Vasectomy: What to Expect on the Day of Surgery

A vasectomy is an outpatient surgical procedure that results in permanent male sterility by preventing sperm from being present in semen. The procedure will be performed at a clinic or day surgery center. Usually, you will only have local anesthetic and will be awake throughout the procedure. You will check in, have the procedure, and return home for recovery. There are a few options when it comes to the type of vasectomy you may have. The decision of which technique to use will be up to you and your healthcare provider.

Before the Surgery

Before the day of surgery, you and your healthcare provider should discuss why you want a vasectomy, and whether permanent birth control is right for you. While a vasectomy may be reversed, it is not always successful in returning fertility. You should consider a vasectomy permanent, and may want to consider discussing the decision to move forward with surgical sterilization with your partner.

Your practitioner will outline the risks for the procedure and how to prepare. You may be asked to sign a consent form, and your healthcare provider will ask you to prepare for surgery by:

• Stopping certain medications like blood thinners several days before your surgery
• Quitting smoking
• Clipping or shaving the public hair around the surgical site
• Bathing or showering the night before and day of your surgery
• Making arrangements for limited activity and time off work after surgery
• Arranging for someone to drive you home after the procedure.

During the Surgery

The two methods used for vasectomies are the conventional vasectomy and no-scalpel or minimally invasive vasectomy.

• Conventional vasectomy: Incisions between 1.5 and 3 centimeters are made in the scrotum (either one in the midline, or one on each side of scrotum) to expose the vas deferens.
• No-scalpel or minimally invasive vasectomies: The vas deferens is accessed through a skin opening of less than 10 millimeters. This minimally invasive procedure carries less risk of bleeding and infection than conventional vasectomy.

The primary difference in these procedure types is how the vas deferens is accessed. Beyond that, the surgery itself is similar. The goal of the vasectomy is to access the vas deferens, a duct in the scrotum where sperm pass as they move from the testes, through the prostate gland, and on to the urethra during ejaculation.

The vas deferens is severed or clipped in a vasectomy, disrupting the flow of sperm into semen and making it sterile. Additional steps may include mucosal cautery (using electrical current to seal the end of the duct) or placement of a layer of tissue (the internal spermatic fascia) between the two divided ends of the vas. Incisions may need to be sealed or sutured with either method, but openings to the vas deferens made during minimally invasive techniques are often left to close on their own.

Prep for Surgery

When you arrive at your practitioner's office or outpatient facility on the day of your surgery, you will be taken to a procedure area. The following may occur.:

• You will be asked to remove any clothing and jewelry, and put on a hospital gown.
• You should empty your bladder.
• You will be taken to the procedural area, and will likely have the surgical area shaved if you haven't done that already, cleaned, and draped with sterile towels in preparation for surgery.
• You may be offered oral medication to reduce anxiety.
• Your healthcare provider will administer a local anesthetic—most likely through an injection—to numb the surgical area before the procedure. You will be awake throughout the procedure.

Surgical Procedure

At this point, the technique may vary depending on whether you are having a conventional or no-scalpel/minimally invasive vasectomy. As minimally invasive procedures are preferred in the United States, this approach will be the focus moving forward. In a minimally invasive vasectomy, your healthcare provider and an assistant will:

• Make a small midline or bilateral incision or puncture in the upper scrotal area measuring less than 10 millimeters to expose the vas deferens.
• The tool called a vas ring clamp or similar instrument may be used to secure an opening in the scrotum.
• The vas deferens will be isolated and pulled through the opening to expose it.
• Although the area will be numbed with a local anesthetic, you may feel a pulling or tugging as the vas deferens is exposed.

There are a number of steps your healthcare provider may take next, depending on the chosen method for dividing and closing the vas deferens. The most common methods, called vasectomy occlusion techniques, are as follows.

• Fascial interposition: A layer of connective tissue is placed between the two divided ends of the vas deferens. The vas deferens may be divided in several ways.
• Ligation: This is the dividing or cutting out of the vas deferens between two points, with or without a fascial interposition. Roughly 1 centimeter of the vas is usually removed.
• Clips: One or more clips may be placed on the end of the vas between two points where sperm flow will be occluded. The space between the two clips may or may not be removed.
• Folding back: In this method, the ends of the vas may be folded back on themselves to keep the two cut ends from meeting.
• Mucosal cautery: Thermal or electrical currents are used to cut the ends of the vas in order to minimize tissue damage. A piece of scar tissue is formed during this technique, which helps to occlude the vas deferens.
• Non-divisional extended electrocautery technique: This is an electrocautery technique that creates an occlusion of up to 3 centimeters in the vas. it is the only occlusion technique that doesn't divide the vas deferens completely.
• Open-ended vasectomy: One end of the vas deferens is left open while the other is occluded, or sealed. This technique aims to reduce pain by decreasing pressure in the vas deferens. When this method is used, fascial interposition is used to prevent the end of the vas deferens from rejoining and restoring the flow of sperm.

Once the occlusion is complete, the vas deferens is returned to the scrotum, and the incision or puncture is sealed with sutures or glue or left to heal on its own. The entire procedure should take less than 30 minutes.

After the Surgery/Procedure

After the surgery, you will be given instructions for post-operative care. Your healthcare provider should advise you to bring a clean jockstrap, compression shorts, or other supportive garment to wear home after the procedure. Someone should be available to drive you home after your vasectomy, and your practitioner should give you instructions on how to care for the surgical area and when to follow up after the procedure.

• Some discharge or bleeding is anticipated, and a small piece of gauze may be placed over the incision/puncture site. The dressing can typically be removed when it is dry or drainage-free, generally a day or two after your vasectomy.
• If the incision edges separate due to drainage or swelling, you can pinch them together with sterile gauze to promote healing.
• Swelling and mild discomfort are expected. Acetaminophen can be used for pain relief, as well as ice packs or frozen vegetables placed on the surgical site for up to 20 minutes at a time in the first 48 hours to reduce swelling.
• Scrotal support with a jockstrap or supportive garment may help reduce pain and swelling.
• Bathing and swimming should be avoided for the first few weeks, but you can usually shower the day after your vasectomy. Pat the area dry with a towel; do not rub.
• You should plan rest and avoid strenuous activity for the first 24 hours after your vasectomy.
• Depending on the physical requirements of your job and your recovery, you may need to take one to three days off of work.
• You should avoid sexual intercourse and other strenuous activity for about a week after your vasectomy.
• If you ejaculate, you may see blood in your semen or experience pain.
• You should use an alternative form of birth control until your healthcare provider confirms your vasectomy was successful.
• Call your doctor if you experience a fever above 100.4 degrees Fahrenheit in the days after surgery, or if you have increased pain, swelling, redness, or discharge from your incision site.

A Word From Verywell

A vasectomy is an outpatient procedure that does not require intense preparation or recovery. Within a week, you should be able to return to most of your normal activities without much discomfort. You will need a backup method of birth control until your practitioner confirms that your vasectomy was successful in achieving sterility.