What to Expect Before, During, and After Vasectomy Surgery

A vasectomy is a surgery performed to render a man unable to have children (sterile). It is one of the most commonly performed surgeries in America, with more than half a million men electing to have the procedure each year. While surgery to sterilize women (tubal ligation) is more popular, the vasectomy surgery is far less invasive and offers a much quicker recovery.

Insurance typically pays for a vasectomy, unless the plan does not pay for birth control of any kind. If the surgery will be paid for out of pocket, the cost can range from a few hundred to a few thousand dollars.

What It Does (and Doesn't) Do

The vasectomy surgery works by preventing sperm from exiting the body. This is done by severing or blocking the vas deferens, the duct through which sperm travels from the testes and out of the body. Sperm is still produced, but it cannot exit the body when a man ejaculates.

While the surgery is effective at preventing pregnancy, it does not alter the ability to have/maintain an erection. There is no change in the quality or quantity of semen, nor is there a change in the ability to ejaculate.

Additionally, a vasectomy does not prevent the spread of sexually transmitted diseases (STDs). Condoms and appropriate precautions should be used to prevent STDs after the surgery.

Effectiveness

A vasectomy is almost 100% effective at preventing pregnancy, making it one of the most effective forms of birth control available. However, it's important to know that it's not effective immediately upon having the procedure—it actually takes about three months for semen to be completely sperm-free. 

Additionally, in rare circumstances, the vasectomy procedure is not effective in preventing sperm from moving out of the testes at all, or the ends of the vas deferens grow back together. This is discovered when the sperm count does not fall after surgery. In this case, the procedure must be repeated to be effective.

Risks of a Vasectomy

As with most surgical procedures, a vasectomy comes with various risks and side effects, although most are minor and last temporarily. These include:

  • Bleeding: A small amount of bleeding should be expected, but serious bleeding should be reported to your doctor. Similarly, bleeding under the skin that may cause swelling or bruising (also known as a hematoma) may also occur.
  • Mild pain: An expected side effect of most surgeries, the pain after a vasectomy is typically mild to moderate in nature.
  • Epididymitis, or chronic ache or pain in the testicles (which is sometimes referred to by the slang term "blue balls") may also occur. In severe cases, surgery may be necessary to remove the epididymis (the tube that allows sperm to pass from the testes).
  • Sexual problems: While there is no physical reason for sexual problems, a small minority of men report problems with their ability to function sexually after surgery. This is typically related to feelings about the surgery rather than the surgery itself.
  • Spermatic granuloma: An abscess that forms at the site of a vasectomy that is caused by sperm leaking from the vas deferens after surgery

Before a Vasectomy

Before your surgery, you'll likely consult with your doctor to ensure it's the right decision for you, as it's safe to assume that a vasectomy will mean life-long sterility. Particularly because this procedure is permanent, the decision to have a vasectomy should not be made lightly. You need to be sure that you do not want to have children again. While there is a procedure to reverse a vasectomy, the success of that procedure is by no means guaranteed. A vasectomy reversal can also be very expensive, as insurance does not typically cover the costs.

Once you've come to the decision that you want to move forward with the procedure, your doctor will likely give you instructions on how to clean your genital area before you come in.

During the Vasectomy

A vasectomy is performed at a doctor's office or surgical center, rather than a hospital. The procedure generally takes about 30 minutes total.

The traditional vasectomy procedure starts with the administration of local anesthesia to numb the genitals. This allows you to remain awake and alert during the procedure, but unable to feel it being done. In some cases, a needleless injection is used to administer the anesthetic in this sensitive area. Your doctor may or may not have this new technology available for use during surgery.

Once the genital area is numbed, the area will be shaved and the skin prepared with a solution that kills bacteria on the surface.

The surgery begins with one or two half-inch long incisions on the underside of the scrotum. The vas deferens is then located and either cut and tied off or cut and cauterized. Research shows that the use of cautery is the most effective option, as it prevents the vas deferens from healing back together.

The incision is then closed with sutures.

No-Scalpel Vasectomy (NSV)

Your doctor may instead consider the no-scalpel version of the procedure, which involves using a pair of hemostats or another sharp instrument, instead of a scalpel. This allows for the creation of a small hole in the scrotum (approximately a centimeter wide) through which the surgeon is able to locate the vas deferens.

After the Vasectomy

Most men take a day or two off of work and are able to return to normal activity within a week. The stitches are typically removed in the doctor’s office seven to 10 days after the procedure. Most men are able to return to active sports and sex at this point; however, birth control is necessary until testing confirms that the surgery was successful and pregnancy is not possible.

Bruising and soreness post-surgery is normal, but that can usually be controlled with mild pain medication and a cold compress, as necessary. Good incision care is very important at this time.

Wearing an athletic supporter or snug underwear during the first few days of recovery can help prevent movement of the scrotum and help minimize pain. While an ice pack may help ease the swelling, be sure to avoid placing it directly against the skin. Wrap the ice in a towel or a pillowcase to prevent burning the skin. A bag of frozen peas or corn works very well in this capacity and can be frozen and reused during the recovery period.

Elevating the scrotum may also help with any soreness. Elevating the area may also help reduce swelling. When sitting or lying down, a washcloth or small towel can be folded and placed under the scrotum to elevate it. Over-the-counter ibuprofen or acetaminophen is a good choice for mild to moderate pain during the first few days after surgery.

Post-Vasectomy Testing

About three months after the procedure, a semen sample will be tested to make sure the surgery worked and that your semen is free of sperm. You'll likely be sent a container for the semen so the sample can be collected in the privacy of your own home.

The sample must then be taken to the lab for testing within one hour of collection. It is important to know the hours of the lab or doctor’s office, so it will be open and able to accept the sample for testing immediately.

When collecting a semen sample, it is important that the semen not come in contact with spermicide, a type of birth control that kills sperm. It is often present in condoms and other types of contraceptives.

Once the sample is taken to the lab, it will be studied under a microscope. When the sample is completely free of sperm, the surgery is considered effective and birth control is no longer needed to prevent pregnancy. However, if there is any sperm in the sample, the man remains fertile and can father children. If this is the case, testing will be repeated at a later date to see if sperm remains in the semen. Until the semen is confirmed to be completely free of sperm, another form of birth control should be used to prevent pregnancy.

In rare cases, pregnancy can result after a vasectomy and a semen sample that is negative for sperm. In these cases, pregnancy usually results because the two sides of the vas deferens can actually heal together and reform the path out of the body. This is the least likely to happen when the surgeon uses a procedure that cauterizes the cut ends of the vas deferens, leaving scar tissue that makes it much more difficult to form this type of self-repair. This type of cautery can be done with both the traditional and no-scalpel (NSV) approach.

A Word From Verywell

In the vast majority of cases, a vasectomy is one of the most reliable forms of birth control. Pregnancy is far more likely to result from not waiting long enough for the active sperm to leave the body following the procedure than from a failure of the surgery. In other words, assume you are 100% fertile until your semen sample is found to have no sperm.

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Article Sources

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Additional Reading

  • MedlinePlus. Vasectomy. Updated January 23, 2018.