Healthy Living: Vasectomies
The first recorded vasectomy was done on a dog in 1823. By the early 1900s, vasectomies were being performed on men, but at that point the procedure had some negative associations—it was used to forcibly sterilize prisoners in the U.S. and other countries, and was championed by supporters of eugenics.
After World War II, vasectomies became a common method for birth control. But the procedure, along with other forms of contraception, was controversial. The landmark 1965 Supreme Court Case Griswold v. Connecticut ruled that a state’s ban on the use of contraceptives violated the right to marital privacy. Prior to that ruling, Connecticut law outlawed vasectomies and other forms of birth control stating, “any person who uses any drug, medicinal article or instrument for the purposes of preventing conception shall be fined not less than forty dollars or imprisoned not less than sixty days.”
Because of its historic controversy and that the fact that it remains uncomfortable for many men to discuss any procedure involving that particular area (never mind one that involves a sharp medical implement), some misinformation about vasectomies persists.
“There are two basic misconceptions about a vasectomy,” says Dr. Jeffrey Small, a Bridgeport pediatric urologist who runs the Vasectomy Center of Fairfield County. “One is that it’s a painful procedure, and the second is that it can possibly affect performance. A, it’s not a painful procedure at all, it only takes a few minutes in the office; and B, it has absolutely no effect at all on performance.”
The procedure is fairly straightforward. Sperm are formed in the testicles, and then pass through two tubes called the vasa deferentia to other glands and mix with seminal fluids to form semen. During a vasectomy each vas deferens is cut and cauterized, which blocks the sperm and keeps it out of the seminal fluid. After the procedure, sperm are absorbed by the body instead of being ejaculated, thus ejaculation can no longer cause pregnancy.
Getting a vasectomy is generally a short in-office procedure performed under local anesthesia with no sedation required. The patient can drive himself to and from the office.
The procedure also has a high success rate and pregnancies following it are extremely unlikely.
Dr. David Rosenberg of Associated Urologists in Manchester says that the age range of men considering vasectomies varies.
“Typically we’re looking at men in their late twenties, early thirties, all the way to men in their early to mid-fifties,” he says. “It’s generally men who have been using contraception for a long time and no longer want to use contraception, or their spouse has an adverse reaction or increased risk from using contraception.”
Though there are permanent birth-control options available to women, such as tubal ligation, a vasectomy is generally considered a less-invasive procedure.
“There are some newer permanent sterilization techniques that can be offered to women in the office-based setting, however the vast majority are still done in the hospital under anesthesia,” explains Rosenberg. He adds that there are also dangers associated with birth-control medication as women age. “We know that birth control, which women commonly take, should not be taken over the age of 35, especially in the smoking population, because of risk of increased blood clots.”
As a result, the decision to get a vasectomy is often seen as a way for a couple to share the birth-control burden—and a procedure that wives are often in favor of.
Once a man or a couple decide to explore a vasectomy, they obviously should be sure they no longer want to have kids; though reverse-vasectomy procedures exist, they are not always successful.
“We tell people that we consider vasectomies nonreversible,” says Dr. Joseph Camilleri, a urologist with the Urology Group in Hamden. “But if something happens, sometimes people get remarried or whatever, there are surgeries to reverse it. The surgeries are not always successful and most of the time insurance will not cover them so people end up paying out-of-pocket, which can be quite expensive. For those reasons we tell people that if you’re sure you don’t want to have more kids then that’s fine, but if you’re not so sure, you should probably consider another method of birth control.”
Camilleri says that before they undergo the procedure some patients ask about putting sperm in a sperm bank. Some urologists encourage this course of action as a backup, but Camilleri disagrees. “We discourage that. We tell people that if you’re that unsure that you think you should bank sperm, then you probably shouldn’t do the procedure,” he says.
Once a couple has decided a vasectomy is the best option for them, there are some choices to make, as there are different techniques to perform the procedure, though ultimately they all have the same result.
“One way is to make a small incision on each side of the scrotum, after giving you some local anesthesia, and each of those incisions is about a quarter of inch in size and are closed up with stiches that dissolve by themselves,” Camilleri says. “Another variation is to make one incision in the middle of the scrotum and do the procedure on both sides through that one incision. There’s another technique called the ‘no-scalpel vasectomy,’ where instead of making an incision in the scrotum, with a sharp instrument you make sort of a stab wound into the scrotal wall and then open that small hole in the scrotum wall that way.”
Pain following the procedure is almost always minimal says Small, the Bridgeport urologist who specializes in the no-needle, no-scalpel technique. “In my practice, and I’ve been doing this for over 20 years, its exceedingly rare that I will ever give a patient anything more than a Tylenol for pain,” he says. He adds that following the procedure “most patients, unless they do very strenuous work, can go to work the next day.”
But there are some activities to avoid following a vasectomy.
“I advise anywhere from two to five days of taking it easy, no heavy lifting or sports,” Small says. “Patients are told not to have sexual activity for a week and no unprotected intercourse for an average of two to three months, but that is dependent on how frequently they are having sex.”
After the procedure, the patient’s system needs to be cleared of existing sperm. “On average it takes 10 to 12 ejaculents,” before the patient can have unprotected sex, explains Small. “For most married men, [the process] takes two or three months.”
After waiting those two or three months, the patient is asked to bring in a semen sample for examination. If the sample no longer contains sperm, the patient is asked to bring in another sample two weeks later. Once the doctor has examined both samples and found them to be sperm-free, the vasectomy is considered successful and the patient can engage in sexual activity without worrying about an unwanted pregnancy.
Camilleri says that if you decide you’d like to explore getting a vasectomy, the first step is to make an appointment with your primary-care doctor or a urologist.
“When somebody wants to have it done, we have them come in for a consultation where we explain the procedure, give them some written material, and examine them to make sure the vasectomy is going to be fairly easy to do and there’s no complicating factors,” Camilleri says. “Then if they want to do it, they make an appointment to come back. Years ago we used to sometimes do it where they came in and then we did it the same day. We’ve gotten away from that because we think it’s better if the people can digest the information about the procedure that we give them. They can take those materials home and just go over them and make sure that they really want to do it.”