Vasectomy
Vasectomy
Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives
Definition
A vasectomy is a surgical procedure performed on adult males in which the vasa deferentia (tubes that carry sperm from the testicles to the seminal
vesicles) are cut, tied, cauterized (burned or seared), or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but the sperm die and are absorbed by the body.
Purpose
The purpose of the vasectomy is to provide reliable contraception. Research indicates that the level of effectiveness is 99.6%. Vasectomy is the most reliable method of contraception and has fewer complications
KEY TERMS
Ejaculation— The act of expelling the sperm through the penis during orgasm. The fluid that is released is called the ejaculate.
Epididymitis— Inflammation of the small tube that rests on top of the testicle and is part of the system that carries sperm from the testicle to the penis. The condition can be successfully treated with antibiotics, if necessary.
Scrotum— The sac that contains the testicles.
Sperm granuloma— A collection of fluid that leaks from an improperly sealed or tied vas deferens. The fluid usually disappears on its own, but can be drained, if necessary.
Testicles— The two egg-shaped organs found in the scrotum that produce sperm.
Tubal ligation— A female sterilization surgical procedure in which the fallopian tubes are tied in two places and cut between. This prevents eggs from moving from the ovary to the uterus.
Vas deferens (plural, vasa deferentia)— The Latin name for the duct that carries sperm from the testicle to the epididymis. In a vasectomy, a portion of each vas deferens is removed to prevent the sperm from entering the seminal fluid.
Vasovasostomy— A surgical procedure that is done to reverse a vasectomy by reconnecting the ends of the severed vasa deferentia.
and a faster recovery time than female sterilization methods. Some insurance plans will cover the cost of the procedure.
Demographics
Approximately 500,000 vasectomies are performed annually in the United States. About one out of every six men over the age of 35 has had a vasectomy. Higher vasectomy rates are associated with higher levels of education and income.
Description
Vasectomies are usually performed in the doctor’s office or an outpatient clinic using local anesthesia. The area around the patient’s scrotum (the sac containing the testicles that produce sperm) is shaved and cleaned with an antiseptic solution to reduce the chance of infection. A small incision is made in the scrotum. Each vas deferens (one from each testicle) is tied in two places with nonabsorbent (permanent) sutures and the tube is severed between the ties. The ends may be cauterized (burned or seared) to decrease the chance that they will leak or grow back together.
“No-scalpel” vasectomies are gaining in popularity. Instead of an incision, a small puncture is made into the scrotum. The vasa deferentia are cut and sealed in a manner similar to that described above. No stitches are necessary and the patient has less pain. Other advantages include less damage to the tissues, less bleeding, less risk of infection, and less discomfort after the procedure. The no-scalpel method was developed in China in the mid-1970s and has been used in the United States since 1988. About one-third of vasectomies in the United States are performed with this technique.
The patient is not sterile immediately following the procedure. Men must use other methods of contraception until two consecutive semen analyses confirm that there are no sperm present in the ejaculate. It takes about four to six weeks, or 15–20 ejaculations, to clear all of the sperm from the tubes.
In some cases, vasectomies may be reversed by a procedure known as a vasovasostomy. In this procedure, the surgeon reconnects the ends of the severed vasa deferentia. A vasectomy should be considered permanent, however, as there is no guarantee of successful reversal. Vasovasostomies are successful in approximately 40–50% of men, although the success rate varies considerably with the individual surgeon. In the mid 2000s between 6% and 12% of American men were requesting reversals of their vasectomies. The cost of the procedure in the United States can be considerable, ranging from $5,000–20,000.
Diagnosis/Preparation
No special physical preparation is required for a vasectomy. The physician will first assess the patient’s general health in order to identify any potential problems that could occur. The doctor will then explain the possible risks and side effects of the procedure. The patient is asked to sign a consent form that indicates that he understands the information he has received, and gives the doctor permission to perform the operation.
Aftercare
Following the surgery, ice packs are often applied to the scrotum to decrease pain and swelling. A dressing (or athletic supporter) that supports the scrotum can also reduce pain. Mild over-the-counter (OTC) pain medication such as aspirin or acetaminophen
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Vasectomy is a minor procedure that can be performed in a clinic or doctor’s office on an outpatient basis. The procedure is generally performed by a urologist, who is a medical doctor that has completed specialized training in the diagnosis and treatment of diseases of the urinary tract and genital organs.
(Tylenol) should be able to control any discomfort. Activities may be restricted for one or two days, and no sexual intercourse for three or four days.
Risks
There are very few risks associated with vasectomy other than infection, bruising, epididymitis (inflammation of the tube that carries the sperm from the testicle to the penis), and sperm granulomas (collections of fluid that leaks from a poorly sealed or tied vas deferens). These complications are easily treated if they do occur. Patients do not experience difficulty achieving an erection, maintaining an erection, or ejaculating. There is no decrease in the production of the male hormone (testosterone), and the patient’s sex drive and sexual performance are not altered. Vasectomy is safer and less expensive than tubal ligation (sterilization of a female by cutting the fallopian tubes to prevent conception).
According to both the World Health Organization (WHO) and the National Institutes of Health (NIH), there is no evidence that a vasectomy will increase a man’s long-term risk of testicular cancer, prostate cancer, or heart disease.
Normal results
Vasectomies are more than 99% successful in preventing conception. As such, male sterilization is one of the most effective methods of contraception available.
Morbidity and mortality rates
Complications occur in approximately 5% of vasectomies. The rates of incidence of some of the more common complications include:
- mild bleeding into the scrotum: one in 400
- major bleeding into the scrotum: one in 1,000
QUESTIONS TO ASK THE DOCTOR
- How often do you perform vasectomies?
- What is your rate of complications?
- How long will the procedure take?
- What will the procedure cost?
- Will my insurance cover the cost?
- Do you perform vasectomy reversal? If so, what is your success rate?
- infection: one in 100
- epididymitis: one in 100
- sperm granuloma: one in 500
- persistent pain: one in 1,000
Fournier gangrene is a very rare but possible complication of vasectomy in which the lining of tissue underneath the skin of the scrotum becomes infected (a condition called fasciitis). Fournier gangrene progresses very rapidly and is treated with aggressive antibiotic therapy and surgery to remove necrotic (dead) tissue. Despite treatment, a mortality rate of 45% has been reported for this condition.
Alternatives
There are numerous options available to couples who are interested in preventing pregnancy. The most common methods are female sterilization, oral contraceptives, and the male condom. Female sterilization has a success rate of 99.5%; oral contraceptives, 95–99.5%; and the male condom, 86–97%.
Resources
ORGANIZATIONS
Alan Guttmacher Institute. 1302 Connecticut Ave., NW, Suite 700, Washington, DC 20036. (202) 296-4012 or toll free (877) 823-0262. http://www.guttmacher.org (accessed April 16, 2008).
Planned Parenthood Federation of America. 434 West 33rd Street, New York, NY 10001. 212-541-7800. http://www.plannedparenthood.org (accessed April 16, 2008).
OTHER
“Facts About Vasectomy Safety.” National Institute of Child Health and Human Development, August 17, 2006 [cited January 5, 2008]. http://www.nichd.nih.gov/publications/pubs/vasectomy_safety.cfm (accessed April 16, 2008).
“Vasectomy.” Planned Parenthood Federation of America, [cited January 5, 2008]. http://www.plannedparenthood.org/midsouthmi/vasectomy.htm (accessed April 16, 2008).
VasectomyMedical.com. April 4, 2007 [cited January 5, 2008]. http://www.vasectomymedical.com (accessed April 16, 2008).
Donald G. Barstow, RN
Stephanie Dionne Sherk
Tish Davidson, AM
Vasectomy reversal seeVasovasostomy
Vasectomy
Vasectomy
Definition
A vasectomy is a surgical procedure performed on adult males in which the vasa deferentia (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, cauterized (burned or seared), or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but they die and are absorbed by the body.
Purpose
The purpose of the vasectomy is to provide reliable contraception. Research indicates that the level of effectiveness is 99.6%. Vasectomy is the most reliable method of contraception and has fewer complications and a faster recovery time than female sterilization methods.
The cost of a vasectomy ranges between $400 and $550 in most parts of the United States. Some insurance plans will cover the cost of the procedure.
Demographics
Approximately 500,000 vasectomies are performed annually in the United States. About one out of every six men over the age of 35 has had a vasectomy. Higher vasectomy rates are associated with higher levels of education and income.
Description
Vasectomies are often performed in the doctor's office or an outpatient clinic using local anesthesia. The area around the patient's scrotum (the sac containing the testicles that produce sperm) will be shaved and cleaned with an antiseptic solution to reduce the chance of infection. A small incision is made into the scrotum. Each of the vasa deferentia (one from each testicle) is tied in two places with nonabsorbable (permanent) sutures and the tube is severed between the ties. The ends may be cauterized (burned or seared) to decrease the chance that they will leak or grow back together.
"No scalpel" vasectomies are gaining in popularity. Instead of an incision, a small puncture is made into the scrotum. The vasa deferentia are cut and sealed in a manner similar to that described above. No stitches are necessary and the patient has less pain. Other advantages include less damage to the tissues, less bleeding, less risk of infection, and less discomfort after the procedure. The no-scalpel method has been used in the United States since 1990; as of 2003, about 30% of vasectomies are performed with this technique.
The patient is not sterile immediately after the procedure is finished. Men must use other methods of contraception until two consecutive semen analyses confirm that there are no sperm present in the ejaculate. It takes about four to six weeks or 15–20 ejaculations to clear all of the sperm from the tubes.
In some cases vasectomies may be reversed by a procedure known as a vasovasostomy . In this procedure, the surgeon reconnects the ends of the severed vasa deferentia. A vasectomy should be considered permanent, however, as there is no guarantee of successful reversal. Vasovasostomies are successful in approximately 40–50% of men.
Diagnosis/Preparation
No special physical preparation is required for a vasectomy. The physician will first assess the patient's general health in order to identify any potential problems that could occur. The doctor will then explain the possible risks and side effects of the procedure. The patient is asked to sign a consent form which indicates that he understands the information he has received, and gives the doctor permission to perform the operation.
Aftercare
Following the surgery, ice packs are often applied to scrotum to decrease pain and swelling. A dressing (or athletic supporter) which supports the scrotum can also reduce pain. Mild over-the-counter pain medication such as aspirin or acetaminophen (Tylenol) should be able to control any discomfort. Activities may be restricted for one to two days, and sexual intercourse for three to four days.
Risks
There are very few risks associated with vasectomy other than infection, bruising, epididymitis (inflammation of the tube that carries the sperm from the testicle to the penis), and sperm granulomas (collections of fluid that leaks from a poorly sealed or tied vas deferens). These complications are easily treated if they do occur. Patients do not experience difficulty achieving an erection, maintaining an erection, or ejaculating. There is no decrease in the production of the male hormone (testosterone), and the patient's sex drive and ability are not altered. Vasectomy is safer and less expensive than tubal ligation (sterilization of a female by cutting the Fallopian tubes to prevent conception).
According to both the World Health Organization (WHO) and the National Institutes of Health (NIH), there is no evidence that a vasectomy will increase a man's long-term risk of testicular cancer, prostate cancer, or heart disease.
Normal results
Vasectomies are 99% successful in preventing conception. As such, male sterilization is one of the most effective methods of contraception available to consumers.
Morbidity and mortality rates
Complications occur in approximately 5% of vasectomies. The rates of incidence of some of the more common complications are:
- mild bleeding into the scrotum: one in 400
- major bleeding into the scrotum: one in 1000
- infection: one in 100
- epididymitis: one in 100
- sperm granuloma: one in 500
- persistent pain: one in 1,000
Fournier gangrene is a very rare but possible complication of vasectomy in which the lining of tissue underneath the skin of the scrotum becomes infected (a condition called fasciitis). Fournier gangrene progresses very rapidly and is treated with aggressive antibiotic therapy and surgery to remove necrotic (dead) tissue. Despite treatment, a mortality rate of 45% has been reported for this condition.
Alternatives
There are numerous options available to couples who are interested in preventing pregnancy. The most common methods are female sterilization, oral contraceptives, and the male condom. Female sterilization has a success rate of 99.5%; oral contraceptives, 95–99.5%; and the male condom, 86–97%.
Resources
books
"Family Planning: Sterilization." Section 18, Chapter 246 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
periodicals
Hartanto, Victor, Eric Chenven, David DiPiazza, et al. "Fournier Gangrene Following Vasectomy." Infections in Urology 14, no.3 (2001): 80-82.
organizations
Alan Guttmacher Institute. 1120 Connecticut Ave., NW, Suite 460, Washington, DC 20036. (202) 296-4012. <www.agiusa.org>.
Planned Parenthood Federation of America. 810 Seventh Ave., New York, NY 10019. (212) 541-7800. <www.plannedparenthood.org>.
other
The Alan Guttmacher Institute. "Contraceptive Use." 1999 [cited February 28, 2003]. <http://www.agi-usa.org/pubs/fb_contr_use.html>.
"Facts About Birth Control." Planned Parenthood Federation of America. January 2001 [cited February 28, 2003]. <http://www.plannedparenthood.org/bc/bcfacts1.html>.
"Facts About Vasectomy Safety." National Institute of Child Health and Human Development. September 3, 2002 [cited February 28, 2003]. <www.nichd.nih.gov/publications/pubs/vasect.htm>.
"Vasectomy: Questions and Answers." EngenderHealth. 2000 [cited February 28, 2003]. <www.engenderhealth.org/wh/fp/cvas2.html>.
VasectomyMedical.com. February 4, 2003 [cited February 28, 2003]. <http://www.vasectomymedical.com>.
Donald G. Barstow, RN Stephanie Dionne Sherk
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Vasectomy is a minor procedure that can be performed in a clinic or doctor's office on an outpatient basis. The procedure is generally performed by a urologist, who is a medical doctor who has completed specialized training in the diagnosis and treatment of diseases of the urinary tract and genital organs.
QUESTIONS TO ASK THE DOCTOR
- How often do you perform vasectomies?
- What is your rate of complications?
- How long will the procedure take?
- What will the procedure cost? Will my insurance cover the cost?
- Do you perform vasectomy reversal? What is your success rate?
Vasectomy
Vasectomy
Definition
A vasectomy is a surgical procedure performed on males in which the vas deferens (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, cauterized (burned or seared) or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but they die and are absorbed by the body.
Purpose
The purpose of this operation is to provide reliable contraception. Research indicates that the level of effectiveness is 99.6%. Vasectomy is the most reliable method of contraception.
Description
Vasectomies are often performed in the doctor's office using a local anesthesia. The patient's scrotum area will be shaved and cleaned with an antiseptic solution to reduce the chance of infection. A small incision is made into the scrotum (the sac containing the testicles that produce the sperm). Each of the vas deferens (one from each testicle) is tied in two places with nonabsorbable (permanent) sutures and the tube is severed between the ties. The ends may be cauterized (burned or seared) to decrease the chance that they will leak or grow back together.
Sterility does not occur immediately after the procedure is finished. Men must use other methods of contraception until two consecutive semen analyses confirm that there are no sperm present in the semen. This will take four to six weeks or 15-20 ejaculations to clear all of the sperm from the tubes.
"No scalpel" vasectomies are gaining popularity. Instead of an incision, a small puncture is made into the scrotum. The vas deferens are cut and sealed in a manner similar to that described above. No stitches are necessary and the patient has less pain. Other advantages include less damage to the tissues, less bleeding, less risk of infection, and less discomfort after the procedure.
In some, cases vasectomies may be reversed. However, this procedure should be considered permanent as there is no guarantee of successful reversal.
Preparation
No special physical preparation is required. The physician will first assess the patient's general health in order to identify any potential problems that could occur. The doctor will then explain possible risks and side effects. The patient is asked to sign a consent form which indicates that he understands the information he has received, and gives the doctor permission to perform the operation.
Aftercare
Following the surgery, ice packs are often applied to scrotum to decrease pain and swelling. A dressing (or athletic supporter) which supports the scrotum can also reduce pain. Mild over-the-counter pain medication such as aspirin or acetaminophen (Tylenol) should be able to control any discomfort. Activities may be restricted for one or two days, and sexual intercourse for three to four days.
Risks
There are very few risks associated with vasectomy other than infection, bruising, epididymitis (inflammation of the tube that carries the sperm from the testicle to the penis), and sperm granulomas (collection of fluid that leaks from a poorly sealed or tied vas deferens). These are easily treated if they do occur. Patients do not experience difficulty achieving an erection, maintaining an erection, or ejaculating. There is no decrease in the production of the male hormone (testosterone), and sex drive and ability are not altered. Vasectomy is safer and less expensive than tubal ligation (sterilization of a female by cutting the fallopian tube to prevent conception).
Normal results
Normally, vasectomies are 99% successful in preventing conception. As such, it is one of the most effective methods available to consumers.
Resources
ORGANIZATIONS
Planned Parenthood Federation of America, Inc.. 810 Seventh Ave., New York, NY 10019. (800) 669-0156. 〈http://www.plannedparenthood.org〉.
KEY TERMS
Ejaculation— The act of expelling the sperm through the penis during orgasm.
Epididymitis— Inflammation of the small tube that rests on top of the testicle and is part of the system that carries sperm from the testicle to the penis. The condition can be successfully treated with antibiotics if necessary.
Scrotum— The sac which contains the testicles.
Sperm granuloma— A collection of fluid that leaks from an improperly sealed or tied vas deferens. They usually disappear on their own, but can be drained if necessary.
Testicles— The two egg-shaped organs found in the scrotum that produce sperm.
Tubal ligation— A surgical procedure in which the fallopian tubes are tied in two places and cut between. This prevents eggs from moving from the ovary to the uterus.
vasectomy
Vasectomy has been known for some hundred years — the first operation performed specifically for the purpose of sterilization took place in Indiana in 1899. It was initially believed that by suppressing the sperm-making functions of the testes, an increase in the sex hormone could be brought about, producing improvements in physical health and sexual vigour. This led to its practice as a ‘rejuvenation’ operation, known as the ‘Steinach’ operation after the Viennese professor whose laboratory experiments led to this conclusion. The numbers of men who underwent this operation in the hopes of increasing their sexual powers cannot be known, but Kenneth Walker, the British expert in male sexual disorders, believed that ‘uncritical and unprincipled medical men’ widely exploited this belief during the 1920s. He himself was sceptical of its benefit in increasing sexual power, attributing any apparent improvement to suggestion.
As a means of contraception, the operation was also, of course, much easier to perform and less drastic than the equivalent operation on the female. However, in spite of the publicity the operation gained in connection with rejuvenation, for many years it was confused in both the lay and the medical mind with castration. The very legality of such a ‘mutilating operation’ was in question.
It increased in popularity as a method of contraception during the 1960s, particularly for couples who had completed their families and were reluctant for the wife to continue taking the Pill for an indefinite period. Unlike female sterilization, it tends to be the choice of couples who share responsibility for fertility control.
There are currently various different operative techniques but the method that is gaining popularity is the ‘no scalpel’ method invented by Professor Li Shungqiang of Sichuan Reproductive Health Institute, Chengdu, Sichuan, P R China, and worldwide this method is now the most commonly used. It is a very minimal technique using specially designed instruments which enable the vas to be divided through a small puncture wound; the ends are then separated by a bit of tissue. It is interesting to note that Professor Li started life as a neurosurgeon but during the cultural revolution he was redirected to work in family planning. Many lesser men would have become very depressed but he immediately set about devising new operations, culminating in his no scalpel technique. It has now been used on hundreds of thousands of men and probably no other living surgeon has influenced the lives of more men.
A question that is commonly asked is ‘Where do the sperm go after vasectomy?’ The sperm-producing cells are in the seminiferous tubules inside the testicle and sperm exit from the top of the testicle into a softer area, the epididymis. The epididymis to a certain extent acts as a filter, and abnormal sperm and debris associated with cell division are cleared from the ejaculate. After vasectomy the whole sperm production has to be absorbed through the epididymis: an exaggeration of its normal function. Seminal fluid continues to be produced normally by the prostate gland and seminal vesicles.
The effect on subsequent sex-life appears to be beneficial in the majority of cases, in spite of the concern often expressed that it may have a deleterious effect on virility (harking back to the old association with castration) — commonly, increased sexual satisfaction and libido has been reported (perhaps substantiating Steinach, or merely reflecting the release from fear of conception). However, this is more likely to occur when the man has deliberately chosen to undertake vasectomy, unlike the case of the Indian men who were persuaded into vasectomy, in return for portable radios, during a drive to reduce the population problem of the subcontinent.
In recent years there has been some concern about the safety of vasectomy. It has been shown that there is no association between vasectomy and heart attacks or vasectomy and testicular cancer, although there have been worries about both. There is still some concern about the association between vasectomy and prostate cancer, but it seems very likely that this apparent association is because of the introduction of new methods to diagnose prostate cancer, and the way statistics are collected, rather than any cause and effect.
Vasectomy is highly reliable provided that an additional method of contraception is employed during the first weeks following the operation, during which live sperm may still be present in the seminal fluid.
The major disadvantage is that it cannot readily be reversed: even with recent developments in microsurgery, the operation to reunite the severed vasa deferens reopens them in 80–90% of cases, but the success rate in terms of achieving pregnancy is at best only 50%. There have been attempts at temporary, reversible blocking or clipping of the tubes, but so far these have failed to achieve a degree of reliability in any way comparable with the permanent operation.
There is a very small late failure rate (approximately 1 in 2000), but vasectomy remains surer than female sterilization. The only more certain method of contraception is complete abstinence.
Tim Hargreave, and Lesley A. Hall
See also contraception; sterilization.
vasectomy
vas·ec·to·my / vəˈsektəmē; va-/ • n. (pl. -mies) the surgical cutting and sealing of part of each vas deferens, typically as a means of sterilization.DERIVATIVES: va·sec·to·mize / -ˌmīz/ v.