Healthy Living: Vasectomies
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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.”