Minimally Invasive Vasectomy INformation
All about Vasectomy
You will find all the information about your upcoming procedure in our information pack below. It is important that you have read all the information and are aware of what to do before and after your procedure and any possible complications.
Your procedure will last approximately 40 minutes
Please ensure to eat breakfast/lunch on day of procedure
You will require someone to drive you home after your appointment
You will receive a list of pre operation questions prior to your appointment please respond promptly
A nurse from our surgery will contact you in advance of your procedure and will be happy to answer any further questions.
If you have queries regarding booking the appointment admin can be contacted on 02890 812211.
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A vasectomy is a procedure that makes a man sterile (this means he has no sperm in his semen and can’t make a woman pregnant). The surgeon cuts and seals the tubes that carry sperm from the testicles to the semen. (This tube is called the ‘vas deferens’)
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A vasectomy takes approximately 30 minutes. Before the operation starts, your surgeon will give you a local anaesthetic injection to numb your scrotum. Then he will make one very small incision in your scrotal skin. Through this small opening, your surgeon will divide and seal each vas so that the sperm can no longer get through.
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No live sperm will still be in your tubes right after the surgery. It takes an average of 12 weeks and 25 ejaculations before all the sperm are out of your semen. However, some men have more sperm or clear their sperm out of the tubes more slowly. A semen test at 16 weeks will show if there are any sperm in your semen. Testing earlier increases the risk of needing repeat testing.
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Most of the time, yes. Once the test show there are no sperm in your semen, you are sterile. However, historically, in a few men one of both tubes healed in such a way to reconnect and sperm can get into the semen again. If that happens, you will no longer be sterile. (See Failure Rate under Complications)
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It is the most effective permanent choice (1 in 2000) but the long-acting contraceptive hormonal implant for women has a similar failure rate but needs replacing as it is not permanent. Your GP should have discussed this option of Long Acting Reversible Contraceptives (LARCS) before referring you for vasectomy.
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Some men want the vasectomy reversed so they can father a child. However, surgery to reconnect
the tubes doesn’t always work. You should not have a vasectomy until you’re sure you won’t want tohave children in the future.
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Yes, your sex drive and your ability to have an erection and an ejaculation will not change after a vasectomy. In fact, some couples find that their sex life is better after a vasectomy because they do not have to worry about the risk of pregnancy.
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The operation is done under local anaesthetic which takes away most of the pain. (There are cases of
surgeons doing their own vasectomy!) However, some men may need a little more anaesthetic during the operation. After the vasectomy, you should rest and put ice packs on your scrotum to help the pain. You should also wear tight fitting underpants for a couple of days. You can take a mild painkiller (no aspirin) if you need it. You might have a little ache for a few days after the operation, especially if you do too much. You may also notice that your scrotum has some bruises and is a little swollen. (These instructions are detailed in After the Operation.)
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You’ll need to go directly home and rest. The best choice is to have a driver to take you home as your car insurance may not cover you immediately after a minor operation. You must NOT walk or cycle home!
You should carry out only light activity on the following two days.
You may return to work after the third postoperative day if you are comfortable and do not have to perform manual labour (e.g. building work). If your job consists of heavy manual labour, you are advised to carry out light duty for the first few days; if this is tolerated, you can advance to a full workload. It will take most men an average of 7 days to return to full strength. All men heal differently and you should just use your common sense.
You may take a shower the day after your surgery. However, don’t take tub baths or sit in water for about one week. This gives your incision time to heal.
You may have sex in one week, if you want to. Remember, though, that you won’ be sterile until an average of 12 weeks after the operation. So, keep using birth control until you have the test to check for sperm in your semen and have been given the “all clear”.
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Sometimes there are small problems, but not very often. The minimally invasive technique (which includes the no scalpel technique) is associated with a much lower incidence of early complications (see Complications).
Before the Operation
Shaving - You do not need to shave the scrotum.
Showering - You should shower and cleanse the genital area thoroughly on the day of surgery.
Fasting - Although the procedure is done under local anaesthetic and does not need you to starve, you should not have a heavy meal for two hours before the procedure. Do continue to drink to prevent dehydration.
Medication
If you are on regular medication, please take it as usual.
Aspirin and prescribed medications which delay clotting are usually prescribed for a good reason and although they increase the risk of bleeding and bruising, each individual case needs to be assessed before surgery.
Clothing & Scrotal Support
You must bring with you a pair of tight, clean underpants or swimming trunks to give yourself plenty of support afterwards (boxer shorts are not suitable as they do not provide enough support).
After the Operation
Going Home
You can go directly home after your procedure. The best option is to be driven home.
Ice Packs
Applying ice packs or similar to the front of your underpants scrotum 20 minutes every hour for the following 4-6 hours after surgery is recommended to prevent or minimise swelling and discomfort.
Ice or frozen peas in a zip-lock bag, wrapped in a towel or “Gel Packs” intended for sprained ankles have been known to work well. This is worth doing as prevention is better than cure: more ice, less pain!
Rest
Lying or sitting down and resting also minimises pain and swelling. If you do too much, you will disturb the surgery site or cause it to bleed internally. This is quite unlikely, but two days of inactivity is a small price to pay to help minimise complications. The amount of time you take off work depends of how much heavy manual work you do (See What activities can I do after the operation?). We would recommend taking the next 2 days off work.
Scrotal Support
You must wear snug-fitting underwear for 3-4 days, 24 hours a day, after the surgery to prevent your scrotum from bouncing.
Wound Care
The surface of the skin normally bleeds a tiny amount. A small dressing prevents staining and sticking to your clothes. Keep the area dry for 24 hours. You may take a shower the day after your surgery. However, don’t take tub baths or sit in water for about one week. This gives your incisiontime to heal. Any stitches are internal and dissolve away by themselves and do not need to be removed.
Sperm Counts
We will give you the form, container, pre-paid envelope and instructions for the sperm count before you go home. If you have posted your specimen and have not heard from us after 2 weeks contact the clinic reception by phone and we shall chase the result for you.
Complications
We perform vasectomy using minimally invasive techniques which minimise complications and most patients report no problems. Unfortunately, complications do occur in real life despite the strictest precautions and an important part of informed consent is that you should know what may happen to a few cases:
Bleeding, a concern of all patients and surgeons usually can be prevented through good surgical technique and careful patient instruction. The patient should be told to avoid aspirin-containing products for several days before surgery and to limit activities after surgery.
Haematoma (bleeding into the scrotum to form a collection of clotted blood) and bleeding from the incision occur in about 1.6% of all vasectomies. The incidence for my practice is 0.1% (5 in 5000 cases). Most haematomas can be treated initially with ice packs and then with heat after the haematoma starts to be cleared by the body itself. Hospitalisation and surgical evacuation is sometimes but rarely necessary but you should contact your GP if there is a lot of bruising or pain. I can be contactable by email or phone but may not be able to see you as quickly as your GP.
Postoperative pain and swelling often occur because a patient tries to be more active than he should.
Infection occurs in 2.2% to 6% of vasectomies performed with traditional techniques and in 0.91% of those done by the no-scalpel method. The incidence in this clinic is 0.04% (2 in 5000) Infections are treated with use of antibiotics.
Testicular atrophy can occur due to injury to the blood supply to the testis. There has not been a case in my practice.
Sperm granuloma After vasectomy, sperm often leak from the vasectomy site. The immune system views sperm as foreign agents and attacks them. The body forms pockets to trap the sperm in scar tissue and inflammatory cells. Firm balls of tissue about one-half inch in diameter then form; these are known as sperm granulomas. They occur in about 40% of vasectomies, but only 3% of cases are painful. Painful granulomas usually respond to nonsteroidal anti-inflammatory drugs (e.g. ibuprofen) and use of scrotal support (e.g., tight-fitting underwear or an athletic supporter). Granulomas that do not respond can be injected with steroids, aspirated or surgically removed, although this is very rarely required.
Vas deferens congestion is common and can last from 3 to 12 weeks postoperatively. It usually manifests during intercourse as a pulling sensation at the time of ejaculation or during strenuous activity as an aching sensation. Usually no treatment is required, but non-steroidal anti-inflammatory drugs and scrotal support may be helpful.
Postvasectomy Pain Syndrome (PVPS) is a very rare chronic pain condition with an unknown cause. Some of the cases are thought to be due to epididymal congestion and sperm granuloma (both mentioned above) but others are thought to be due to trapped nerves. No one really knows exactly why. Research has reported a wide variation in the chance of this happening from 0.1% right up to 20%.
When to consult your GP
It is normal to experience some pain, bruising and swelling although this can be minimised by rest and time off work. I am always available to contract but you may be able consult your own GP quickly if you suspect infection from pain, inflammation of the skin, tenderness and swollen glands in the groin, or if there are any other worries after the operation.
FAILURE RATE
Perhaps the most important complication for any patient undergoing vasectomy to realise is the failure rate of vasectomy as a contraceptive method.
Follow-up semen analysis is extremely important.
The early failure rate of vasectomy is about 0.3%, similar to that of tubal ligation in women at 0.4%. This is when live sperm continue to be found in the semen 7 months after a vasectomy because one or both tubes have mended themselves and re-joined. This should not result in a pregnancy provided it is detected by semen analysis and alternative contraceptive methods are continued.
Contraceptive failure (a pregnancy) can occur when couples do not use another form of birth control until a semen specimen is free of sperm.
Late Recanalisation. This is when the tubes rejoin months or years after a successful vasectomy and a semen analysis had shown no sperm in the semen. The chance of this happening is usually quoted as 1: 2000 but is based on research done in 1993 and is still at least 10 times lower than that for tubal occlusion i.e. sterilisation in women. There have been no more recent studies, as it is extremely rare.