Each year, nearly 500,000 men in the United States choose to get a vasectomy. Their reasons vary, most have either already completed their families or do not want to have children. Vasectomy is the most common means for permanent birth control for men via a surgical operation that makes men sterile (unable to father a child). Figures show that one out of every six men over age 35 has had a vasectomy, and among married couples in the United States, only female sterilization and oral contraception are relied upon more often for family planning. Vasectomy is a simple, low-risk surgery, which doesn't limit sexual pleasure, and it's nearly 100% effective. While you and your partner will not need any other contraceptive afterward to prevent pregnancy, a vasectomy does not prevent against sexually transmitted diseases.

How vasectomy works

A vasectomy makes men sterile by blocking sperm from the semen, the fluid that is ejaculated during sex.

Sperm, the reproductive cells in men, are produced in the testicles. They pass through tubes called the vas deferens to other glands in the testicles and mix with seminal fluids to form semen. Vasectomy involves cutting or otherwise blocking the vas deferens to keep sperm out. After a vasectomy the sperm are absorbed by the body instead of being ejaculated. Without sperm, your ejaculate cannot make a woman pregnant.

Vasectomy techniques

A vasectomy takes 30 to 45 minutes. In the conventional approach, the skin of one scrotum is first numbed with a local anesthetic, then the physician makes one or two small incisions, or cuts into the scrotum. The vas is cut, and a small piece may be removed. Next, the doctor ties the cut ends and sews up the scrotal incision. The entire procedure is then repeated on the other side.

An improved method, devised by a Chinese surgeon, has been widely used in China since 1974. This so-called nonsurgical or no-scalpel vasectomy was introduced into the United States in 1988, and many doctors are now using the technique here instead of the conventional method. In a no-scalpel vasectomy, the skin of the scrotum is not cut. Instead, a special instrument is used to make a tiny puncture in the skin and then stretch the opening so the vas can be cut and tied. This approach produces very little bleeding, and no stitches are needed to close the punctures, which heal quickly. The newer method also produces less pain and fewer complications than the conventional approach.

Will it hurt?

Local anesthetic is most often used during a vasectomy to make it virtually pain-free. Some discomfort may be felt when the local anesthetic is injected or when the tubes are brought into the incision. After vasectomy, you will probably feel sore for a few days, and should rest for at least 1 day. There seems to be less pain associated with no-scalpel procedures. Using an athletic supporter, ice bag, and non-aspirin pain reliever may help ease the pain. Avoid strenuous physical labor or exercise for 3 to 5 days. You can expect to recover completely in less than a week. Many men have the procedure on Friday and return to work on Monday.

What about complications?

Complications can occur with any kind of surgery. Major complications with vasectomy are uncommon, usually not serious, and have to do with infection, which is a possibility with any kind of incision. If you have any infection symptoms after the procedure, let your doctor know. Warning signals include: a fever over 100.4°F, blood or pus oozing from the site of the incision, and/or excessive pain or swelling.

Other potential problems:

• Bleeding into the skin during surgery may cause bruises that will soon clear up. Occasionally a hematoma develops (a lump with bruising) which may require medical attention.
• Sperm will leak from the tubes and cause a small lump - granuloma - under the skin near the site of the operation in about 18 of 100 cases. Sperm granuloma usually clear up by themselves. Surgical treatment is sometimes required.
• Rarely, an abscess may develop. Treatment with antibiotics is successful.
• Very rarely, the cut ends of the vas deferens grow back together - a process called recanalization. This most often happens within 4 months of the operation and may allow pregnancy to happen.

Can the operation fail?

Yes, but in fewer than 2 of every 1000 cases.

How soon can I have sex again?

When you have sex again, depends on you. You can resume sexual activity within a few days after a vasectomy, but you'll have to use protection since it takes about 8 to 10 weeks and 15 to 20 ejaculations to clear sperm out of your system. Use another form of birth control for vaginal intercourse until a semen analysis shows there are no longer sperm in your seminal fluid.

How is semen analysis done?

You will provide a sample of your semen by masturbating or by using a special condom during sexual intercourse. The fluid will be examined under a microscope to see if there are any sperm in your seminal fluid.

Will vasectomy affect my sexual pleasure or masculinity? Your erections, orgasms, and ejaculations will very likely be the same. Most men say they have greater sexual pleasure because they don't have to worry about an unwanted pregnancy. Many say there is no change. Rarely, men lose some sexual desire. More rarely, men lose the ability to become erect. Often, such losses have to do with their emotional condition before the operation.

Vasectomy makes you sterile, not impotent. It doesn't affect the hormones that effect masculinity. Masculine attributes such as a beard, a male voice, and sex drive, are still made in the testicles. Hormones still flow throughout the body in the bloodstream and male characteristics remain unchanged after a vasectomy. And while there will be no sperm in the ejaculate, the change in the amount you ejaculate will be unnoticeable since sperm only makes up between 2% and 5% of your semen.

How much does a vasectomy cost?

Fees range between $240 to $1000 for an interview, counseling, examination, operation, and follow-up sperm count. (Sterilization for women costs up to four times as much.) Some clinics and doctors use a sliding scale according to income.

Is help with payment available?

Some private health insurance policies may pay some or most of the cost. In about 35 states, Medicaid pays but puts some restrictions on patient eligibility. Check with your local department of Social Services or Planned Parenthood clinic to see if you are eligible for assistance in paying for your vasectomy.

Is vasectomy reversible?

Yes. Success rates for vasectomy reversal have greatly increased thanks to new and improved microsurgical techniques. Still, there is no guarantee that reversal will be successful. The process is also very involved, requiring 2 hours or more of intricate microsurgery, and is expensive (from $5000 to $15,000).

Nearly 2% to 6% of vasectomized men ultimately seek reversal. Most do so because of remarriage, the death of a child, or an improvement in finances followed by the desire for another child.

How is vasectomy reversal done?

There are two types of vasectomy reversals: vasovasostomy and epididmovasostomy. A vasovasostomy is the operation most frequently performed for vasectomy reversal, and the surgery of choice. It involves stitching the cut ends of the vas deferens together.

Epididmovasostomy is a much more complicated procedure requiring a great deal more expertise at microsurgery. However, it is performed in situations where sperm is blocked from getting to the vas deferens because of excessive inflammation or scarring in the epididymis, a tube located behind the testis. An epididmovasostomy is performed by connecting the vas deferens directly to the epididymis.

How successful is vasectomy reversal?

Studies show that reversal results in the return of sperm to the ejaculate in over 90% of men. Approximately 50% of couples subsequently achieve a pregnancy. Whether vasectomy reversal is successful depends largely on the time between the vasectomy and the reversal. Simply put, the sooner you have the reversal, the better your chances of success.

The chance of finding sperm within the vas within 5 years of vasectomy is 86%; after more than 20 years it is still 60%.

Also, the success rates vary with technique. Studies indicate that with vasovasostomy, sperm appears in semen approximately 85% to 97% of men and approximately 50% of couples subsequently achieve pregnancy. Following epididmovasostomy, sperm appears in the semen in approximately 65% of men, and approximately 20% of couples subsequently achieve a pregnancy.