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Learn more from urologist Sevann Helo, M.D.

Vasectomy overview

Hello. My name is Dr. Sevann Helo. I'm a urologist and a member of the Mayo Clinic mens health team in Rochester, Minnesota. Choosing to undergo a vasectomy is big decision. You'll want to make sure and do your research ahead of time. In this video, I'll break it down to everything that you should know before undergoing vasectomy. I hope that you'll find this video helpful. Alright, so let's get started. First, what exactly is a vasectomy? Well, your tubes called the vas deferens, are the tubes that carry sperm from the testicles out to your urinary tract where they enter your ejaculate. It's a permanent form of birth control, that's key. So if you're not sure whether or not you want to have children in the future. You may want to hold off from having a vasectomy done. It is a reliable and cost-effective form of birth control compared to some of the other options. And it is less invasive than a tubal ligation, which is a similar procedure available for females looking for a permanent form of birth control.

Common questions that guys ask about vasectomy. Number one, it does not affect your sex drive or your testosterone level. Your testosterone is the male hormone that's responsible for your sex drive, your ability to put on muscle mass, and your erectile function. Second, it does not affect your ability to get or keep an erection or your ability to orgasm. Lastly, a lot of guys ask if they're going to notice if there's less fluid in their ejaculate. You might, but it's highly unlikely as the volume is slightly changed after vasectomy. Lastly, vasectomy does not increase the risk of prostate cancer. That's a very common question that patients ask.

Not all men who undergo vasectomy are ultimately happy with their decision. Half a million men undergo vasectomy each year. And up to 8% of those will choose to have their vasectomy reversed in the future for one reason or another. Men to whom that is more likely to happen to include men who are less than 30 years old at the time of their vasectomy, men who have never had children before, men whose partner is currently pregnant, men who had been considering vasectomy for less than a year. And while vasectomy reversal can be performed, there's no guarantee that it will be successful. And it's typically a costly procedure that's rarely covered by insurance. So again, you want to be a 100 percent sure that you want to undergo vasectomy before committing to it.

What about sperm banking? Well, if you're not 100 percent sure that you don't want to have children in the future. You can store sperm prior to your vasectomy just in case you change your mind. There is a yearly storage fee that's typically charged That can be a couple hundred dollars per year. That sperm that you store could be used for intrauterine insemination as long as your counts are high enough. If not, then it will need to be used for in vitro fertilization, which is a costly procedure that is not covered by most insurance companies in most states. So again, you want to be a 100 percent sure that this is what you want. Otherwise, I would highly recommend waiting.

So let's talk a little bit about the procedure itself. The procedure takes about 30 minutes in the office. We'll use some numbing medication on the skin and the tube that carries the sperm called the vas deferens to numb that area up as well. In the office, we have the option of nitrous gas, which is laughing gas like you would get at the dentist's office if you need something to help you relax. If you're extremely anxious about your vasectomy, please let our team know ahead of time so that we can see if there's anything additional that we can give you or offer you to make you more comfortable at the time your vasectomy. During the vasectomy will make a small opening in the skin where we'll locate the vas deferens, that tube that gets cut during vasectomy, we’ll then cut that tube, put a clip on it, burn the inside with cautery, and then sew tissue between the two ends as a means to try and prevent the two ends from going back together. You may wonder, what about no scalpel vasectomy? Well, quite honestly, there's no way to get through the skin or to cut through the vasectomy without some sort of sharp instrument. Even if we use a scalpel, it's extremely small. The opening we make is small and it's the equivalent of a no scalpel technique.

After the procedure, we’ll ask you to avoid any strenuous activity that would include lifting greater than 10 pounds for at least 48 hours. Keep in mind that all the stitches we’ll use are dissolvable so there's nothing that you'll need to have removed. You can start having sex after a week. And we'd ask that you actually ejaculate at least 20 times before you undergo your semen analysis at three months. The reason for this is we'd like you to get all the sperm out before you undergo that first semen analysis. Otherwise, sometimes there can be a few sperm left behind in the fluid. We’ll also ask that you use an alternative form of birth control until you're cleared by your urologists after your semen analysis.

So what are the risks with the vasectomy? Well keep in mind that vasectomy as a relatively low-risk procedure, but there are a few risks that you should be aware of. The first one is a hematoma. This is a collection of blood in the scrotum that can occur after any kind of surgery in that area. It usually doesn't require any further treatment. It just takes several weeks for the all of that fluid to go away. You also can get an infection. This is extremely rare after vasectomy, but if this occurs, we will give you a course of antibiotics. There is a one in 2 thousand chance that the vasectomy can fail at any point in time. So it's not a 100 percent guaranteed. Again, that risk is about one in 2000. It's extremely low. Next, there is a risk of chronic pain and this is really important that patients hear about this prior to vasectomy. As up to 15% of patients can have some sort of ache or twinge of pain occasionally. Chronic testicular pain is defined as pain that's lasted for longer than three months. Sometimes it can appear as pain after the vasectomy that never seem to go away completely. Or it can occur several months after your vasectomy and it can be due to a sensation of fullness within the testicle. It can be caused by discomfort with ejaculation because of the fluid build up in the testicle. And the risk of having really severe pain is extremely low. That's a one to 3% risk of pain that's quite severe and that would need additional treatment.

So here I want to talk a little bit more about post-vasectomy pain syndrome. This is chronic pain in the testicle or with ejaculation that occurs after vasectomy. So which men are at increased risk for this? First would be men with a history of chronic pain in any other part of their body that can include lower back pain or any kind of chronic pain syndrome that they may have. This also includes men who are on chronic pain medications like opioids. These are the strong types of prescription pain medications. Next, men who have any kind of history of testicular or groin pain. If you already have pain in that area prior to your vasectomy, you'll definitely want to talk to your doctor about it to see if vasectomy is a good decision for you. Lastly, men who have a history of sexual abuse may also be at increased risk for post-vasectomy pain syndrome.

Thank you so much for taking the time to watch this Mayo Clinic Men's Health moment about vasectomy. I hope that you'll choose Mayo Clinic for your care. You can reach us at 507-266-3430 to schedule an appointment or visit our Mayo Clinic Men's Health website at www.menshealth.MayoClinic.org. Thank you so much for taking the time to watch this video about vasectomy. I hope that you found it helpful. If you're interested in scheduling your appointment for a vasectomy with our Mayo Clinic men's health team in Rochester, Minnesota or in Minneapolis, Minnesota. Please go to www.menshealth.MayoClinic.org. There you'll be prompted to create a Mayo Clinic account and complete a questionnaire regarding vasectomy. Once you've submitted the questionnaire, you'll be offered an appointment. Thank you very much. I hope that you found this video helpful.

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Aug. 21, 2021
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  8. Taneja SS, et al., eds. Complications of surgery of the testicle, vas deferens, epididymis, and scrotom. In: Taneja's Complications of Urologic Surgery: Diagnosis, Prevention, and Management. 5th edition. Edinburgh, U.K.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 19, 2018.

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