Vasectomy

Vasectomy is a safe, simple and effective birth control method.

One of the most common and popular means for contraception around the world is vasectomy – a brief, surgical procedure used for male sterilization. It is a popular means of birth control for couples that have decided that their family is complete. It is nearly 100% effective and is intended to be permanent.

More than 600,000 American men undergo vasectomy each year. The vasectomy procedure is commonly performed in a doctor's office or procedure suite and usually takes about 15 to 20 minutes.

The simplest and safest vasectomy method is the No-Needle, No-Scalpel Vasectomy. The physician anesthetizes the surgical area with a jet-air anesthetic device, which delivers the numbing agent without use of a needle. Small segments of each vasectomy are removed one or two tiny punctures in the skin. Often no skin sutures are necessary.

Vasectomy is reimbursed by most health insurance plans.

Common Fears: Real and Imagined

The idea of having a vasectomy can raise fears. While apprehension is common, the best remedy is knowing the facts.

Couples are well-advised to consult with a board-certified urologist who speaks to couples openly about their concerns. Education and communication are among a doctor's best tools. Clear answers and quality information will help ease, if not eliminate, many of these apprehensions.

Having an operation involving the testicles is every man's fear. To a greater or lesser degree, just about every man would rather not have anything to do with a procedure on or near his genital region. Simply recognizing that this fear exists is a first step.

Many men recognize that having a vasectomy could be the best solution for their personal or family situation, and that their short-term fear is offset by a long-term benefit for themselves and their spouse. Having the procedure is likely to be a family decision, but it is ultimately a significant step that the man can take to contribute to the couple's ongoing relationship.

Much anxiety is reduced by the knowledge and understanding that a vasectomy is common, safe, simple and quick procedure. The vasectomy procedure is far easier for the man than surgical options available for his wife. Tubal ligation is more invasive, is performed under general anesthesia, can result in greater discomfort and has potentially higher risks than a vasectomy procedure. In addition, vasectomy is the less expensive option.

Pain

A vasectomy procedure includes a local anesthetic that quickly numbs the area -- application of the anesthetic with the no-needle, air-jet device feels like a small rubber band being snapped against the skin. Thereafter, there will be a slight pulling sensation during the procedure itself. Many patients report mild discomfort for the first day or two after the anesthetic wears off. Local swelling and discomfort is best treated with a combination of support with a jock strap, local ice packs (many patients use bags of frozen vegetable) and nonsteroidal anti-inflammatories (NSAID's) such as Aleve/naproxen or Advil/ibuprofen. Rarely, a prescription-strength medication is required for post-vasectomy pain.

To reduce a man’s anxiety before and during the procedure, the doctor might prescribe an anxiety reducing medication such as Valium.

Risks of Vasectomy in Bucks County

Both the doctor and the patient will want to carefully review all the risks before deciding about any procedure. A vasectomy is regarded as both safe and simple, but as with any operation some medical problems could result. Go over these carefully with your doctor. Problems resulting from a vasectomy are infrequent and are usually treated easily if they do appear. These include the possibility of infection or swelling around the incision or inside the scrotum, bleeding beneath the skin causing bruising or inflammation and the development of a small lump due to a sperm leak from the vas. Chronic, post-vasectomy pain is uncommon.

The myth of lost "masculinity or libido"

Vasectomy does not alter a man’s testosterone, sexual drive, erections, or orgasms. The volume of ejaculated semen following vasectomy is indistinguishably different. The man's body continues to produce sperm but the vasectomy prevents the sperm from leaving his body as part of his semen.

Fear of failure

A vasectomy is one of the most reliable means to prevent conception. Existing sperm will remain in the man's system for up to four months following a vasectomy; therefore sterilization does not occur immediately. Once the doctor confirms the absence of sperm by examining a man's semen specimen with a microscope four or more month's after the vasectomy, the chance of pregnancy is minimal. The risk of vasectomy failure -- because the severed ends of the vas deferens have rejoined -- is significantly less than one percent.

Absence from work or limited activity

Doctors often recommend that a patient rest following the procedure and avoid strenuous activity or heavy lifting for 3-7 days. Most patients can return to work within three days and can resume all activities within one to two weeks.

Vasectomy: The Procedure in detail

Pre-procedure

You need to stop any blood thinning medications 7 days before. Take the first dose of the prescribed antibiotic one hour prior to the procedure. If desired, take the prescribed dose of Valium (diazepam) one hour prior to the procedure. If you take the Valium, you will need a driver to and from the procedure.

Prep

You will be placed in a position laying flat on your back on the procedure table. The penis will be suspended onto your lower abdomen. The front of the scrotum will be shaved and cleansed with antiseptic solution.

The urologist will administer a local anesthetic: a "no needle" device uses compressed air to apply lidocaine to the skin and underlying vas deferens. Typically, this feels like a small rubber band is being snapped against the skin.

Because No Needle jet anesthetic is relatively new to vasectomy procedures, few doctors use this technique. All the surgeons at Central Bucks Urology employ this technique.

Visit www.NoNeedleVasectomy.com for more information.

How the No Scalpel vasectomy is performed

As the name suggests, the "No Scalpel" method does not involve a scalpel. After anesthetizing the area, the doctor locates the patient's vas deferens under the skin of the scrotum by hand. Small, pointed forceps painlessly puncture the skin and tissues surrounding the vas deferens, creating a tiny opening for the vas deferens to be gently lifted out, then cut, tied, clipped and/or cauterized and put back into place.

The surgeon may elect to close the opening in the skin with sutures. However, because the skin opening is much smaller than a conventional incision, it can close quite quickly without the necessity of suturing. Antibiotic ointment may be applied to the puncture site, covered by dry gauze. At the end of the procedure, your underwear or scrotal support will help keep the gauze in place when you get up from the table and walk out of the procedure room.

Post-op

At home, apply an ice pack to the gauze on the anterior scrotum. Ice the area for 30-60 minutes 4-6 times on the day of the procedure. Naproxen (Aleve) 220 – 440 mg every 12 hours or ibuprofen 600 mg every 6-8 hours can be used to alleviate pain and/or swelling. Take a prescription strength pain medication only if you need to.

You can shower the next morning. Do not immerse the scrotum under water for 7 days following the vasectomy (no baths, hot tubs, swimming).

Do not engage in strenuous activity for 3-5 days following vasectomy.

Refrain from sexual activity for 3 days following vasectomy.

Continue to use another form of birth control for four months following vasectomy.

Bring a semen specimen back to Central Bucks Urology four months after vasectomy for microscopic evaluation.

Top 10 PA Vasectomy Q&A

Basically, what is a vasectomy?

A vasectomy is a minor surgical procedure used by urologic surgeons to make a man sterile. It is one of the most popular forms of contraception in the United States and worldwide, and is regarded as safe, simple and highly effective. A vasectomy is performed by cutting the vas deferens, the small tube that carries sperm from the man's testicles to become part of his semen. Although the man continues to have sexual intercourse and climax as before, his semen does not contain sperm and he cannot father a child following a vasectomy.

What is a "No-Scalpel" Vasectomy (NSV)?

The No-Scalpel technique is one of two main methods surgeons use to perform a PA vasectomy. Many doctors favor the No-Scalpel method because - unlike the traditional vasectomy approach - a scalpel is not required and there are no incisions (only one or two small openings in the skin). In addition, the NSV often results in less discomfort after the procedure with a reduced risk of bleeding or infection. Also, there is no perceptible scarring.

How long does the No-Scalpel procedure and recovery take?

The procedure itself usually takes about 15 minutes, sometimes less. However, including the office routine, paperwork and preparation, the total time in a doctor's office may be about an hour. The procedure is likely to produce tenderness, discomfort and slight swelling in the first two or three days afterwards, with a return to nearly all usual activities typically within a week.

How effective is a No-Scalpel PA vasectomy?

A vasectomy of any type ranks among the most effective means of protection from pregnancy. Although no procedure is totally safe or effective, the failure rate for a vasectomy is less than one percent. (By comparison, the failure rate for latex condoms is 12 percent or more; for diaphragms, it's 18 percent.) Couples who want a highly reliable and permanent form of contraception often opt for a vasectomy where the success rate is over 99 percent.

Does it work immediately?

No. Vasectomy does not make a man sterile right away. Immediately after a vasectomy, active sperm remain in the semen for a period of time. It may take 15 to 20 ejaculations and four months before semen is free of sperm. Your doctor will test the semen and let you know when you can safely consider the vasectomy to be complete. During this four-month period following the vasectomy, you will need to continue to use another form of birth control.

What happens to the sperm?

The body absorbs unused sperm cells normally - whether or nor you've had a vasectomy. After the procedure, the testicles will continue to produce sperm, but they will not leave the body in the semen. They dissolve and are simply and naturally absorbed by the body.

Will my sex life be affected?

A vasectomy only blocks sperm and does not affect your sexual drive, your ability to have an erection, orgasm or ejaculation or your ability to have and enjoy sex. Sperm is only a small fraction of the total liquid in your semen. The amount of fluid, intensity - even color and texture - does not appear to change when sperm is absent. Male hormones continue in the bloodstream, and secondary characteristics (such as beard or voice) do not change. Some couples say their relationship is improved by not having to worry about contraceptive techniques or unplanned pregnancy.

What is the cost of a No-Scalpel vasectomy?

The actual cost of the procedure ranges from $750 to $1,500, but this cost is covered under many health insurance programs. You will want to ask your insurance company or HMO if any or all of this cost is provided under the benefits of your coverage.

Are there risks or complications?

Yes, as with any surgical procedure, there could be complications. Fortunately, complications are uncommon, typically minor and easily treated. Complications include pain, infection, bleeding, bruising, swelling or fluid accumulation.

Following the procedure, some men experience pain, often as a dull ache, caused by a pressure on the miniature tubes of the epididymis. This circumstance usually resolves with time. Very rarely, if this pain proves to be persistent, removal of the epididymis is advised.

Does vasectomy increase the risk of prostate and/or testicular cancer?

No. A single study published during the early 1970's linked vasectomy with prostate cancer. Subsequent analysis of that data demonstrated that men who had undergone vasectomy were more likely to be screened for prostate cancer later in their life; this screening led to a higher rate of early detection of prostate cancer. The absence of a causal link between vasectomy and cancer has been corroborated by more than three decades of surveillance studies. To review a recent study looking at a group of nearly two thousand men which concluded that there is no increased risk of prostate cancer after a vasectomy, click the link: The Journal of the American Medical Association.

Can a PA vasectomy be reversed?

You should consider any vasectomy to be permanent. Microsurgical vasectomy reversal can be successfully performed in the majority of cases. However, the likelihood of achieving pregnancy can vary greatly depending on individual circumstances, including how much time has passed since the vasectomy. If you are seriously considering a vasectomy, it's best to assume that it will be a permanent change.

The Surgeons at Central Bucks Urology have performed more 10,000 vasectomies since 1992. If you think that this form of permanent contraception is right for you, call to schedule a consultation.


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