VASECTOMY

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is vasectomy (male sterilisation).

During a minor operation, the tubes that carry sperm from a man's testicles to the penis are cut, blocked and sealed.

This prevents sperm from reaching the seminal fluid (semen) which is ejaculated from the penis during sex. There will be no sperm in the semen, so a woman's egg cannot be fertilised.

Vasectomy is either carried out under a local or general anaesthetic and takes about 15 minutes.

Facts about vasectomy

• In most cases, vasectomy is more than 99% effective. Out of 2,000 men who are sterilised, one will remain fertile thus risking pregnancy during the rest of his lifetime.
• Male sterilisation is considered permanent – once is done, you do not have to think about contraception again.
• You need to use contraception until two semen analyses show no evidence of sperm. It can take up to 30 ejaculations to clear the sperm that are already in the tubes.
• Your scrotum (testicles) may become bruised, swollen or painful – In some men (quoted as 10-30%) they experience ongoing pain in their testicles which can be extremely severe and difficult to treat.
• As with any surgery, there's a slight risk of infection.
• Reversing the operation is not easy and is rarely available on the NHS.
• Vasectomy should not protect against sexually transmitted infections (STIs). By using a condom, you will protect yourself and your partner against STIs.

How vasectomy works

Vasectomy works by stopping sperm from getting into a man’s semen. This means that when a man ejaculates, the semen has no sperm and a woman’s egg cannot be fertilised.

How vasectomy is carried out

Vasectomy is a quick and relatively painless surgical procedure. The tubes that carry sperm from a man's testicles to the penis are cut, blocked and sealed with heat. In most cases, you will be able to return home the same day.

Vasectomies can be carried out under local anaesthetic. This means that only your scrotum and testicles will be numbed and you will be awake for the procedure. You will not feel any pain, although it may feel uncomfortable.If a  general anaesthetic is used you will be asleep during the procedure. I will  suggest this if the vas are very difficult to feel or if you are extremely nervous about the operation.

A vasectomy has no effect on sex drive or ability to enjoy sex. You will still have erections and ejaculate normally. The only difference is that your semen will not contain sperm. The volume of ejaculate is almost the same as normal and you will not notice a difference.

During a conventional vasectomy, the skin of your scrotum is numbed with local anaesthetic. I will make two small cuts, about 1cm long, on each side of your scrotum.

The incisions allow me to access the tubes that carry sperm out of your testicles. These tubes are known as "vas deferens". Each tube is cut and a small section removed. The ends of the tubes are then closed, either by tying them or sealing them using diathermy (an instrument that heats to a very high temperature).

The incisions are stitched, using dissolvable stitches, which will disappear naturally within about a week.

Before you decide to have a vasectomy

You should only have a vasectomy if you are certain that you do not want to have any, or any more, children. If you have any doubts, consider another method of contraception until you are completely sure.

You should not make the decision about having a vasectomy after a crisis or a big change in your life , for example, if your partner has just had a baby or has just terminated a pregnancy.

If you have a partner, discuss it with them before deciding to have a vasectomy. If possible, you should both agree to the procedure, but it is not a legal requirement to get your partner's permission.

You can have a vasectomy at any age. However, if you are under 30, particularly if you do not have children I would think very carefully before having it.

Recovering after the operation

It is common to have some mild discomfort, swelling and bruising of your scrotum for a few days after the vasectomy. If you have pain or discomfort, you can take painkillers such as Paracetamol.

It is wise to avoid heavy lifting and sport for two to three weeks after the operation.

Wear supportive underwear such as a jock strap.

Is common to have blood in your semen in the first few ejaculations after a vasectomy. This is not harmful.

It is best to keep the wound dry for 24 hours and then shower rather than bath for 48 hours. After this you can return to your normal routine.

A few men continue to have small numbers of sperm in their system but these sperm do not move (they are known as non-motile sperm). If you are one of these men, I will discuss different options with you. The chances of the sperm being fertile” may be low enough to consider the vasectomy successful or you may be advised to have further tests or consider other options.

Advantages

• The failure rate is only one in 2,000 – out of 2,000 men who have a vasectomy, only one will get a woman pregnant in the rest of his lifetime
• Vasectomy does not affect your hormone levels or sex drive.
• It will not affect the spontaneity of sex or interfere with sex.
• Vasectomy may be chosen as a simpler, safer and more reliable alternative to female sterilisation.

• Disadvantages

• Chronic testicular pain in 10-30% of patients

• Vasectomy doesn’t protect against STIs
• It is difficult to reverse.
• You need to use contraception after the operation until tests show your semen is free of sperm – if your semen contains sperm,
• ”your sperm may still be fertile thus risking pregnancy”.