By Dr. Gary Bellman
I am a board certified urologist performing vasectomies for over 20 years at it is my pleasure to address the common concerns and questions men have when considering a vasectomy.
What is a vasectomy and how is it done?
A bit of anatomy; the sperm is produced in the testicles and runs through a small tube called the vas deferens. A vasectomy involves cutting both the right and left vas deferens through a tiny incision in the upper scrotum.
I generally put a very tiny clip on each end of the tube and remove a segment.
A no needle no scalpel technique is used and can often be done in the office in 15-20 minutes with minimal discomfort. There are no sexually effects from a vasectomy so erections, libido and the amount and quality of ejaculate are unaffected. Most men don’t realize that the fluid produced during orgasm comes mostly from the prostate and other glands such as seminal vesicles and cowpers glands. So there should be no ramifications on sexual performance. A vasectomy does not affect one’s manlihood or testosterone!Very rarely can one experience recurrent pain on one side where a vasectomy was performed;fortunately that is rare and there are remedies for that should it occur.
Can you leave one or both of the tubes open?
Some men want one or both of the tubes left open to avoid a sperm granuloma which is an accumulation of trapped sperm fluid, which is quite rare. Yes one or both tubes can be left open if one so desires.
Is a vasectomy reversible?
Yes it is reversible but it is somewhat involved to reverse and even when successful there is not always easy to conceive a child. Men should be pretty sure they don’t want more kids when getting a vasectomy. A good option is sperm banking prior to a vasectomy, which can be safely stored for years.
Should you decide to have a child the sperm is thawed and placed into the women’s cervix through a process called artificial insemination. This is not the same as the very costly in vitro fertilization.
Will you consider a vasectomy on a man in his 20s.?
Some urologists will and some will not. I have a conversation with the individual and make sure he does not want children in the future. I strongly encourage younger men to bank sperm.
What do you think of RISUG?
RISUG stands for reversible inhibition of sperm under guidance. It is a procedure similar to a vasectomy where an incision is made and the vas deferens is identified and instead of cutting it a compound is injected into the tube to block the flow of sperm. This has been developed in India and is still being studied. The concept is that it can function like a male contraceptive providing protection and easier to reverse. My concerns are that injection a solution into the vas deferens may not be 100% effective. Men who come for a vasectomy don’t want a 98 or 99% effectiveness and it hasn’t been proven to be easier to reverse. I am not sure of the fate of this procedure but currently I don’t perform it and wouldn’t recommend it.
The closest safe approach to a male contraceptive that you can turn on and off relatively easily is testosterone replacement.
What happens to the sperm that’s being produced in the testicle?
Men sometimes are concerned the testicles will swell if the sperm is not released from the testicles and this is not the case. The sperm is produced and then absorbed back into the body and new sperm is produced. There is no swelling or uncomfortable backup of fluid.
Office versus asleep, costs?
Many men are fine to have this performed in the office with local anesthetic though some want to be put to sleep so it can be done in a surgery center.
Insurances sometimes cover vasectomy depending on the insurance and the plan. A cash price for a vasectomy is usually around $900. (much cheaper than an unwanted child or child support).
It is recommended to apply ice to the scrotum for the first two days and taking it easy. Thereafter no exercise or sex for 1 week.
It is also important to use protection after a vasectomy until you do a semen test that show you are “shooting blanks”.
Can you have a vasectomy and still get someone pregnant?
The answer is theoretically yes. There is an extremely rare process by which the two tubes that have been cut can reconnect. It is very important to get a semen analysis 6-8 weeks after a vasectomy to make sure there is no semen. It is possible the wrong tube was cut and one side needs to be redone. Again fortunately rather rare.
A vasectomy is a minimally invasive, safe method for permanent male contraception with minimal side effects. It is much easier for a man to undergo a vasectomy than a women to have a tubal libation.
Dr. Gary Bellman, M.D., is a Board Certified Urologist, interested in Testosterone replacement and men’s health. He went to medical school and urology residency at McGill University, did a fellowship at Long Island Jewish Medical Center and has taught at UCLA for many years. He is currently in private practice in the San Fernando Valley, a suburb of Los Angeles.
For more information on Dr. Bellman, visit his Websites: http://www.drgarybellman.com/