Vasectomy: Overview

In This Article

A vasectomy is the only form of permanent contraception in men. This minor surgery, also called male sterilization, involves closing off the vas deferens—the two tubes located near each testicle—that normally carry sperm outside of the body. Besides being very effective, there is a low risk of complications associated with a vasectomy.

What Is a Vasectomy?

The vas deferens is a tube that stores and carries sperm cells made in each testicle. It connects the epididymis to the urethra, where the sperm mixes with semen and leaves the body.

In all vasectomies, the ends of the two vas deferens are closed off by being tied off, clipped, or cauterized (seared with heat).

This 20- to 30-minute elective surgery is usually performed by a urologist in their office or at an outpatient surgical center under local anesthesia.

Less commonly, a vasectomy may be performed in a hospital or surgical center under general anesthesia. The ultimate location depends on a man's anatomy and personal preference.

A vasectomy is one of the most commonly performed surgeries in the United States, with more than half a million men electing to have the procedure each year.

Various Surgical Techniques

There are two main surgical techniques that a doctor can use to access the vas deferens:

  • Conventional or incisional vasectomy: The vas deferens is accessed by using a scalpel to make a two centimeter or so incision in the scrotum (the sac that holds the testicles).
  • No-scalpel vasectomy: The vas deferens is accessed by using specialized surgical tools. The doctor first uses a vas ring clamp to clamp the vas deferens from the outside. Then, a skin opening of 10 millimeters or less is made by a vas dissector, a scissor-like device with a fine pointed end. The vas deferens is then exposed by gently spreading out the skin and tissue overlying it.

While both vasectomy techniques are equally effective, the no-scalpel vasectomy is associated with less bleeding, infection, and pain than a conventional type. It is the more preferred surgical technique in the United States.

Contraindications

The main contraindications to getting a vasectomy include the presence of the following:

  • Scrotal hematoma
  • Genitourinary or groin infection
  • Sperm granuloma

However, a vasectomy may be performed if and when the above issues are resolved (e.g., the infection is treated and cleared with an antibiotic).

Possible contraindications to undergoing a vasectomy include the presence of a:

Purpose of Vasectomy

After a vasectomy, sperm cells are still produced by a man's testicles—they just cannot mix with semen and are, instead, absorbed by the body. This is intentionally done with the specific goal of rendering a man unable to have children.

Since a vasectomy means life-long sterility, before undergoing one, a man will first consult with his primary care doctor or urologist to ensure it's the right decision for him and his family.

Particularly because this procedure is permanent, the decision to have a vasectomy should not be made lightly. If you have a partner, they should be included in the decision. You should be certain you do not want to have any biological children in the future.

Besides not desiring children, it's also essential that you are clear on and accepting of other realities of this surgery, such as:

  • The timeline of sterility after a vasectomy: It is not immediate, so another form of contraception is required for a period of time.
  • The risk of pregnancy after a vasectomy: It is approximately 1 in 2,000.
  • The potential risks and complications of a vasectomy (e.g., bleeding, infection, or chronic scrotal pain)

All of this should be thoroughly discussed at your preoperative vasectomy consultation.

Being Denied Surgery

In rare instances, if a surgeon does not believe a vasectomy is in the best interest of their patient, they may refuse to perform it. This situation may occur in a male who, while competent and without any medical contraindications, is believed by his surgeon to be too young to make such a lifelong, permanent decision.

While a doctor cannot be forced to perform a vasectomy, they should explain their thoughts behind refusing the surgery and refer the patient to another doctor (if desired by the patient).

Remember that as long as you do not have any medical contraindications for the surgery, the green light to have this procedure is ultimately yours to give.

How to Prepare

Once you've come to the decision that you want to move forward with a vasectomy, your urologist will review your medical history and perform a physical exam to make sure you are cleared for the procedure.

Before preparing for your vasectomy, you will be asked to sign a consent form to confirm that you are opting for the procedure and that you are aware of its intent as well as its risks—including possible ineffectiveness.

Once a surgery date is scheduled, you will receive instructions on what to do in preparation for your procedure. It may be suggested that you:

  • Avoid certain medications for a period of time before your procedure (for example, blood thinners like aspirin or ibuprofen).
  • Shave and clean your genital area before arriving.
  • Eat a light meal on the day of your procedure.
  • Bring in jockstrap or tight pair of compression shorts to wear after the surgery.
  • Arrange for someone to drive you home after the surgery.

What to Expect on the Day of Surgery

On the day of your vasectomy, you will be asked to dress comfortably and to not wear any jewelry or anything else that may interfere with the procedure.

Once you arrive, you will be asked to change into a gown. At this time, you may be given an anti-anxiety medication (sometimes, it's taken prior to arriving at the office). You will then relax and lie down with your back on the exam or operating table.

A vasectomy typically then proceeds with the following steps:

  • Administration of local anesthesia underneath the skin (often by shot or a very small needle) to numb the genitals
  • Shaving of the genital area, if needed (once the area is numbed)
  • Preparation of the skin within and around the surgical site using a solution that kills bacteria

The surgeon will then access the vas deferens through an incision or puncture in the scrotum. Once exposed, the vas deferens can be cut, tied with a stitch, or seared. While you should not experience pain during this time, you may feel a tugging, pulling, or cramping sensation.

The skin on the scrotum will then be closed with dissolvable stitches or be left to heal on its own.

After the surgery, you will be able to go home right away, although someone will need to drive you. Your doctor will give you post-operative instructions on what activities to avoid and what symptoms to expect in terms of recovery.

Recovery

After a vasectomy, you can expect some of the following symptoms during recovery:

  • Your scrotum may be numb for one to two hours.
  • You may have mild soreness and swelling in your scrotum for three to four days.
  • You may have a little bleeding or discharge from your incision site.

When you return home, to ease pain and swelling, your doctor will ask you to do the following:

  • Place cold packs (a bag of frozen peas or corn also works) on the scrotum; never place ice directly on the skin.
  • Elevate the scrotum by placing a folded washcloth or hand towel under the area when sitting or lying down.
  • Wear a jockstrap or tight compression shorts or underwear.
  • If needed, take a pain reliever like Tylenol (acetaminophen).

You will also be advised to: 

  • Lie back and relax at home for a day or two after the surgery.
  • Stay home from work for one to two days.
  • Avoid heavy lifting or strenuous exercise for one week.
  • Avoid sex for a week.
  • Avoid taking a bath or swimming for a 24 to 48 hours after the surgery.

When Does a Vasectomy Become Effective?

It's important to keep in mind that a vasectomy is not effective until three months after the surgery (when the sperm has cleared from the tubes), so contraception (e.g., condoms) is important during this time to prevent pregnancy.

About three months after the procedure, or after you have had the opportunity to ejaculate 20 times, a semen sample will be tested to make sure the procedure worked and that your semen is free of sperm.

When to Seek Medical Attention

During your recovery, it's important to call your doctor if you experience any of the following symptoms:

  • Fever
  • Severe or worsening scrotal pain, swelling, or abnormal discharge or bleeding
  • Problems urinating
  • A lump in your scrotum

Long-Term Care

The long-term implications of a vasectomy are positive in the sense that this surgery offers a permanent solution to birth control for those who seek it.

Other benefits of a vasectomy are that it:

  • Is less expensive than tubal ligation, a surgery for permanent birth control in women
  • Is low-risk (complications are rare)
  • Involves a mild and quick recovery
  • Has no negative effects on sexual health

That said, there are a few points to keep in mind.

For one, a vasectomy does not protect against sexually transmitted infections, so condom use is still needed if more than one partner is involved.

Secondly, in the rare event that a vasectomy fails (less than 1%), it may need to be repeated. A failed vasectomy is determined if any motile sperm are seen on a post-vasectomy semen analysis taken at six months.

Potential Risks

As with any surgical procedures, a vasectomy comes with various risks and side effects, although most are rare.

Immediate risks after a vasectomy include:

  • Hematoma: Some swelling, mild discomfort, and bruising of your scrotum is normal after a vasectomy. These symptoms should go away within two weeks. But a hematoma is a complication that causes significant bleeding into your scrotum, which causes painful swelling.
  • Infection: A wound infection or infection within the scrotum (called epididymitis) may occur after a vasectomy. Potential symptoms include fever, and a tender and red scrotum.
  • Spermatic granuloma: After a vasectomy, a small, usually painless lump, called a granuloma, may develop in the scrotum. This is caused by the leakage of sperm from the vas deferens.
  • Post-vasectomy pain syndrome: Approximately 1% to 2% of men who undergo a vasectomy experience chronic testicular pain that is constant or comes and goes. The pain interferes with a man's quality of life. Medications may help, while surgical interventions (for example, a reversal of the vasectomy) are last-resort options.

A Word From Verywell

Overall, a vasectomy is a low-risk and very effective form of birth control. That said, undergoing a vasectomy is a very personal decision—one that requires careful thought, especially given its permanency. While reversing a vasectomy is theoretically an option, it can be a technically challenging procedure, as well as costly and possibly unsuccessful.

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