Vasectomy

Vasectomy is the most common form of male contraception in India. When a man wants to practice reliable birth control without placing the burden on the female partner, he may undergo this relatively simple surgical procedure.

What is Vasectomy?

Vasectomy is the clinical term given to the process of surgically obstructing or dividing the tubes that deliver sperm from testes. The procedure usually takes about half an hour and involves minimal surgery. Generally, the patient recovers quickly with relatively few complications or failures, and no discernible negative impact on sexual performance. Vasectomy is intended as a permanent form of male sterilization, but it may sometimes be possible to reverse the process surgically, at a later date.

How does vasectomy work?

To understand how vasectomy works, it is necessary to have a basic understanding of the parts of the male reproductive system and how they function. The testes are the paired male organs that produce sperm. They are located in an external sac called the scrotum, at the base of the penis. Each testis is connected to a small, coiled tube called the epididymis, where sperm are stored for as long as six weeks as they mature. The epididymes, in turn, are connected to the prostate gland by a pair of tubes called the vas deferens. The vas deferens are part of a larger bundle of tissues, blood vessels, nerves and lymphatic channels called the spermatic cord. When a person reaches sexual climax, seminal fluid produced by the prostate gland mixes with sperm from the testes to form semen. The semen is then ejaculated through the penis.

Does vasectomy have any effect on the amount of semen ejaculated or a man's sex drive?

In a vasectomy, the surgeon cuts and ties off the ends of the vas deferens. This prevents sperm from mixing with the seminal fluid. So, the semen that is ejaculated is devoid of sperm. Although the testes will continue to produce sperm, they can no longer pass through the vas deferens. Instead, they die and are absorbed into the body. Because semen consists of about 95% seminal fluid, there is may be no discernible difference in the ejaculate. Similarly, because the testes continue to produce the male hormone testosterone, which is absorbed into the bloodstream, the procedure has no effect on a man's sex drive.

Is there any method other than surgery for performing vasectomy?

The classical method of performing vasectomy has been gradually replaced by a 'no-scalpel' type of surgery. This is also a type of surgery, but a very small puncture is made through which the vas deferens is cut and put back in place. Because the wound is very small, it heals quickly. This method is quicker than the conventional surgery. Postoperative discomfort and incidences of bleeding or infection are also lower.

What should a person who has undergone surgery do during the post-operative period?

Vasectomy patients are usually allowed to go home soon after the surgery, they are asked to lie down, with their feet elevated. Although it is not necessary to remain immobile, excessive motion, such as that caused by walking around, increases the chance of inflammation in the scrotum and the area around the incision. It is normal for the patient to feel some moderate discomfort during the first day or two after his anesthetic wears off. Ice packs may be applied on and off to help keep swelling to a minimum. Mild over-the-counter painkillers may be used as needed. Any stronger painkillers should be used only if prescribed by a doctor. Use of aspirin and anti-inflammatory analgesics, such as ibuprofen, could be avoided for at least a day or two after surgery because they tend to "thin" the blood and may cause bleeding in the area of the incision. Strenuous exercise and heavy lifting should be avoided for 2 to 3 days or longer if discomfort persists. Thereafter, a person's activity will depend on the degree of discomfort experienced by the person. Most people may return to work within 3 days after surgery.

Does vasectomy produce instant sterilization?

Vasectomy does not produce instant sterilization. A substantial amount of sperm still remains in the vas deferens below the portion that was removed. In most men, it takes from 10 to 14 ejaculations over the next 2 months or so before a sperm count of zero is reached. The patient may produce a semen sample for analysis about 8 weeks after surgery to confirm sterility. Until then, some other form of reliable birth control method may be practiced. Doctors typically consider the procedure successful when the patient produces two negative sperm samples, taken 2 weeks apart. In rare cases, patients continue to show sperm in their samples for up to a year after surgery. This may be the result of poor sperm migration out of the vas deferens after surgery, or it may indicate that the severed ends of the vas deferens have reattached themselves to one another, a condition called recanalization. The only solution to this problem is a repeat vasectomy.

What are the complications of vasectomy?

Complications are rare with vasectomies, if the procedure has been done with proper care in appropriate settings. But any surgical procedure, no matter how simple, carries some degree of risk. Some patients experience more pain, bleeding or inflammation than others, and their discomfort may persist longer than normal. Often this is caused by a buildup of back pressure within the vas deferens and will eventually subside. Occasionally a condition called sperm granuloma may develop, in which residual sperm find their way out of the tied ends of the vas deferens, producing irritation and a small nodule. These usually heal with time, although surgical removal is occasionally required.

Can a Vasectomy be reversed?

The intent of a vasectomy is to produce a permanent condition of male sterility. But there are two microsurgical procedures that have been successful in restoring the flow of sperm through the vas deferens. Most vasectomy reversals are done on an outpatient basis. The most common procedure, called vasovasostomy, involves the stitching of the disconnected ends of the vas deferens back together with ultra-fine sutures. This procedure uses microsurgical methods. The other reversal procedure, called vasoepididymostomy, is performed when inflammation or scarring from the original vasectomy blocks the epididymis - the tubular structure connecting the testes to the vas deferens. In this microsurgical procedure, the blockage is bypassed by surgically connecting the vas deferens directly to the epididymis in a new location.