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Vasectomy

What is a Vasectomy?

A vasectomy is a procedure that makes men infertile by blocking the sperm movement from the testes. The procedure prevents the passage of sperm by cutting the sperm tubes and blocking their ends. It is the most efficient form of contraception currently available.

The production of the male hormone (testosterone) by the testes is entirely unaffected. Your ejaculation after a vasectomy will be free of sperm although the semen volume will remain unchanged.

Sperm is produced in both testes (testicles) and then travels in a tube on both sides (called the vas deferens: plural = vasa) to the seminal vesicle at the back of the bladder. The prostate gland and seminal vesicle produce most of the fluid ejaculated (approximately 98% of the semen).

The testicles produce sperm that travels through the two tubes called the called the Vasa Deferens. You can feel these tubes through the scrotal skin. They are like firm spaghetti-sized tubes on both sides of the penis. The VasaDeferens tubes carry sperm from the testicles out through the penis.

The No-Scalpel Vasectomy (NSV)

Dr. Li Shunqiang developed the NSV in China in 1974. In 1985, an international team made up of members from the World Health Organization (WHO) and Access To Voluntary And Safe Contraception (AVSC), were visiting China to study alternative vasectomy procedures, including the No-Scalpel Vasectomy. In 1988, after careful observation and review of the No-Scalpel Vasectomy procedure, they decided to introduce the technique to North America. Since then, over a million No-Scalpel Vasectomies have been performed in North America and nearly 20 million in China.

With this new approach, there is no knife, no cutting incision, no stitches, and no needles. Men who have undergone No-Scalpel Vasectomy express amazement at the minimal physical discomfort they experienced both during the procedure and the healing.

There is no longer reason to be worried about this now simple procedure if you were previously worried about the idea of a scalpel.

The NSV is a gentle and straightforward procedure that has significant advantages over conventional vasectomy. It is comparatively faster, has a shorter recovery time, is safer and is virtually pain-free.

The No-Scalpel Vasectomy (NSV) procedure interrupts merely the flow of sperm by cutting the sperm tubes and blocking their ends (see the diagram below).

The procedure is straightforward and can take anywhere between 10 and 30 minutes. We use a particular “no sting” local anesthetic which we inject into the skin in the front of the scrotum instead of doing injections into the testicles.

The physician makes a single small opening in the centre of the scrotum below the penis without using a scalpel. The hole is only 2 to 4 millimetres in size and will close rapidly and heal without stitches. We locate the vas tubes and remove approximately one or two centimeters from each. We tie up the upper ends with a thread that slowly dissolves over 12 weeks. This leaves the bottom ends open (hence the name “Open-Ended method”) allowing sperm which is still produced to escape into the scrotum. The open-ended method reduces any pressure build-up and pain in the testes and epididymis after the procedure.

We don’t use the closed-ended technique to block the vas tube. We prefer the Open-Ended Technique. Once we cut the vas tubes, we obstruct the upper end of the tubes. The lower end that leaves leaving the testicle is left unblocked. Many studies show that this method can reduce the risk of long-term congestive pain in the testicle. This approach not only has no detrimental impact on the success rate of the procedure but it creates only half of the thermal cautery damage because we just cauterize the upper ends of the tubes. Furthermore, the open-ended method decreased the risks of pressure in testicles.

before vasectomy
after vasectomy

The No-Needle Vasectomy 

MadaJet vasectomyIf you dislike needles, we can arrange for a no-needle vasectomy.

A MadaJet® is a spray applicator which delivers a fine stream of liquid anesthetic at a pressure significant enough to penetrate the skin to a depth of about 5 mm, enough to envelop the vas tube held snugly beneath the skin. Each vas is positioned in turn beneath the very middle of the front scrotal wall and given two or three squirts.

How does it compare with the conventional vasectomy?

The traditional vasectomy involves the doctor making two incisions, one on each side of the scrotum, and then stitching up the incisions. The doctor then removes the stitches a few weeks later.

The no-scalpel vasectomy has several advantages over the conventional vasectomy. The procedure lasts 10 minutes and has a lower risk of infection and bleeding. Compared to the traditional vasectomy method, the No-Scalpel approach results in:

  • Less discomfort after the procedure;
  • Fewer complications;
  • Lower risk of infection and bleeding; and
  • No need for stitching.
“Compared with the traditional incisional method, No-Scalpel Vasectomy results in less bleeding, hematoma, and pain during or after the procedure. Also, it takes less operation time, and vasectomized men can resume sexual activity more quickly. Currently, more than 40 countries use the No-Scalpel technique.”
World Health Organisation
World Health Organisation

Effectiveness of contraceptive methods

Below are the percentages of women who become pregnant during the first year of use of contraceptive measures

No Method
85%
Cervical Cap (women who have given birth)
32%
Withdrawl
27%
Fertility Awareness-Based Methods
25%
Female Condom
21%
Diaphragm
16%
Cervical Cap (women who have not given birth)
16%
Male Condom
15%
Oral Pill Contraceptives and Progestin-Only Pills*
8%
Patch
8%
Vaginal Ring
8%
Injection
No Method 3%
Intrauterine Methods (Copper T)
0.8%
Female Sterilization*
0.5%
Intrauterine Methods (LNG-IUS)
0.2%
Male Sterilization (Vasectomy)
0.15%
Implant
No Method 0.05%

*Tubal ligation carries 20% more risks of complications than a No-Scalpel Vasectomy.

**Oral contraceptives are contraindicated if over 35 years of age and a smoker. This method puts women at a much higher risk of having complications such as blood clots and death.

“If the female sterilization is more frequent than the male sterilization, the vasectomy is an act less dangerous, simpler and probably more effective.”
World Health Organisation
World Health Organization

Things to consider before you make a decision

The vasectomy has become increasingly popular in recent years. This trend may suggest that more and more people recognize the overall convenience, safety, and reliability of the procedure. Since the introduction of the NSV and the No-Needle Technique, the vasectomy has become a much more straightforward procedure.

Personal stress – Do you think you might be making a hasty decision at a stressful moment in your life?
External pressure – Do you feel pressured into making this decision by someone or by particular circumstances?
Relationship stability – Do you frequently question the stability of your relationship?

A vasectomy will seldom help you resolve problems you experience in any of these areas.

Vasectomy reversals (re-canalization) are not always successful. If you wish to do a re-canalization within three years following the procedure, there is a 30% chance of failure. This number rises considerably ten years after the initial procedure. When both extremities of the testicle cords are reconnected, there is always a chance that the sperm cells will be sterile. This is because when men undergo a vasectomy, the body creates antibodies (anti-sperm cells). These antibodies are not dangerous for your health: the body just deactivates the sperm cells as they are produced. Unfortunately, this makes the outcome of a vasectomy reversal unpredictable.

The philosophy of you and your partner in regards to abortion should be considered. If you are both not philosophically opposed to abortion, then you have a backup plan should other contraceptive methods fail. If this is your case, a vasectomy may not be critical to avoid an unintended pregnancy. You must keep in mind that if your partner falls pregnant, the choice to keep the baby is hers.

We encourage men who are seeking vasectomy to consider sperm storage. Studies have shown that a significant number of men who opt for a vasectomy tend to change their minds many years later. Many reasons lead to this change of heart, including the death of a spouse or child, a separation, a new relationship, or a new perspective on family. Sperm can be frozen and preserved for years, which provides an insurance policy for the future.

Imagine if, years after having a vasectomy, you meet a new partner who wants to one day have children. In this scenario, you can tell her that you’ve had a vasectomy but that you banked your sperm. For this reason and many others, sperm storage can be a wise decision and a worthwhile investment.

A special message to young men with fewer than two children

If you are under the age of 30 and have less than two children, please consider the following points before having a vasectomy

Men who have vasectomies when they are in their 20’s, especially if they have had fewer than two children, are the ones to most likely seek a vasectomy reversal, often regretting the vasectomy if the reversal is not successful. Men under 30 years old who have a vasectomy are twelve times more likely to undergo the inverse operation: a three-hour procedure that costs thousands, without a guarantee of success.

There are many men who, in their 20’s, believed that they would never want any children, only to be delighted with fatherhood when they were in their 30’s. You may be convinced now that you will never want children, but people change, and you may have a very different outlook on fatherhood in ten years from now.

Some women who have no desire for children when they are in their early 20’s. However, when they are in their 30’s, and they see that many of their friends are having children of their own, they may have a much stronger desire to become a mother.

Since more than half of marriages end in divorce, you may not be with the same partner ten years from now, and a new partner may have a much stronger desire for children than your present partner does. Just because your current partner claims that she will never want children, her tune may change ten years from now, or she may not even be your partner in ten years.

Even though you are an adult, your parents helped you get to where you are today. Having a vasectomy is your decision, but you should grant your parents respect by letting them render an opinion. Is this something you would ever regret not telling them? In most cases, yes. Would you ever regret telling them? No.

If your parents discourage you from having the procedure done, it is because they know you better than any doctor would. One day, you may thank them. If they do not succeed in discouraging you, they may, however, decide to split the cost with you for sperm storage. They may feel much better about the procedure vasectomy knowing that you have a backup plan.

Risks associated with this procedure

Despite all precautions, the vasectomy procedure involves the following risks

Mild inflammation to serious infection or abscess may occur in the skin, vas deferentia, or testicles. Treatment may include observation, antibiotics, or very rarely, surgical treatment.

Blood clots or bruises usually clear up with no intervention. In some cases, medical or surgical treatment is needed.

Very rarely, skin attaches to the vas, or a connection is formed between the vas and skin — a fistula. This may require surgery.

Fluid build-up in the scrotum may clear on its own, or it may need to be removed surgically.

This refers to swelling caused by leakage of sperm from the vas deferens. Spermatic Granuloma usually resolves on its own but may require drainage.

There may be temporary discomfort or pain in the testicles. Pain may be chronic and severe. Post-Vasectomy Pain Syndrome can affect up to 1% of patients.

The cut ends of a vas deferens may grow back together. Rarely, the tubes grow back together again, and pregnancy may occur.

Decreased sexual desire or inability to have an erection is reported in about four out of 1,000 cases. The most likely causes are emotional — there is no physical cause for sexual dysfunction associated with vasectomy.

Pre-Procedure Instructions

Stop taking aspirin, ginkgo, olive leaf extract, fish oil and other natural medicines for 1 week before your procedure as these may increase bruising and bleeding. Talk to your family doctor or pharmacist before stopping any medication.

At the time of your booking, let us know:

  • If you are taking aspirin, warfarin or other ‘blood thinning’ medication prescribed by a doctor, before ceasing medication.
  • If you have had previous surgery for undescended testes as a child.

Ring and confirm your attendance 48 hours before the procedure

At home on the morning of the procedure, after showering or bathing with soap, use a new blade to shave.

The procedure: shave the scrotum. Please shave the underside of the penis and all of the front wall of the scrotum, remove the hair all the way to the top of the penis, including any pubic hair that seems to fall onto the scrotum  (we suggest that you don’t use depilatory creams such as Veet and Nair as these can cause chemical burns. Waxing is an option as well.

Note: Do not shave the day before your procedure as it can lead to an infection.*

Wear supportive underwear (not boxers)

Note: There are no other special requirements. As the operation is carried out under local anesthetic alone.

  • It is safe to drive to and from the surgery yourself
  • You can eat and drink as normal (no restrictions required)

Post-Procedure Instructions

If you experience discomfort in the first 24-48 hours after the local anesthetic wears off, rest with your feet up and take some anti-inflammatory medication such as two tablets of ibuprofen 200mg, 4 times a day after food. Ibuprofen can be obtained from any supermarket or pharmacy. You will also be given a prescription for a strong pain reliever in case the ibuprofen is insufficient. The prescription should only be taken if needed.

In rare cases, an ache and/or swelling can develop after a few days or even weeks after the procedure is done. This is usually due to inflammation of the epididymis and testes. In this case, you can use anti-inflammatory.

NOTE: you should not take ibuprofen if you have had a stomach ulcer in the past or suffer from asthma. Please, let the physician know on your first visit

Bruising of the skin on the scrotum is not a concern so long as it is not associated with scrotal swelling, as it just reflects the broken blood vessels under the skin and will disappear with time.

In the rare case that the wound bleeds, pinch the skin around and the wound with 2 fingers for 10 minutes. The pressure should be strong enough for your nails to blanch, reflecting that you are cutting off the blood flow.

You may shower, but do not rub soap directly into the scrotum for the next two days. Do not have a bath or go swimming three days after to ensure that the wound heals a bit.

We advise you to continue wearing supportive underwear for two days and place the gauze provided until the wound heals itself.

Avoid strenuous exercise, prolonged walking, bike riding, climbing and heavy lifting for the first two days (as well as sexual intercourse). Allow your level to adapt itself to your healing process, meaning do not push yourself if you are not comfortable.

You are not sterile yet! Sterility takes both time and an adequate number of ejaculations following the vasectomy.

The procedure is considered a success with a sperm count of zero is reached. The odds of sterility after achieving this point are extremely low. 80% of men have a very low to nill sperm count two to three months post-procedurally. 99% of men will be sperm-free six months post-procedurally.

To validate the sterility of the sperm, you will be given a pathology request slip and a specimen jar on the day of the intervention. Then, eight to twelve weeks after your operation, you will have to deliver a semen specimen by in the jar supplied to you.

Frequently Asked Questions (FAQ)

A vasectomy is currently the safest form of indefinite 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 for examination for sperm presence. You are sterile when they no longer find sperm. One in five patients still can have sperm present, and repeat tests are performed every month 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 a tubal ligation. This includes the inability 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, the subsequent failure of the procedure (due to the spontaneous rejoining of one or both vasa) is infrequent, occurring only in about 1 in 5000 vasectomies.

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 two 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)

No-scalpel vasectomy instruments are very sharp artery forceps. The doctor uses them to make a tiny opening into the skin of the scrotal wall. A ring clamp is 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. The sharp artery forcep spreads adherent tissue and blood vessels away from the vas under direct vision. Then, the vas is divided and the upper end tied off so that it will seal closed.

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 organized.

Please note that OHIP does not cover vasectomy reversals and sperm storage.

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.

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 minuscule 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.

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.

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 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.

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.

Fees

TO MAKE AN APPOINTMENT, YOU FIRST NEED A VASECTOMY PRESCRIPTION FROM YOUR FAMILY DOCTOR.

Pain Control

Use of the No-Needle device $100

Anesthetic cream $25

Scrotal support $30

Subtotal: $155

Consultation

Internet/phone/skype consultation $135

Follow up appt by phone or skype $70

VIP waiting room and service $130

Subtotal: $335


Grand Total: 490$

OTHER:

  • Contacting your family doctor for a consultation: 30$ admin fee
  • Finding a referral doctor for you : 70$ (or you go to a walk-in clinic near you for free…)

NOTE:

The vasectomy itself and the typical vasectomy tray portion that we use is free of charge and paid by OHIP.

A 100$ deposit is mandatory for any vasectomy. It can be reimbursed if you cancel 2 weeks in advance or with a documented force majeure.

You can opt out of the premium package and have a vasectomy free of charge, but we will only reimburse you the 100$ deposit when you come in for your final follow up appointment. You will have to come see us at the clinic on 4 separate occasions:

  1. The initial consultation
  2. The vasectomy itself
  3. Post-operation follow up (48-72 hours after vasectomy)
  4. Semen Results

*We do not give results by phone for privacy reasons*

We apologize in advance for any inconvenience OHIP does not fund this specific method. If you have any questions or would like more information regarding this, please ask us on your next visit. Thank you for your understanding.

Contact us

613-749-4668

1328 Labrie Ave

Ottawa, ON

Canada


Disclaimer: As with any medical treatment, results will vary among individuals, and there is no implication that you will receive the same outcome as patients herein. There could be pain involved. These concerns should be discussed with your healthcare provider prior to any treatment so that you are properly informed. The information in this website is offered for educational purposed only and does not imply or give medical advice. The photos used may be models and not patients.