Introduction
Male sterilisation, also referred to as 'vasectomy', is a medical procedure where the two tubes connecting the testicles to the prostate (vas deferens) are cut and tied off, thus preventing sperm from being present in the ejaculate and acting as a permanent form of contraception. Sperm is still created in the testicles but is simply reabsorbed into the body after a vasectomy. Everything otherwise functions as normal after the procedure.
The procedure is more than 99% effective in preventing conception and around 15,000 men undergo the procedure every year in Australia. The procedure is designed as a permanent contraceptive option, however it is possible to reverse a vasectomy using microsurgical techniques to re-attach the severed end/s of the vas deferens tubes.
After a vasectomy reversal the chances of conception are 50%-70%. There are other options if natural conception is not possible, such as In Vitro Fertilisation (IVF) using sperm extracted from the testicles.
The main benefits of the procedure are that it is a permanent form of contraception, the procedure itself is relatively simply and quick and that there are no changes to natural sexual function and of course no need for any other form of contraception.
The main disadvantages are that it is not effective immediately, as some sperm will remain within the vas deferens, which generally takes 2-3 months to clear (during which time normal contraception needs to be used). There can also be some short-term pain, swelling or bruising after the procedure.
It is important to be aware that after a vasectomy a man can still be open to sexually transmitted infection (STI) and the only effective protection against these is to use condoms.
Preoperative Instructions
All patients are given full instructions on how to prepare for the procedure well ahead of the day of surgery. In most cases the following preparation is required:
- Inform the surgical team of what medications you are currently taking and follow any guidelines given by the team, especially regarding blood thinning medication.
- If any symptoms of illness occur before the procedure (e.g. cold or fever) inform the surgical team.
- Bring (or wear) reasonably close-fitting underwear to give support to the scrotum after the procedure.
Procedure
A vasectomy procedure is relatively straightforward and takes between 15 -30 minutes. It is generally carried out under local or general anaesthesia. The procedure is as follows:
- Using either a scalpel, a small incision (around 1cm) is made to the skin in the upper part of the scrotum.
- The vas deferens tube is located, tied off and cut.
- The ends of the tube are sealed either with a stitch or using a heat process (diathermy).
- The incision is then closed and stitched.
As there are two vas deferens tubes, this procedure is either repeated for each side of the scrotum, or just one central incision is made to complete both sides.
Postoperative Instructions
Although patients can generally return home the same day as the procedure, it is strongly advised not to drive and to arrange to be driven home.
Any postoperative pain can be alleviated using normal pain medication and using ice packs. Closer fitting underwear also helps to relieve any discomfort. Avoid any immersion in water (e.g. hot baths, swimming pool) for around 10 days, although showering is fine.
There may be a small quantity of blood in the semen in the first or second ejaculation after the procedure. This is normal, however contact Mr Liddell if this continues or if you have any concerns.
Patients are advised to take 2-3 days off work after the procedure and avoid heavy lifting, strenuous physical activity and any sexual activity during the seven-day period immediately after the procedure.
As explained above, normal contraception should be used until a semen sample taken by your doctor confirms that sperm is not present.
Risks
A vasectomy is a straightforward and safe procedure, however in rare cases complications may arise.
If for example there is any fever, bleeding or swelling or redness at the incision site or excessive pain, this could indicate infection and you should contact Mr Liddell or your doctor immediately.
Other possible issues include:
- Bruising (this generally improves without medical intervention).
- Fluid around the testicles (in ~1% of cases and in most cases, this only lasts a week or so).
- Appearance of small lump under the skin near the site (in ~18% of cases, caused by sperm leakage).
- Decreased libido / Erectile Dysfunction (in ~0.4% of cases, possibly psychological).
- Mild infection (in ~7% of cases).
- Recanalisation (this is where the two ends of the vas deferens grow back together).