Vasectomy is one of the safest and most effective methods of permanent birth control. It is much safer and less expensive than the other common contraceptive surgery, tubal ligation. For these reasons, some 10 000 men in Australia choose vasectomy each year.
No-Scalpel Vasectomy: Minimally Invasive, Effective & Reversible Birth Control
Conventional vasectomy blocks the vas deferens preventing sperm from being added to a man’s ejaculation fluid, semen. A local anaesthetic is given, and one or two incisions are made in the scrotum with a scalpel. The two vas deferens are revealed, cut and blocked. The incisions are then closed with sutures.
A safer, far less invasive procedure, the No Scalpel Vasectomy (NSV) reduces vasectomy’s already low complication rate. Developed in China in 1974, it differs from conventional vasectomy in how anaesthesia is given and in how the two vas deferens (vase) are reached. Worldwide, more than 15 million men have had the procedure.
NSV uses an advanced technique to anaesthetise the scrotum more effectively. It requires no scalpel. Instead, the physician avoids complex surgery by carefully isolating the vas deferens using the fingers of one hand. The vasa are then fixed just below the scrotal skin with an instrument designed to hold firmly without pinching. A single small incision is made with pointed forceps. The vasa are then delivered through the skin, cut and sealed in a conventional way. When the operation is complete, no sutures are needed to close the tiny opening.
Benefits of No Scalpel Vasectomy
- Less discomfort
- 10 times fewer complications
- No stitches or sutures needed
- Quicker recovery
Choice of anaesthesia
Most men are suitable for a local anaesthetic technique. They do not need to fast and are able to drive themselves to and from the day surgery unit where the vasectomy is performed.
General anaesthesia is necessary when prior scrotal surgery has been performed, rendering the vasa difficult to palpate. Men of a nervous disposition may also elect to have general anaesthetic.
When performed by an experienced surgeon, the procedure takes 5 – 10 minutes and is associated with very little patient discomfort.
How will vasectomy affect me?
Vasectomy is NOT castration. Vasectomy only interrupts the tubes that carry sperm from the testes to where they are added to your semen. Your penis and testes are not altered. All hormonal and sexual functions are unaffected, so your voice, body hair and interest in sex remain the same. Your body still produces semen and erections and ejaculation occur normally. The only difference is that your semen will no longer contain sperm. As before, the body naturally absorbs unused sperm.
How should I prepare for my vasectomy?
For a non-anaesthetic vasectomy, no special preparation is necessary. You will not need to fast and you can drive yourself to and from the procedure. You are advised not to shave your scrotum pre-operatively. A very small area will be shaved on the operating table before the procedure.
Can I discontinue other birth control methods straight away?
No! Sperm can remain in the vas deferens above the operative site for weeks or even months after vasectomy. You will not be considered sterile until two post-surgical semen tests show that no sperm remain. Until then, you must continue to use other birth control to prevent pregnancy.
Are there potential complications?
Yes. All contraceptive methods carry some risk as well as benefits. Vasectomy is a very low risk procedure, but complications are possible.
Though rare, bleeding (haematoma) and infections are the most common complications of vasectomy. No-scalpel vasectomy, the procedure that I perform, reduces their likelihood because the blood vessels responsible for the bleeding are less likely to be affected and because the opening in the scrotum is mall. The risk is in the order of 1%.
Another potential risk is failure. Vasectomy is not guaranteed to be 100% effective. Even when the operation is performed perfectly, it is possible in rare cases for sperm to find its way across the void between the two blocked ends of the vas deferens. This situation, called recanalization, is highly unusual but it does occur. This is another reason why samples must be taken some 6 to 8 weeks post-vasectomy to verify that your semen contains no sperm. Recanalization usually occurs in the first 2 – 3 months after vasectomy, but it has been known in extremely rare cases to occur even years later.
Sperm granuloma, a hard, sometimes painful lump about the size of a pea may form as a result of sperm leakage from the cut in the vas deferens. The lump is not dangerous and is almost always absorbed by the body over time.
Congestion, a sense of pressure caused by sperm in the testes and epididymes, may cause some discomfort for 2 – 12 weeks after vasectomy. Like sperm granuloma, congestion resolves itself in time.
Is vasectomy painful?
No. You may feel some discomfort when the local anaesthetic is given. After it takes effect, you should feel no pain, though some men may feel a slight “tugging” sensation as the vasa are manipulated. Some minor discomfort may persist for a few days after surgery.
Post-vasectomy pain syndrome occurs in a very small percentage of men, perhaps fewer than 1%. It is possibly due to epididymal congestion, secondary to tubal obstruction. Most men find that the dull ache of post-vasectomy pain syndrome resolves with time; reassurance is all that is necessary.
A small number of men are bothered by this syndrome in the long-term and for these men, surgical intervention may be necessary. Surgical interventions include vasectomy reversal surgery (link), denervation of the spermatic cord or epididymectomy. Epididymectomy is the most effective means of controlling post-vasectomy pain syndrome. It may be performed unilaterally or bilaterally. It does, however, render the vasectomy irreversible on the side in question.
Does vasectomy pose long term health risks?
Many studies have looked at the long term health effects of vasectomy. The evidence is reassuring, suggesting that no permanent risks exist. Men who have vasectomy are no more likely than other men to develop cancer, heart disease or other health problems. In 1993, a panel assembled by the US National Institutes of Health, the Association of Voluntary Surgical Contraception and the US National Cancer Institute reaffirmed the conclusion of most medical experts that vasectomy is a safe and effective means of permanent birth control.
Can vasectomy be reversed?
In many cases, the cut ends of the vas deferens can be surgically reattached. However, this operation, a vasovasostomy is expensive and, for a variety of reasons, does not guarantee a return to fertility. Vasectomy should therefore be considered a permanent procedure. Before you choose to have a vasectomy, make quite sure that you and your partner do not want any more children.
Urology Outpatient Clinic
Doctor Katelaris performs vasectomies both at the Sydney Adventist Hospital in Wahroonga and in the Urology Outpatient Clinic in Hornsby.
Before surgery we will discuss the procedure in person to determine the suitability of no-scalpel vasectomy for you. At some point, you will be required to sign a consent form. It will state that you understand vasectomy and its possible risks and that it is not guaranteed to result in permanent sterility. Prior to signing this form, be sure that you are informed and comfortable with your decision. It is important that you fully discuss and resolve with me any lingering questions or concerns that you may have.
The decision to undergo vasectomy should be undertaken between a man and his partner in a careful, well-considered manner. It is important that you and your partner agree that the time has come for permanent sterilization. Relationship difficulties may arise if you are pressured into having a vasectomy and, conversely, if you have a vasectomy without the agreement of your partner. Where mutual consent is lacking, a cooling-off period is recommended so you can resolve any issues and come to an agreement concerning your contraceptive practices.
Do not consume any aspirin or other NSAIDs for 10 days without prior medical approval. Taking aspirin or NSAIDs increases the risk of bleeding during the procedure.
After surgery You may feel a little sore for a few days. We recommend for a week that you refrain from strenuous physical activity. Sex can usually be resumed 7 days after the procedure. Post-operatively, you may shower from day one but swimming is not advised for five days until the wound is completely healed.
The first post-operative semen analysis will be performed three months post-operatively and after 20 ejaculations. Usually, you will not need a follow up consultation.