Overview of Vasectomy
There are many ways to prevent pregnancy such as not having sex (abstinence), pulling out before ejaculation (withdrawal method), use of condoms, liquids that kill sperm (spermicidal solutions), cup-like devices placed in a woman’s vagina before sex (diaphragms, cervical cups), devices placed in a woman’s uterus to prevent pregnancy (intrauterine devices), birth control pills, hormone implants, hormone injections, breastfeeding (lactation amenorrhea method), morning-after pills (emergency contraception techniques), surgical methods like vasectomy and tube tying (tubal ligation).
This brief overview is about vasectomy, a surgical method for male sterilization used to prevent pregnancy. The word ‘vasectomy’ might seem a bit technical, but it just refers to a surgery where a small tube in the male (the vas deferens) is cut, tied off and separated into different layers of tissue. This tube carries sperm from the testes, so cutting it prevents sperm from being part of the ejaculation, thus preventing pregnancy.
About three-quarters of these surgeries are performed by urologists, doctors who specialize in urinary tract problems and men’s reproductive health. Other medical professionals like general surgeons and family medicine physicians also sometimes perform this surgery.
Most importantly, vasectomies are very effective at preventing pregnancy, with about a 99.7% success rate. They also have very low risk after surgery, with only about 1-2% of men experiencing complications.
Anatomy and Physiology of Vasectomy
A vasectomy is a procedure that involves certain parts within the scrotum, which is the sack that holds the testicles. To get to the important part called the vas deferens, the doctor will have to go through several layers within the scrotum. Starting from the outermost layer, these include the skin, Scarpa’s fascia (a layer of tissue beneath the skin), dartos (a muscle layer), external spermatic fascia (a continuation of a muscle called the external oblique), cremaster muscle (another muscle layer), internal oblique fascia (another layer of tissue), tunica vaginalis (a covering derived from a layer of belly lining), tunica albuginea (another covering), and finally the testicle.
On the back part of the testicle, there’s a part called the epididymis, with its ‘head’ on the top and ‘tail’ on the bottom, while the ‘body’ lies in between. The vas deferens, or ‘sperm duct,’ begins at the ‘tail’ end of the epididymis and runs upwards and inwards along the spermatic cord. It then travels through a passage known as the external inguinal ring and the inguinal canal, after which it goes into the body cavity through the internal inguinal ring.
The vas deferens then enters a structure called the ejaculatory duct, where it merges with the seminal vesicles, which assist in the production of semen. From there, it goes through the prostate, a small gland below the bladder in men, and enters the urethra – the duct where urine is discharged – at a part known as the seminal colliculus and ejaculatory duct. The vas deferens also has a covering with its own blood supply, which is provided by the artery of the vas deferens. Its waste blood is drained through a network of veins called the pampiniform plexus. This part of the body gets its communication signals from short adrenergic neurons, or nerve cells.
Why do People Need Vasectomy
Vasectomy is a type of surgery chosen for the purpose of male sterilization, which means it is used to prevent pregnancies. The doctor performing the surgery should always explain the risks, benefits, and other possible options before the operation. This decision should be considered carefully over time. It’s important for both the person getting the surgery and their partner to take part in this decision, although legally only the person getting the surgery needs to give their permission.
When discussing vasectomy, it is absolutely crucial to understand that it is meant to be a permanent procedure. Although there are ways to reverse a vasectomy, they should never be the main reason to decide to get a vasectomy in the first place. The idea here is that if you aren’t entirely sure about wanting a permanent method to prevent pregnancies, then a vasectomy may not be the best option for you. Usually, the most common reason men decide to reverse a vasectomy is after significant life changes, like divorce and remarriage.
When a Person Should Avoid Vasectomy
There are typically no definite reasons why a man can’t have a vasectomy. However, there are cases where it might be better for the surgery to be done in a hospital rather than in a doctor’s office. These instances might include when the tubes that carry sperm, known as the vas deferens, are hard to identify during the initial examination, if there’s a risk of excess bleeding due to a blood clotting disorder (coagulopathy), history of operations on the scrotum, long-term testicle pain (chronic orchialgia), or if there’s a disease like cancer affecting the testicle.
Moreover, some situations may pose an ethical challenge for the doctor. For example, if the man is very young, has no children, his partner does not agree with his decision, or if his partner is pregnant and there’s a risk of losing the baby. The doctor will need to consider all of these issues during a discussion with the patient before proceeding to perform a vasectomy.
Generally, it is advised that if a man wants to have a vasectomy while his partner is pregnant, he should wait until after the baby is born and healthy before proceeding with the surgery.
Equipment used for Vasectomy
The following list contains supplies that a doctor might use during a vasectomy, a surgical procedure for male sterilization:
* Antimicrobial prep: A solution used to clean the skin before an operation to reduce the chance of infection.
* Fenestrated drape: A sterile sheet used to cover the patient, with a hole to expose the area that will be operated on.
* Sterile gloves: Gloves worn by the doctor to maintain a clean environment.
* Anesthetic: A medication to numb the area before the start of the surgery.
* Vasectomy dissecting forceps: A tool used by the doctor to hold and separate tissues during surgery.
* Vas tenaculum or vas ring forceps: Special tools that hold the vas deferens (the tube that carries sperm) during the surgery.
* Cautery: An instrument that uses heat to stop bleeding.
* Forceps: A grasping tool the doctor uses during surgery.
* Vas scissors: Special scissors used to cut the vas deferens.
* Clip applier or suture: Tools used to close the vas deferens by applying a small clip or stitch.
* Absorbable suture: A type of stitch that is gradually absorbed by the body and doesn’t need to be removed.
* Hemostats: A tool used to control bleeding.
* Antibiotic ointment: A type of medicine that helps prevent infection.
* Sterile gauze: A type of bandage that is applied to the wound after surgery.
* Athletic supporter: A special type of underwear that provides support to the surgical area.
* Operating light: A bright light source to help the doctor see better during the procedure.
The doctor may also use a loupe magnification to get a better view during the surgery.
Who is needed to perform Vasectomy?
Usually, a vasectomy (a surgery to make a man permanently unable to get a woman pregnant) involves one or two medical experts. These include the doctor who carries out the procedure and sometimes, a helper. These professionals are well-trained to ensure the whole process is done safely and correctly.
Preparing for Vasectomy
Before a doctor performs a vasectomy (a procedure to stop the production of sperm), they will have a detailed conversation with the patient. This talk will include discussions on the patient’s medical, sexual, and social history. The doctor will specifically focus on any issues related to the urinary and reproductive organs, any pain or trauma experienced in the genital region, details on any past surgeries on the genitals, sexual function, and instances of testicular cancer. They will also discuss any blood-related issues, particularly those related to blood clotting. The doctor will also take into account the patient’s life situation, including their partner’s thoughts, potential to have children, past pregnancies, and any previous pregnancy challenges.
After this discussion, the doctor will conduct a physical examination focusing on the patient’s genitals. They will assess the scrotum to check for any complications. The patient’s comfort during the examination, the mobility of the tubes that carry sperm (vas deferens), and the presence of conditions like hernias, swollen veins in the scrotum (varicoceles), fluid-filled sacs that contain sperm (spermatoceles), testicular lumps or pain will be checked.
Once the doctor completes the examination, they will have a thorough conversation with the patient about the procedure’s benefits and potential risks. They will also explain other options besides vasectomy, giving the patient enough information to make an informed decision. Key points discussed include the fact that vasectomy is generally irreversible; the patient will not be considered infertile until semen analysis shows no or minimal inactive sperm; the risk of pregnancy after negative semen analysis is around 1 in 2000; and that there is a small chance that the procedure might have to be redone. They will also discuss the risks of complications after the procedure and the alternatives to vasectomy.
The risk of complications like internal bleeding (hematoma) and infection is 1-2%, while the risk of severe testicular infection (Fournier’s gangrene) is extremely rare. Chronic scrotal pain, requiring further treatment, and inflammation of the tube at the back of the testicle (epididymitis) each have a risk of around 1%. The formation of a lump due to leaking sperm (sperm granulomas) occurs less than 5% of the time, and fewer are symptomatic. Lastly, the doctor will inform that the patient will continue to produce semen, but it will not contain sperm, and there will be no change in the quantity of the semen or the patient’s libido following the procedure.
Different types of vasectomies include no-scalpel techniques, laparoscopic procedures, and open surgeries often combined with other abdominal procedures. Other birth control methods include abstinence, withdrawal, condoms, spermicidal solutions, diaphragms, cervical cups, IUDs, contraceptive pills, implants, injections, breastfeeding amenorrhea method, emergency contraception, and tubal ligation.
For the procedure, we recommend the patient to shower and shave their scrotum the night before and on the day of the surgery to keep the area as clean as possible. Detailed instructions or video guidance can help the patient understand how to do the shaving correctly.
How is Vasectomy performed
Getting ready for this procedure, known as a vasectomy, you will need to shave your scrotum either before you get to the hospital or right before the surgery. To make sure everything is clean, your scrotum will be washed with a special cleaning solution. Then, a sheet with a hole in it (called a drape) will be placed over you so only your scrotum is exposed while the rest of your body is covered.
The surgery itself involves finding and blocking a tube called the vas deferens. This tube allows sperm to mix with other body fluids to make semen. By blocking this tube, no more sperm can mix into your semen, which prevents pregnancy.
Different surgeons have different ways of doing this surgery, and it might be a bit different for different people. But here’s a general idea of what happens:
The surgeon find the vas deferens by feeling for it. Your skin is numbed with a local anesthetic, and a cut is made on your scrotum. The surgeon may then numb the area around the vas deferens. A small tool is used to make some space around the vas deferens. The tube is then held with a special tool so it doesn’t move.
The covering around the vas deferens is removed. This makes the tube easier to work with and gives the surgeon more control. Once the vas deferens is exposed, it is clipped in two places on both sides. A piece is often removed in between the two clips. This helps make sure the tube is blocked. Sometimes, the ends of the tube are sealed with heat.
The procedure is then repeated on the other vas deferens. The skin over the wound is then stitched together or glued. The area is covered with an ointment to prevent infection, and a bandage is applied.
You may feel a bit woozy after the surgery, so you’ll be asked to rest for a while before you get to leave.
About 2 to 4 months after the surgery, you’ll have to do a semen analysis. This is to make sure there are no more sperm in your semen. If more than a certain number of sperm are still found in your semen, you may need to have the surgery again.
After the surgery, you might have some pain. This should improve after a couple of days. You should avoid physical activity and sex for about 3 to 5 days. Showers are okay, but you should avoid swimming or soaking in water for about a week.
Usually, follow-up visits with the doctor are not needed unless you’re having problems or are worried about something. Many doctors will ask for a follow-up sperm count before they will say that the vasectomy has worked. This is usually done about 3 months after the surgery.
Possible Complications of Vasectomy
During a vasectomy, which is a type of surgery that prevents men from fathering children, patients might feel pain at the surgical site and within the stomach area. Some people also might get lightheaded and feel like throwing up. There might also be bleeding or trouble locating the tube known as the vas deferens, which carries sperm from the testicles.
After the surgery, some patients might notice signs of certain complications. In the early stages after a vasectomy, some men might find blood in their semen, but usually, this goes away on its own. The chance of getting a swollen or painful lump (hematoma) or an infection near the surgical site is around 1% to 2%. In very rare cases, a serious infection called Fournier’s gangrene can occur. The risk of inflammation in the tube at the back of the testicle that stores and carries sperm (epididymitis) is around 1%.
In the longer term after the surgery, about 1% of the patients experience constant pain in the scrotum that might need further treatment. Sperm granulomas, small lumps of immune cells that form as a reaction to sperm leaking from the tubules, can happen in less than 5% of cases and very few cases show symptoms. If a man has zero sperm (azoospermia) or less than 100,000 non-moving sperm per milliliter, the chance of his partner getting pregnant is around 1 in 2000. A vasectomy fails in about 0.24% of cases, which means that the man would need to undergo the procedure again.
What Else Should I Know About Vasectomy?
Vasectomy is the fourth most popular method of birth control, coming after condoms, birth control pills, and tubal ligation (a procedure for women that blocks their fallopian tubes). Vasectomies are done quickly, are just as effective as other methods, and cost about a quarter of what a tubal ligation does. However, because vasectomies are permanent, if you’re not completely sure about not wanting any more kids in the future, you might want to think about using a different birth control method.