Vasectomy Procedure Details
Please watch the video below for more information about the vasectomy procedure.
Dr. Robert Bates, Urologist
If you’re interested in a vasectomy, there are two questions I ask every patient.
First of all, do you have children? And second of all, if there is a significant other, is that person in agreement? The reason I ask those questions is that vasectomies are potentially irreversible. You can try to reverse it, but it’s not always successful and it’s usually a very significant out-of-pocket cost.
ABOUT THE PROCEDURE
We offer the vasectomies McKenzie Health in the Specialty Clinic in Watford City. It’s myself and the patient in the room. If their significant other wishes to be with them for moral support, it’s fine with me.
The procedure takes 15-30 minutes to conduct. I use what’s called a no-scalpel technique – no incision. There’s just a little puncture wound. I start out by putting local anesthetic into the front of the scrotum in the skin. That numbs up an area about the size of a half dollar or so. I then inject local anesthetic down around the vas. There’s one for each testicle and that is the worst part of the whole thing; it’s going to feel like someone’s squeezing the testicle hard for about 10 seconds or so, and then it’s gone.
I then make one single, little puncture wound in the skin, reach down inside, grab ahold of the vas, usually starting in the right side and pull that vas up through that hole as a loop. I then cut out a fragment that interrupts the flow of sperm from the testicle to the prostate gland area. It ends up being like cutting your garden hose.
Next, I do three things to prevent those two ends from joining back together again. First, I remove a segment and that physically separates them. Second, when I cut the vas, it’s with a red hot wire and so it cauterizes, scarring the ends of the vas. As a backup plan, I put little titanium surgical clips on each side. These are 3 to 6mm long. They’re like little crimping devices, and will be one on each side. You won’t feel them. They won’t set off any alarms, but they’re in there holding the ends closed just to be sure that there’s no reestablishment of transfer of sperm from the testicle to the prostate gland area.
When I get done with the first side, I just let go. It drops back down into the scrotum, and then I almost always can manipulate the other vas through the same hole and do the same thing when I get done. That little puncture wound just puckers closed on its own, so there’s no stitches in the skin. I put a gauze dressing on an athletic supporter that we provide and then send you home with instructions.
The first instruction is that you go home that day, put ice on your scrotum, sit around the house, watch television, read a book, eat, drink, breathe, sleep. Take it easy. You may feel perfectly fine, but follow the instructions. The day afterwards, the dressing, the athletic supporter and the ice are all optional. If you want to leave them on, that’s fine. If you want to take them off, that’s fine. You may take a quick bath or a quick shower. It does not hurt to get this wound wet. Then take it easy for 2 days. You don’t have to lay in bed the whole time, but no heavy work or vigorous activity. As I say to patients – no digging ditches or chopping wood. Just take it easy. You may feel perfectly fine, but if you take it easy, we can really reduce the risk of complications, primarily bleeding. The second instruction is that if you’re sexually active, you and your partner need to use some means of birth control, until we see two semen specimens in the lab free of sperm.
When you come in to have the vasectomy, I will go over all these instructions. We give you 2 containers, and after 2 days of taking it easy, you can resume sexual activity. Bring in a semen specimen to the lab 1 month and 2 months after the vasectomy. We find out the results. We give you a call. Once you’ve got two negative specimens, you’re home free and can drop the means of birth control.
After The Procedure
It will make you sterile. You will not be able to father any children, but it should have no effect, whatsoever, on your sexual activity – erections, ejaculations, sexual drive, libido – no effect.
Secondly, guys kid each other about side effects. For instance, that your beard is going to fall out, you’re going to gain weight, your voice is going to change, etc. None of those are true. Almost all of those guys have had vasectomies, and they’re pulling your leg. There’ll be no other side effects on you personally. And lastly, the overwhelming body of medical evidence would indicate that men who have had vasectomies are no greater risk of any particular diseases or conditions than anyone else except things directly related to the vasectomy.
There are things that can happen that we’d prefer not seeing happen. First failure of the operation, meaning that you have a vasectomy. All goes well according to your perspective and mine, but we’re checking semen specimens and we’re out 3, 4 or 5 months and we’re still seeing sperm. The risk of that happening is somewhere in the world literature between 0 and 0.5%. Can it happen? Yes. If it happens, we recommend patients have their vasectomy redone because it’s easier, cheaper and safer than their partner having a tubal ligation. We would have the patient return and do the procedure again. It’s extremely rare for that to happen. What we’re really worried about is bleeding. If you have a vasectomy, you’ll have a little puncture wound. There’ll be some swelling the size of a marble, a little black and blue, a little tenderness, maybe a little discharge. That’s normal. Major bleeding is a concern, along with swellig of the scrotum (baseball) and black in color. It is very painful.
The best way to avoid that is to go home and take it easy for 2 days. If we all do our jobs, the risk of that heavy, severe bleeding is less than 1%. Infections are a risk, but they’re extremely rare. You have a little puncture wound in a warm, moist place. You’re up and about. The wound is healing. You may see a little discharge into your underwear, and that’s normal wound healing. If there’s an infection, you’ll know it and you’ll be knocking on somebody’s door because it’ll be very evident. But that, again, is extremely rare for that to occur.
Everyone worries about pain. The best I can say is after doing these for 4 decades, having one done on myself, that the vast majority of guys will tell me afterward, the anticipation is worse than the procedure. I usually don’t hear from patients except to see the results of the semen analysis.
From Dr. Bates
I want to emphasize if there are questions or concerns following the procedure, no question is unreasonable to ask.
One of us is always available, and we’ll get back to you. And if it’s something that we really need to see, we’ll make sure you get into the clinic as quickly as possible.
It’s a very straightforward procedure, very commonly done. Vasectomies are the most common means of permanent birth control now in the United States. Once it’s done, it’s done. It’s just an issue that you don’t need to be concerned about.