Information: Key-Hole Vasectomy (Male Sterilisation)
What is a vasectomy?
Vasectomy is a small operation to cut the vas deferens. This is the tube that takes sperm from the testes to the penis. Sperm are made in the testes. Once the vas deferens is cut, sperm can no longer get into the semen that is ejaculated during sex.
How reliable is vasectomy?
Vasectomy is very reliable. About 1 in 1000 operations fail, with semen tests showing sperm still present after the operation. Even after a successful operation about 1 in 2000 men who have had a vasectomy will become fertile again at some point in the future. This is because, rarely, the two ends of the cut vas deferens re-unite after a period of time.
How is a vasectomy done?
It is usually done with a local anaesthetic. Local anaesthetic is injected into an area of skin on either side of the scrotum above the testes. A very small cut is then made to these numbed areas of skin.
The vas deferens can be seen quite easily through the ‘key-hole’ incision. The vas is then divided, and the ends of the vas are tied. The small cuts to the skin are then allowed to seal naturally. Dissolvable stitches are occasionally used if the incisions require it. The operation takes about 15 minutes.
There is usually some mild discomfort and bruising for a few days after the procedure, but most men can return to work the next day. Wearing tight fitting underpants can help the discomfort.
Are there any risks to the operation?
Most men have no problems after a vasectomy. Problems are uncommon but include the following.
- As with any operation or cut to the skin, there is a small risk of a wound infection.
- The bruising around the operation site may be quite marked, but will go in a week or so.
- Rarely, sperm may leak into the scrotum and form a swelling.
- A small number of men have a dull ache in the scrotum for a few months after the vasectomy operation. This usually settles over time.
How do I know it has been successful?
Some sperm survive in the 'upstream' part of the vas deferens for several weeks after vasectomy. These can get into the semen for a while after the operation. About 8 weeks after the operation you will need to produce a semen test. This is looked at under the microscope to check for sperm. If this is clear of sperm you will be given the 'all clear'. If sperm are still present, the test is repeated a month later. You still need to use other forms of contraception, such as condoms, until you get the 'all clear'.
What are the advantages of vasectomy?
It is permanent and you don't have to think of contraception again. It is easier to do, and more effective, than female sterilisation.
What are the disadvantages of vasectomy?
It may take a few months before the semen is free from sperm. As it is permanent, some people regret having a vasectomy, especially if their circumstances change.
Will it affect my sex drive?
No. The sex hormones made by the testes (testosterone etc) continue to be passed into the bloodstream as before. Also, vasectomy does not reduce the amount of semen when you ejaculate during sex. Sperm contributes only a tiny amount to semen. Semen is made in the seminal vesicles and prostate higher 'upstream'. Sex may even be more enjoyable as the worry or inconvenience of other forms of contraception is removed.
What happens to the sperm?
Sperm are still made as before in the testes. The sperm cannot get past the blocked vas deferens and are absorber naturally back into the body.
Some other points about vasectomy
Don't consider having the operation unless you and your partner are sure you do not want children, or further children. It is wise not to make the decision at times of crisis or change, such as after a new baby or termination of pregnancy. It is best not to make the decision if there are any major problems in your relationship with your partner. It will not solve any sexual problems.
Doctors normally like to be sure that both partners are happy with the decision before doing a vasectomy. However, it is not a legal requirement to get your partner's permission.
Some common questions about vasectomy
Is vasectomy done on the NHS?
Yes, it is possible to have a vasectomy done on the NHS. However, waiting lists may vary throughout the country and may be very long. Some men prefer to have it done at a private clinic or hospital.
Does the operation hurt?
No more than any other minor operation that uses local anaesthetic. The injection of local anaesthetic may sting a bit for a few seconds. It is put in just a small area of skin, so it is nothing to worry about. After this the operation is usually painless. After the operation, when the local anaesthetic wears off, the top part of the scrotum is normally mildly sore for a few days. Ignore any 'scare stories' that seem to be a favourite joke topic for some men.
What if I change my mind?
Vasectomy is considered permanent. There is an operation to re-unite the two cut ends of the vas deferens. It is a difficult operation and not always successful. It is also not available on the NHS, so you would have to pay for this yourself.
How soon after the operation can I have sex?
You can resume sex as soon as it is comfortable to do so. However, remember you will have to use other methods of contraception (such as condoms) until you provide a semen specimen that is clear of sperm. Some sperm will survive 'upstream' from the cut vas deferens for a few weeks. You must wait till the 'all clear' before stopping other forms of contraception.
I have heard that there is an increase in the risk of cancer after vasectomy surgery. Is this true?
The answer is no. A few years ago there was a 'scare' about a possible link. Since then several surveys have been done and have shown that there is no link between vasectomy and an increased risk of any cancer.