm, or ejaculation. Cutting them has no effect on sexual performance other than depriving the semen of sperm.

Note that in rare cases, sperm can continue to live in the seminal vesicles up to three months after the procedure. Typically, a semen analysis will be conducted at 6 weeks and 98% of men have no sperm, however, 1-2 will have non-motile sperm.

Vasectomy Effects on Premature Ejaculation

A vasectomy has no effect on sexual arousal, orgasm, or ejaculation. A vasectomy will neither cause premature ejaculation nor will it eliminate premature ejaculation. Men suffering from premature ejaculation must treat the condition by other means.

Vasectomy Effects on Erection

A vasectomy does not affect erectile tissue, which fills with blood upon arousal and causes the penis to become erect, either through sexual activity with a partner or through masturbation. 

Neither does a vasectomy affect the mechanisms of male sexual arousal. A vasectomy is highly unlikely to cause or cure any form of erectile dysfunction.

Are There Any Alternatives to Vasectomies?

A vasectomy is the only form of medical sterilization currently available to males.

Men concerned about the procedure or its after-effects must rely on other forms of birth control to prevent pregnancy.

Vasectomies vs. Condoms

While condoms are inexpensive, they are disposable. Over the long run, a vasectomy may actually be cheaper than condom use.

Based on reports by the Kinsey Institute on the sexual behavior of males between the ages of18 and 69, the average male has sex 3,804 times. Conservatively estimating a cost of $0.75 per condom,the average male in question would spend $2,853 on condoms!

Impeccable use of condoms prevents pregnancy 98% of the time. Many people fail to use condoms properly, however, resulting in an effective prevention rate of only 85%. By contrast, a vasectomy is over 99% effective.

Many people prefer the sensation of sexual intercourse without condoms, making a vasectomy an attractive option compared to condom use.

Importantly, a vasectomy has no effect on the transmission of sexually-transmitted diseases or infections, while condoms greatly reduce their spread when used properly.

Condom use is therefore recommended for sexual intercourse outside of trusted, monogamous or "fluid-bonded" relationships. Fluid-bonded partners only use condoms with other sexual partners, using no condoms while having intercourse together.

Vasectomies vs. Pull Out

The "pull-out method," also known as "coitus interruptus," "withdrawal," or "pull-and-pray," is one of the most ancient forms of birth control, particularly in remote or impoverished areas.

When performed perfectly, it has a success rate of 96% to 98% in preventing pregnancy.

However, sperm can still be present in pre-ejaculatory fluid emitted by the penis. The pull-out method is therefore widely considered an unreliable form of birth control, especially stacked up against the 98.85% effectiveness of vasectomy in preventing pregnancy.

Many couples prefer the sensation and intimacy of the male ejaculating inside the vagina, making a vasectomy more attractive for long-term sexual satisfaction.

Vasectomies vs. Female IUD

Illustration of Female IUD Device

Afemale intrauterine device (IUD) is one of the most effective forms of reversible contraception. The device lasts up to ten years, but insertion and removal can cause the woman discomfort. Discomfort after insertion is rare.

The failure rate of an IUD has been estimated between 0.2% and 0.8%—highly effective compared to other methods, but still less effective than vasectomy with its 0.15% failure rate.

When Can I Start Having Sex Again After the Procedure?

You can start having sexual activity as soon as the post-operative discomfort subsides and you feel up to it.

As discussed before, however, other methods of birth control should continue to be used until the semen is confirmed to be sperm-free in follow-up lab tests.

This could be up to three months, twenty ejaculations, or even longer after the operation. Until this time, live sperm remaining in the seminal vesicles could still impregnate a partner.

How Long Does It Take to Recover from a Vasectomy? 

Recovering from a vasectomy may vary among patients but typically patients who undergo procedure on Friday will make it to work on Monday.

What the Recovery Process is Like

The scrotum has been cut and must heal. This process can entail some pain or mild discomfort, bruising, and/or swelling. Mild or moderate painkillers will usually ease the recovery.

Speak to your doctor if pain persists and you think you need stronger pain-management medication.

The first several ejaculations after the procedure may contain blood. This might look alarming, but is no cause for concern. The semen will abate shortly.

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Dr. Jed Kaminetsky
Dr. Jed Kaminetsky

Dr. Jed Kaminetsky M.D. is an American Board Certified Urologist and earned his Medical Degree at New York University. In his tenure he became a member of the American Urological Association and the American College of Surgeons. Dr. Kaminetsky pioneered the minimally invasive Rezum BPH treatment and is an expert in male and female dysfunction.


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