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Vasectomy / Vas Reversal

The most common form of male contraception in the country

Each year, about half a million men in the United States who want to practice reliable birth control without placing the burden on their female partners undergo this relatively simple surgical procedure.

Vasectomy is the clinical term given to the process of dividing the tubes that deliver sperm from testes. The procedure typically takes about half an hour and involves minimal surgery. Generally, the patient heals quickly with relatively few complications or failures, and no discernible negative impact on sexual performance. Although intended as a permanent form of male sterilization, it is sometimes
possible to reverse the process surgically at a later date.

What a Vasectomy Does and Doesn’t Do

In a vasectomy, the physician cuts and ties off the ends of the vas deferens. This prevents sperm from mixing with the seminal fluid. At ejaculation then, the semen is devoid of sperm. Although the testes will continue to produce sperm, they can no longer pass through the vas deferens.

Because semen consists of about 95% seminal fluid, there is virtually no discernible difference in the ejaculate. Similarly, because the testes continue to produce the male hormone testosterone, which is absorbed into the bloodstream, the procedure also has no effect on a man’s sex drive.

Preparing for a Vasectomy

Our physicians usually require their vasectomy patients to do three things on the day of their surgery.

  • Shave – To prevent infection, the patient should shave a 2- to 3-inch area of hair from the scrotum at the point where the penis joins the scrotum. The patient should shower thoroughly after shaving to wash away all the cut hair.
  • Bring a pair of tight jockey shorts or an athletic supporter – This is necessary to provide support for the affected area after surgery and to facilitate the placement of bandages. Because they provide no support, boxer shorts are unsuitable.
  • Additionally, patients are advised to abstain from the use of aspirin and anti-inflammatory analgesics, such as ibuprofen, for a week before surgery. These medications tend to “thin” the blood and can cause excessive postoperative bleeding in the area of the incision.

Common Questions and Concerns

How a vasectomy is performed – “no-scalpel” vasectomy

A typical vasectomy is done on an outpatient basis in our office. The physician first numbs the scrotum and vas deferens with a local anesthetic.

In recent years, many physicians, including our practice, have adopted a new surgical technique called “no-scalpel” vasectomy. This process uses a special clamp to encircle and hold the vas deferens without making an incision. A special forceps is used to penetrate the scrotum, then opened to stretch the skin, providing a small puncture through which the vas deferens can be gently lifted out, cut, sutured or cauterized, and put back in place. Because no incision has been made, the tiny opening quickly closes without the need for sutures.

Compared to the conventional vasectomy, the “no-scalpel” approach is slightly quicker (about 10 to 20 minutes), causes less postoperative discomfort and lower incidences of bleeding or infection.

What to expect during the postoperative period

Our physicians typically advise their vasectomy patients to go home immediately and lie down, elevating their feet. Although it isn’t necessary to remain immobile, excessive motion, such as that caused by walking around, increases the chance of inflammation in the scrotum and/or the area around the incision.

It is normal for the patient to feel some moderate discomfort during the first day or two after his anesthetic wears off. Ice packs, applied 15 minutes on and 15 minutes off, can help keep swelling to a minimum, and mild over-the-counter painkillers like acetaminophen can be used every 4 hours as needed. Stronger painkillers can be prescribed by the doctor, if necessary.

The patient can remove his bandage or dressing the day after surgery, although he should continue to wear his undershorts for support. It may be necessary to place gauze inside the shorts for a few days to protect against any bleeding or seepage from the incision as it heals.
It is all right to shower the next day. The patient should not take a bath or go swimming for several days, however.

In general, strenuous exercise and heavy lifting should be avoided for 2 or 3 days – longer if discomfort persists. Thereafter, the degree of discomfort should guide one’s activity, including athletic and sexual activity. Although patients typically can return to work within 3 days, most report that it takes them at least a week before they feel completely “normal” again.

Sterility

It is important for the patient to realize that the vasectomy does not produce instant sterilization. A substantial amount of sperm still remain in the vas deferens beyond the portion that was removed. In most men, it takes from 10 to 14 ejaculations over the next 2 months or so before a sperm count of zero is reached. The patient typically is asked to produce a semen sample for analysis at about 3 months after surgery. Until then, another form of reliable birth control should be practiced.

In rare cases, patients continue to show sperm in their samples for up to a year after surgery. This may be the result of poor sperm migration out of the vas deferens after surgery, or it may indicate that the severed ends of the vas deferens have reattached themselves to one another, a condition called recanalization. The only solution to this problem is a repeat vasectomy.

The incidence of vasectomy failure is estimated between .5% and 1% and varies with the skill and experience of the physician and with the approach used to block the tubes. It is for this reason that testing semen samples is essential. If, in the unlikely event that repeated semen checks show persistent live moving sperm, your vasectomy will have to be repeated.

Possible complications

Although complications are rare with vasectomies, any surgical procedure, no matter how simple, carries some degree of risk. Some patients experience more pain, bleeding or inflammation than others, and their discomfort may persist longer than normal. Often this is caused by a buildup of back pressure within the vas deferens, and will eventually subside.

Occasionally a condition called sperm granuloma will develop, in which residual sperm find their way out of the tied ends of the vas deferens, producing irritation and a small nodule. These usually heal with time, although surgical removal is occasionally required.

Can a vasectomy be reversed?

While the intent of a vasectomy is to produce a permanent condition of male sterility, there are two microsurgical procedures that have been successful at restoring the flow of sperm through the vas deferens. Our office does provide these vasectomy reversals.

The most common, called vasovasostomy, involves stitching the disconnected ends of the vas deferens back together with ultra-fine sutures. This procedure uses microsurgical methods involving a microscopic camera and very small tools.

The other reversal procedure, called vasoepididymostomy, is performed when inflammation or scarring from the original vasectomy blocks the epididymis – the tubular structure connecting the testes to the vas deferens. In this microsurgical procedure, the blockage is bypassed by surgically connecting the vas deferens directly to the epididymis in a new location.

Urology Associates of Danbury does provide vasectomy reversals to our interested patients.

Arranging Your Vasectomy Appointment

Call our office to receive your informational packet in the mail to review in the comfort of your home.

If you are interested in obtaining a vasectomy, please phone our office at 203.748.0330 to arrange an appointment. You will be sent an informational packet, which you can review in your own home.

Typically we do the consultation and the vasectomy in the same visit, however, if you would prefer to speak to our physician first, we will gladly arrange that for you.

Most health insurers cover the vasectomy procedure but it is always best for you to check with your individual plan or the human resource representative where you work to make certain of your coverage.

While the intent of a vasectomy is to produce a permanent condition of male sterility, there is a microsurgical procedure that has been successful in restoring the flow of sperm through the vas deferens. This procedure is called a vasovasostomy and is done on an outpatient basis. Dr. Gorelick and Dr. Beck have had extensive microsurgical training.

Vasovasostomy

Vasectomy Reversal

A vasovasostomy involves stitching the disconnected ends of the vas deferens back together with ultra-fine sutures. This procedure uses microsurgical methods involving very fine instruments. At times, a vasoepididymostomy is performed. This involves stitching the end of the vas deferens to the epididymis (the tube draining sperm out of the testes).

Urology Associates of Danbury, P.C. enjoys excellent success rate with these procedures and have performed many vasectomy reversal procedures under the operating room microscrope. A vasectomy reversal is more significant surgery than the vasectomy and you will usually have some modest discomfort. You will need to wear a scrotal support for several weeks afterwards and excessive lifting, straining or intercourse will be prohibited for approximately six weeks following the surgery.

Our doctors may prescribe antibiotics, but they are optional and are not always necessary as it is rare that infection develops. If pain occurs, oral analgesics can effectively be prescribed.

For reasons that have not been clearly determined by medical science, it may take you a long time to see resulting sperm even when the reversal is successful. The success of the procedure cannot be judged until an entire year has passed from the surgery. However, the semen analysis is checked during this period to see at what point there is sperm and to see its quality. Many men who have a vasovasostomy (vas to vas connection) will see sperm fairly soon after the operation. Other men, especially those who have had vaso-epididymostomies may need to wait a full year.

The chances of resulting sperm in the ejaculate after a vasectomy reversal are excellent. Although this does not guarantee pregnancy, the chances of a subsequent pregnancy are still high. However, the chance of pregnancy declines with increasing time from the reversal procedure.

Keep in mind that the sperm produced from the resulting vasectomy reversal can also be used with additional assisted reproductive techniques to significantly increase the chances of a pregnancy.