Vasectomy Overview
Vasectomy is a minor surgical procedure to cut and close off
the tubes (vas deferens) that deliver sperm from the
testes; it is usually performed as a means of contraception. The
procedure typically takes about 30 minutes and usually causes
few complications and no change in sexual function. About
500,000 vasectomies are performed annually in the United States.
A vasectomy is less invasive than a tubal ligation (i.e., the
procedure used to prevent a woman's eggs from reaching the
uterus) and more easily reversed. An increasing number of
couples choose it as a means of permanent birth control.
Male Reproductive System
To understand a vasectomy, it is helpful to understand the male
reproductive system and how it functions. The testicles, or
testes, are the sperm- and testosterone-producing organs.
They are located in a sac at the base of the penis called the
scrotum. Each testicle is connected to a small, coiled tube
called the epididymis, where sperm are stored for as long
as 6 weeks while they mature. The epididymes are connected to
the prostate gland by a pair of tubes called the vas
deferens. The vas deferens are part of a larger bundle of
tissue, blood vessels, nerves, and lymphatic channels called the
spermatic cord. During ejaculation, seminal fluid
produced by the prostate gland mixes with sperm from the testes
to form semen, which is ejaculated from the penis.
Preparation for a Vasectomy
Surgeons typically require men to do 4 things before vasectomy.
They are:
-
Shave and wash the scrotum (to prevent infection and to
allow easier access)
- Bring a pair of tight-fitting underwear or athletic
supporter (to support the scrotum and minimize swelling)
- Arrange for a ride home (to minimize exertion and
movement that exacerbates swelling)
- Avoid anti-inflammatory drugs, such as ibuprofen and
aspirin, before surgery (they thin the blood and can cause
excessive bleeding)
Procedure
A urologist performs a vasectomy on an outpatient basis,
frequently in the office. The procedure takes about 30 minutes.
The patient typically remains clothed from the waist up and lies
on his back. The scrotum is numbed with one or more injections
of local anesthetic (lidocaine), the vas deferens is gathered
under the skin of the scrotum, and a small incision (usually 1
centimeter or less) is made. The vas deferens is then pulled
through the incision, cut in two places, and a 1-centimeter
segment is removed. Each end of the vas deferens is surgically
tied off or clipped, and placed back in the scrotum. The
incision is sutured and the procedure is repeated on the other
side of the scrotum. Some urologists cauterize the ends of the
vas deferens, but others find that cauterization complicates
reversal and is unnecessary. The incisions are dressed and most
men go home immediately after the procedure.
No-Scalpel Vasectomy
In the no-scalpel vasectomy, a surgical clamp is used to hold
the vas deferens while a puncture incision (instead of a cut) is
made with special forceps. The forceps are opened to stretch the
skin, making a small hole through which the vas deferens is
lifted out, cut, sutured or cauterized, and put back in place.
The puncture incision does not require suturing. Some urologists
recommend the no-scalpel method because they find it is quicker
and minimizes postoperative discomfort and the risk for bleeding
and infection. Recently, as encouraging studies are reported,
more vasectomies are being performed using this approach.