Some frequently asked questions…
How reliable is a vasectomy?
A vasectomy is currently the safest form of permanent contraception for men, but you must keep in mind that you will not be sterile immediately. After 8-12 weeks a sperm count is performed which involves taking a specimen of your semen to a pathology centre where it will be sent away to be examined for the presence of sperm. When no sperm are found, sterility has been achieved. One in five patients still can have sperm present and repeat tests are performed monthly until none are left, 99% are clear by 6 months. The overall failure rates quoted are about 1 in 1000 compared with 1 in 250 in women who have tubal ligation. This includes failure to identify and deal with the vasa, an extra vas and early or late spontaneous rejoining of the ends with re-canalisation. Once it has been established that the semen is clear of sperm subsequent failure of the procedure, due to the spontaneous rejoining of one or both vasa is very rare, occurring only in about 1 in 5000 vasectomies.
Is it painful?
Most patients report that “it was much better than the dentist”. There is no sudden pain post operatively which can occur after waking from a general anaesthesia or after the use of standard local anaesthetics or sedation.
THERE ARE 2 OPTIONS:
- Needle: the slow introduction of a warmed mixture of quick and long acting anaesthetics with a ‘no sting’ additive is relatively painless, works almost instantly and lasts 4-6 hours.
- ‘No Needle’:this option is available (see below FAQ’s ‘No Needle Vasectomy)
How is a ‘no-scalpel’ vasectomy performed?
SHARP ARTERY FORCEP
No-scalpel vasectomy instruments, used in China since the mid-70’s and introduced into the United States and Australia in 1989, are simply a very sharp artery forcep, used initially to make a tiny opening into the skin of the scrotal wall, and a ring clamp, used to secure each vas tube in turn beneath this opening. The sharp artery forcep is then used to spread all layers (the vas sheath) down to the vas tube itself and to then deliver a small loop of the vas through the opening as the ring clamp is released. The ring clamp is then used to hold the vas, while the sharp artery forcep spreads adherent tissue and blood vessels away from the vas under direct vision, so that the vas can be divided and the upper end tied off, so that it will seal closed.
Can a vasectomy be reversed?
Vasectomy should be considered irreversible. If you are contemplating a reversal or intracytoplasmic sperm injection (ICSI) then vasectomy may not be the best choice for you. (ICSI involves taking an immature sperm directly from the testicle and injecting it into an egg) The success rate for reversal operations is 90% in the first 3 years. The success rate declines with time due to decreased sperm production and the development of anti-sperm antibodies.
Sperm storage is available and can be organised.
OHIP does not cover vasectomy reversals and sperm storage.
Does a vasectomy affect sexual function?
Physically a vasectomy makes no difference to your sex drive or performance, as testosterone and semen production (apart from the sperm component) remains unaffected. Many men say their sex life is improved because they no longer have to worry about the higher rates of contraception failure with other methods.
What happens to the sperm?
The cut end of each vas closest to each teste is left open letting the sperm which are still produced in the testes after the vasectomy escape into the scrotum. As the volume of immature sperm is miniscule they are reabsorbed by the body without causing any swelling. This technique minimises post-operative discomfort as there is no build-up of pressure in the testes and epididymis.
Are there any side effects of vasectomy?
Serious side effects are uncommon. Most men experience some discomfort, bruising and swelling around the operation site of a minor and transient nature. This is usually relieved by simple pain medications and supportive underwear. In rare cases postoperative bleeding, inflammation of the epididymis and testes, infection, cyst formation, delayed wound healing or persistent pain (post vasectomy pain syndrome) can occur. If any unexpected symptoms or effects arise, call us for advice or return for review.
Prostate Cancer, heart attacks and other issues
Although there have been past media reports of links with cardiovascular disease, male menopause and cancer of the testes and prostate, these have not been supported by large studies in many countries. The American Urological Association Vasectomy Guideline Panel reviewed very carefully the concept that vasectomy might be a risk factor for prostate cancer and concluded that here is no risk.
Although this does not mean that there can be no possible ill effect on health, vasectomy remains one of the safest and most effective permanent contraceptive choices available.
MadaJet® is a spray applicator which delivers a fine stream of liquid anesthetic at a pressure great enough to penetrate the skin (5mm in depth) deep enough to envelop the vas tube held snugly beneath the skin. Each vas is positioned beneath the very middle of the front scrotal wall and is given two or three squirts, numbing the skin and both vas tubes. There is 1% of men (usually men who have thick skin or scarring due to prior surgical procedures in the area) that will require a bit more anesthetic delivered with a fine needle, usually with no pain at all because of the partial anesthesia achieved with the MadaJet.
This option has a premium of $100 to the standard vasectomy cost.
Is it a Laser vasectomy?
No. The vas tubes are most easily and safely divided under direct vision with a fine surgical scissor. The expression “LASER” has great popular appeal, and the use of laser energy in the performance of a simple vasectomy serves no purpose but to play up to its popular appeal. Lasers have proven to be indispensable for certain types of retinal (eye) and skin procedures, and they offer an alternative, though not necessarily better. A laser (like any other form of light) cannot pass through opaque tissue without burning a hole in it, so a laser cannot be directed at internal organs such as the vas tubes without an access opening, in the same way that sound waves can be used to destroy kidney stones without an incision. Lasers play no role in a procedure as simple as vasectomy and introduce an unnecessary element of risk. A recent search revealed no articles in the medical press.