Information sheet

About 90,000 men have a vasectomy each year and it is generally a very safe procedure. However, in order to give informed consent, anyone deciding whether to have a vasectomy needs to be aware of the possible side-effects and the risk of complications.

A vasectomy is an operation that blocks, seals or cuts the tubes (known as the vas deferens) which carry sperm from your testicles to your penis. You will still be able to ejaculate and your ejaculate will look just like before in amount and colour, but will no longer contain any sperm, so you cannot make your partner pregnant. The sperm in your testicles are naturally reabsorbed back into the body and do not build up.

A vasectomy may be appropriate for you if you already have children, are certain that you have completed your family and cannot forsee any change in your future circumstances in which you would want children. A vasectomy may somtimes be appropriate for you if you don’t have any children but are sure that you will never want to father children.

You have to be a minimum of 24 years old, but it is important to know that research has shown that you are more likely to have regrets after a vasectomy later on if you are either under 30 or if you do not have children already.  You need to be very sure about your decision and that you fully understand what it will mean.  No-one can force you to have the operation if you do not want to.

 

If you have a partner, you should discuss your wish and agree together which option suits you best as a couple.

There are recognised alternatives to a vasectomy and they will be discussed later in this letter.

Procedure

Traditionally, the conventional technique was done with a scalpel (a very sharp blade), which tended to cause bleeding, the need for stiches inside the scrotum, and increased swelling, bruising and discomfort after the operation.

The no-scalpel vasectomy uses a so-called hyfrecator, that does all the necessary “cutting” with help of electricity. The advantage here is that any blood vessels that are being hit will be immediately cauterised, which in turn means that most of our procedures are fairly or even completely bloodless.

The following will happen when you come in for your vasectomy with us:

• You first will be asked to take off your trousers and pants and lie down on our operation table before you will be covered with a “modesty” sheet of paper
• Your bottom will come to lie on a metal plate or “earth plate” which we need to use in conjunction with above mentioned hyfrecator
• The doctor will then use an antiseptic fluid to wipe your scrotum with to reduce an infection risk
• Your lower half will then be covered with a larger sheet which will just leave the scrotum visible
• The doctor will then examine your scrotum to ensure that they can feel the tubes(vas) on both sides
• Now the first injection will be given into the skin and around the part of the tube that will be cut (no injection will be given into the testicle!)
• After each injection the doctor will wait for around a minute to give the anaesthetic the chance to have its full effect
• Now a ringed forceps will be used to encircle the tube/vas for the surgeon to be able to bring the vas to the surface to treat it with the hyfrecator
• After the treatment/cutting of each vas with help of the hyfrecator the ring forceps will be removed to allow the vas to slide back into its normal position in the scrotum
• At the very end, depending on the surgeons preference, one stitch may be put into the incision wound on the scrotum or it may be left open. You will then be free to get dressed and have the after-operation chat with the doctor
• During the after-op chat you will be provided with some more information, importantly also how to organise the check of your semen sample after 4 months to ensure that the procedure was successful

Benefits of the No-Scalpel Technique

Average time off work after a no scalpel vasectomy is 1.8 days, rather than 3.5 days with the standard vasectomy.

The rate of complications such as haematoma, and infection, is just 0.4% compared with the 3.4% for conventional vasectomy.
The duration of the procedure is less than 20 minutes on average – up to 50% faster than conventional techniques. 

The rate of complications was much lower in the no scalpel group, recovery was faster and the rate of pain, bruising and swelling was tenfold less than in men who had undergone standard vasectomy.

Vasectomy: What are the risks?

Any surgical procedure carries some risk, but vasectomy is considered to be low-risk, and complications are uncommon. It is important to note that vasectomy should be considered a permanent and irreversible form of birth control, and it does not protect against sexually transmitted diseases or AIDS.

Complication	No Scalpel Vasectomy	Traditional Vasectomy
Infection	1%	3.48%
Haematoma	1%	2%
Sperm Granuloma	0.8%	2.8%
Epididymitis	0.5%	1%
Failure after one year	0.2%	< 0.5%
Recovery Time	1.5 days	3.5 days

Bleeding Generally painless bleeding may occur following vasectomy and collect under the skin, so that the penis and scrotum appear bruised and/or swollen. The scrotum skin is very thin, which may make bruising appear worse than it actually is and is a normal reaction after vasectomy.

Haematoma Bleeding inside the scrotum rarely may cause painful swelling immediately following a vasectomy. The result is known as a haematoma, and while seldom serious, it should be reported to a doctor. The risk of haematoma occurring is around 1 in every 100 men (1%).

Infection If blood collects under the skin following vasectomy, it can become infected. The risk of infection occurring is around 1 in every 100 men (1%). Such infections usually respond favourably to oral antibiotic treatment, antimicrobial creams and hot baths, usually within a week. Rarely, the infection can be more severe requiring treatment in hospital.

Early Failure This means that the tubes that have been cut join up later on. The risk of this occurring is around 1 in 200 men. It can take up to four months for this to happen, which is why we ask you to wait four months before a semen sample is handed in to the hospital to be checked.

Late Failure/unplanned pregnancy There is also a reported risk of a “late failure” which is pregnancy that happens after a man has been given the all-clear (that is, after tests have confirmed there are no sperm in their semen) after a vasectomy.  This risk is much lower at 1 in every 2000 men.

**The main risk after a vasectomy is that your partner gets pregnant because you stop using contraception too soon after the operation; that is, before you have been told that it is safe to do so or before you have had a negative sperm test.**

Postoperative Pain Some degree of scrotal pain or ache is normal following a vasectomy. Taking regular paracetamol with or without codeine is recommended over anti-inflammatory drugs such as ibuprofen or aspirin, which can cause bleeding. Painful discomfort normally disappears within a day or two, while a slight ache may remain longer, in some cases up to a week or two.

Chronic Pain/Post-vasectomy pain syndrome Long-term dull aching in the testicles may occur following vasectomy that is thought to be caused if the epididymis becomes congested with dead sperm and fluid. If this occurs, it usually disappears within six months but can rarely persist long-term. Current guidelines state that the risk of chronic pain occurring is between 1 to 2 out of every 100 men but the most up-to-date data suggests the risk may be lower at around 2 in every 1000 men (0.2%).

Epididymitis This uncommon condition occurs when the larger tube behind the testicle, connected to the vas, becomes inflamed and swollen. The application of heat and the use of anti-inflammatory medication usually clear this up within a week.

Immune Reactions Following vasectomy, the immune system may recognize the absorbed sperm cells as foreign proteins and produce antibodies in response. While many men may experience this immune reaction, current evidence indicates that this reaction generally is not harmful. Immune reactions can also contribute to the development of clogging of arteries, which in turn could lead to heart attacks. However, there is no evidence of an increased risk of atherosclerosis because of a vasectomy.

Prostate Cancer Studies have demonstrated that there is no increased risk of prostate cancer with vasectomy

Sexual Difficulties It is usually reported that men who undergo vasectomy and their partners express greater enjoyment and spontaneity of sex. However, occasionally a man may experience sexual problems after vasectomy, but these almost always have an emotional basis. Counselling usually alleviates the problem.

Sperm Granulomas Very rarely, sperm leakage from the testicular cut end of the vas may cause a small and usually painless lump. This lump does not pose a danger and frequently resolves over time.

Allergic Reaction Rarely, some men may experience itching and hives, as an allergic reaction to local anaesthetic.

Antibodies Sperm which are no longer released through ejaculation and absorbed by the body may attract antibodies produced following vasectomy.

In Summary

• Although a simple, safe and common surgical procedure, any surgical procedure includes some risk.
• A vasectomy is considered to be low risk, and complications usually are uncommon.
• Some pain and discomfort may be expected, but this normally decreases and disappears within days, given routine post operative care.
• It’s important to review possible risks and complications with your physician.

Can it be reversed?  

All sterilisation operations are meant to be permanent. The chances of a reversal operation being successful vary a great deal. There is no guarantee of success.

Vasectomy is free through the NHS but you will usually have to pay to have the operation reversed. The cost for a reversal currently stand at over £3,000.

Are there alternatives?

If you are a couple you need to consider both vasectomy and female tubal occlusion, but also other long-term methods that women can use to avoid getting pregnant. They include:

• Copper IUDs (which used to be known as the coil) – the IUD (intrauterine device) is put into your womb and can safely stay there for up to 10 years
• A progestogen IUS (intrauterine system) – this is a hormone-releasing IUD that lasts for five years. The Mirena system is as effective as vasectomy and even more effective than tubal occlusion.
• Progestogen implants – this uses a small flexible tube inserted under the skin of the arm to release the hormone progestogen. The implant lasts for three years.

The main advantage of these methods is that they can be reversed. Like tubal occlusion and vasectomy, they all have risks and benefits. Your doctor or nurse can tell you more about them.

If you are still happy to go ahead please remember:

 

Before the operation

• Have a light meal
• Have a nice hot shower just before you come in – this will relax the genital area and also wash away any surplus bacteria and therefore reduce an infection risk
• Trim the hair on the top of the scrotum so that it is very short, especially the top part under the base of the penis. Shaving is not necessary and we actually would prefer you not to shave on the day to avoid there being any fresh cuts which also might increase an infection risk
• Wear tight underwear on the day of the operation – the better the scrotum is supported after the procedure, the less swelling there will be. Swimming trunks are very effective.
• Stock up with paracetamol – some studies have shown that taking paracetamol on the day of the operation and the day after significantly reduces the perception of discomfort over the whole of the following week.
• Your partner is very welcome to accompany you.
• Arrange for someone to drive you home afterwards – some car insurers don’t insure you for a few hours after a local anaesthetic, because on rare occasions severe dizziness can suddenly come on up to a couple of hours afterward.

What to expect afterwards

Numbness

After a vasectomy, is it common to experience some numbness of the scrotum caused by the local anaesthetic. As the anaesthetic wears off (after 30min to 1h), the scrotum may become sore and some bruising may develop. Occasionally, if the surgeon has difficulty finding both the vas deferens, the swelling or bruising can be quite severe.

Post-operative pain

Painful discomfort normally disappears within a few days, while a slight ache may remain longer up to one to two weeks. Taking regular paracetamol should help relieve any discomfort. Follow the instructions on the packet. Please avoid taking anti-inflammatory drugs (ibuprofen e.t.c) or alcohol for at least 72 hours following the operation as these increase the risk of bleeding.Please continue towear tight-fitting underwear day and night for a couple of days after the operation as this will also help to ease discomfort and prevent swelling.

Return of usual activity

We very much advise to rest (sit or lie) on the day of the operation and the day after as this will help a lot to keep swelling down and reduce discomfort. Some men feel fit enough to go back to work the day after their vasectomy, but we advise only to do so if it is work that allows you to sit down.

It’s best to avoid heavy lifting or vigorous exercise for a whole week after the operation, as this can put a strain on the healing wounds and more importantly might set off a bleed.

Wound Care

Please avoid any showers or bath for three days, in order to keep the wound dry. After this, it’s fine to have a bath or shower as normal, but the area should be gently patted dry with a clean towel. Any dissolvable stitches will disappear on their own after about a week but if one is still in your skin after two weeks we advise to tug it gently which should remove it easily.

The area should heal fairly quickly, however we ask you to contact us if you are concerned about any swelling or other discomfort that you are worried about.

Should you start to feel in general unwell, particularly within the first 72 hours after the procedure we kindly ask you to contact the hospital immediately, as more severe symptoms might mean that that there is not only an infection, but possibly sepsis (a rare complication of a vasectomy).

Post-vasectomy semen analysis

To find out whether your vasectomy has been successful you will be asked to provide at least one semen sample no earlier than 16 weeks following your vasectomy and after you have performed a minimum of 30 ejaculations. This is very important to clear out all of the remaining sperm still present within your tubes.  

If there are no sperm in your semen, the test result is negative. We will send you a letter to tell you about the result.

If you still have sperm in your semen, we will give you paperwork for another test.

A few men continue to have small numbers of sperm in their semen, but these sperm do not move (they are known as ‘non-motile’ sperm). It is not always clear whether this means you could make your partner pregnant. If you are one of these men, your doctor will discuss your options with you.

Sex and contraception

We advise that sex and masturbation is only resumed after one week. Don’t worry if your ejaculate is initially slightly pinkish stained – it will go back to its normal colour soon.

**Remember: You must use effective contraception after the operation until your follow-up semen test shows that the vasectomy has been successful.**

 

Is there anything else I should know?

You have the right to be fully informed about your health care and to share in making decisions about it. The Beccles Vasectomy Clinic will respect this and take your wishes into account.

You will need to sign a consent form to show that you understand and agree to have the operation.

All operations involve some risk. If you have special concerns about certain kinds of risks, let your doctor know so that they can tell you more.

You will be told if there were any difficulties during the operation that mean it may not have been successful.

Sources and acknowledgements

Faculty of Sexual & Reproductive Healthcare Clinical Guidance. Male and female Sterilisation. Clinical Effectiveness Unit. September 2014.

www.fsrh.org  

American Urological Association. Vasectomy (2015)

www.auanet.org

Association of Surgeons in Primary Care

www.aspc-uk.net

© Royal College of Obstetricians and Gynaecologists 2004

www.rcog.org.uk

Family Planning Association
www.fpa.org.uk

British Pregnancy Advisory Service
www.bpas.org