Vasectomy is a form of long term birth control that is very safe (1 in 1 million mortality rate in Westernised Nations). It is far safer than the equivalent female operation (1 in 25 thousand mortality rate). The operation technique:
Local anaesthetic is introduced to the sc***um and then around the right and left vas separately. If the patient is particularly anxious they can be given sedation (inhaled penthrane). After the local anaesthetic is effective then Li vas forceps are used to grasp the vas, usually on the right side first. A small hole, approximately 5mm, is then made with a needle point haemostat. The lining around the vas (the sheath) is then divided (opened) so that the vas can be removed from the sheath. It is then cut and the end closest to your body is cauterised. Then the sheath is moved to lie between the two free ends of the vas and the sheath is then closed around the end closer to the body. A layer of tissue now lies between the two ends. The vas is then moved back into the sc***um and the procedure is then done on the left side. This is a non scalpel open ended vasectomy with fascial interposition. It offers the best side effect profile with the least chance of failure. What should I consider before having a vasectomy? Vasectomy should be considered a permanent form of contraception. Therefore you should think through the implications of permanent contraception. The most important two questions that you need to be comfortable with are:
Would I want to have more children if my wife died? Or my child or children died.They are not easy questions to answer but you must have at least thought about those possibilities before considering vasectomy. If you would want to have more children if either of those unfortunate circumstances occurred then vasectomy is not appropriate for you. If you think that it would be a good idea to store some s***m, “just in case”, then having a vasectomy is not appropriate either. Vasectomy reversal is possible but it isn’t something that you would want to rely on. For some men, when they have a vasectomy, it will be irreversible. It would be possible to try IVF therapy, the chances of IVF working are not good. What can make vasectomy irreversible is the formation of anti-s***m antibodies. This means that due to having a vasectomy your body’s immune system decides that s***m are similar to germs and starts to attack them as they are produced. Vasectomy reversal means that the two ends of the vas are stitched back together. However if there are no s***m to swim back up the tubes then obviously this will not return fertility. There are other circumstances where vasectomy is not appropriate. Factors that will be taken into consideration are your age, your partner’s age, number of children, your health and your partner’s health. At the time of the initial consultation a brief physical examination will be done to make sure that you are suitable for vasectomy. The risks or surgery will be discussed. It is very important that any questions you have be asked at the initial consultation. How many vasectomies have you performed?
1400 as of July 2016. I am currently doing six vasectomies per week on a Friday morning. How long will it take? You will be at the surgery for approximately 40 minutes. The vasectomy itself normally takes between 15 and 25 minutes. Can I drive myself home? Most men will be able to drive home without difficulty. If you think that you will be particularly anxious about the vasectomy, then it is a good idea for you to not drive yourself home. A small number of men faint after having a vasectomy. This is more common in men who are quite anxious prior to the procedure. When can I resume s*x? It is a good idea to wait one week before resuming s*x. When can I resume physical activity? It is a good idea to have a week off vigorous physical exercise. If you hurt yourself post vasectomy, it will not cause vasectomy failure. However, it may increase the chance of further post operative bleeding and pain at the site of the vasectomy. Am I sterilised immediately? You need to wait until you get the written clearance letter stating that your vasectomy has worked. This letter is posted to you after your three month follow up s***m test. Yes, vasectomies can fail. It is very important that you perform a s***m test three months after the procedure to ensure that it has worked. There is a one in three hundred failure rate, or 0.33%. If your three-month s***m test shows the vasectomy was successful, there can still be a failure at a later for unknown reasons. This is rare and is reported in the medical literature as around 1 in 5000 cases. What do I do if it fails? If failure occurs, it will be detected at the three-month post-operative s***m test. Another vasectomy should then be performed which will be done at no extra cost. This is usually successful. Are there any long term health consequences of vasectomy? No long term life threatening consequences of vasectomy have been detected. Men do not have [more] any increased incidence of heart disease, testicular cancer, prostate cancer or any other health problems. A small number of men develop post vasectomy pain syndrome. It is a poorly understood and poorly defined syndrome. The clinic has had 3 cases out of the last 1400 vasectomies where men have returned with pain that has not resolved by itself over a six to twelve month period. There are options for these men to have their pain treated. Is there any change to s*xual function? There is no change to testosterone levels and no change in s*x drive. S***m only makes up 3% of ej*****te volume so there will still be an ej*****te as normal. There is no change in the sensation of or**sm or s*xual function in any way. How painful is vasectomy? This is partly dependent upon the patient as anxiety increases the perception of pain. At the end of the procedure, most patients state that it isn’t as painful as a trip to the dentist. Post-operative pain is easily controlled with application of an ice pack (or packet of frozen peas) plus paracetamol if needed. Most men will return to work on the Monday following their operation. Will there be much bleeding? Bruising at the site of the incision is normal. About 1% of men develop a post-operative haematoma (blood clot). If that happens, you will experience is a lump with or without pain inside the sc***um, normally at the site of the vasectomy and normally only on one side. It will normally be reabsorbed by the body over a few weeks and is normally painless. What is the complication rate? About 3% of men have returned for review in the first month after their vasectomy, usually for ongoing discomfort. This normally settles without you doing anything apart from taking pain relief if needed. There have been no reported cases of serious infection in the last 1400 cases. It has been more than 6 years since there were any minor skin infections post vasectomy in our practice. There is a 1 in 500 chance of having a large post-operative haematoma. Following your vasectomy, you will be provided with a mobile phone number to call if you have any immediate concerns over the weekend.
