Bilateral Vasectomy

(Adapted from Association of Biomedical Andrologists, British Andrology Society and British Association of Urological Surgeons 2016 guideline)

What is Vasectomy?

  • A vasectomy involves cutting the two tubes (vas deferens) that carry sperm carry sperm from your testicles to your penis.
  • A vasectomy will not affect your sex drive or ability to enjoy sex.
  • You will still have erections and produce the same amount of fluid when you ejaculate. The only difference is that the fluid will not contain sperm.
  • Your body will still produce sperm, but they can’t travel out through your penis and are naturally reabsorbed by the body.

How reliable is vasectomy?

  • Vasectomy is a reliable method of permanent contraception – but not quite 100%. About 1 in 1000 operations are not successful, and semen tests show sperm still present after the operation.
  • Even after a successful operation about 1 in 2000 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 in time (Late recanalisation).

What should I expect before the operation?

  • Before surgery you will be asked to sign a consent form.
  • This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

What are the alternatives?

The alternatives to vasectomy include long-term contraceptive options for women.

Can Vasectomy be reversed?

  • A vasectomy should be considered a permanent operation.
  • However, some men come to regret the operation and want it reversed. A vasectomy reversal operation rejoins each of the tubes that carry sperm from the testicles to the penis, which were cut during a vasectomy. However, this doesn’t guarantee that your fertility will be restored and it is not funded by the NHS.

How is a vasectomy done?

  • It will be done in the procedure room at outpatient clinic as a day case, which means that you can have the operation and go home the same day.
  • It is usually done with a local anaesthetic (but is sometimes 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 is cut, and the two ends are tied. The small cuts to the skin are then stitched back together with dissolvable stitches. The operation takes about 20-30 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.
  • Bleeding inside the scrotum can make it swollen and painful. This is called a haematoma and may require further surgery.
  • It is possible for sperm to leak out of the cut tubes and collect in surrounding tissues. If this happens, hard lumps, called sperm granuloma (up to 10%), can form. Sperm granuloma is not harmful, and can be treated with anti-inflammatory medicines. However, occasionally they can be painful and need to be removed (2-3%).
  • A small proportion of men develop long-term testicular pain (chronic testicular pain in 5%).This may be due to pinched nerves or scarring, congestive epididymitis as a result of elevated pressures in closed-ended vasectomy and may require further surgery.
  • Vasectomy failure is expected in 1 out 1000 men who undergo a vasectomy.
  • Very rarely, even when performed correctly, there is a very small risk about 1 in 2000 (0.04%-1%) the tubes can rejoin naturally and you will become fertile again.
  • If you have a general anaesthetic, as with any operation there is a small risk associated with the anaesthetic.

Recovering from vasectomy:

  • On the day of surgery: you will need to arrange for someone to drive you home and then stay with you for the first 24 hours
  • It’s sensible to take it easy for a few days, but you can drive and go back to work as soon as you feel able.
  • For as long as you need, wear close-fitting underwear, such as a jock strap, day and night. This will support your scrotum and help to ease any discomfort and swelling.
  • Don’t do any heavy lifting or vigorous exercise during the first week after the operation.
  • You can bathe and shower but you should dry the area gently and thoroughly.
  • You can have sex as soon as you feel comfortable but you should use another form of contraception until the live sperm that remain in the tubes have gone.

How do I know it has been successful?

You will need to have one semen test to ensure that your tubes are clear of sperm. The semen sample will be three months after surgery.

You need to have 20 ejaculates by 3 months so you can give a semen sample

If these semen samples are clear of sperm (azoospermia ), you will be given the ‘all clear’ and you can stop all contraception methods. You may be given ‘special clearance’ if semen analysis after 3 months from the Vasectomy showed less than 100,000 per ml non-motile sperm (as the risk of pregnancy is still small and no more than the risk of pregnancy after 2 azoospermia as a result of re-canalisation)

You still need to use other forms of contraception, such as condoms, until you get the ‘all clear’.