Intro: It's your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS (Host): What exactly is a vasectomy? How reliable is it? Well, we're here today to help dispel the myths surrounding vasectomy and to give you the information you need to make this very important decision. Right here, on It's Your Health Radio with Henry Mayo Newhall Hospital, I'm Melanie Cole and joining me today is Dr. Kian Asanad. He's a urologist with Henry Mayo Newhall Hospital and Keck Medicine of USC. Dr. Asanad, thank you so much for being with us today. Can you first, for the viewers, tell us a little bit about what a vasectomy is? What is it intended to do?

Kian Asanad, MD: Yes. Hi, Melanie. So, vasectomy is a sterilizing procedure for men that I think is an excellent option. We make typically a single opening or two openings in the scrotum and we access the vas deferens. The vas deferens is the tube that carries sperm from the testicle to the ejaculate and to the outside world. And what we do is we disconnect the vas deferens as like a roadblock, if you will, to make men sterile and no longer have sperm in the ejaculate.

Melanie Cole, MS: Before we get into reliability and reversibility and all of those things, let's get right to the point, doctor, because I think that most men I know hear you discuss slicing in and they're like, "Nope." Tell us a little bit about the procedure and how it is not a painful procedure.

Kian Asanad, MD: Sure. I typically won't use a needle and won't use a scalpel, make a single puncture in the middle of the scrotum. It's done under a local anesthetic. The whole procedure takes about 10 to 15 minutes. The office appointment itself takes about 30 minutes to get you checked in, clean prep, do the procedure and go over your instructions. Nowadays, we're not using lots of needles and lots of knives. I will typically give men an anxiolytic to take an hour before the procedure to help kind of take the edge off, relax them, relax the muscles of the scrotum. It makes the procedure a lot more comforting.

Melanie Cole, MS: How reliable is it? Because certainly if they're doing it, there's a very good reason for that. And it's less invasive than, say, a hysterectomy for a woman. How reliable is this?

Kian Asanad, MD: Absolutely. A vasectomy is incredibly effective, over 99% success rate. I typically quote, and it's been reported in the literature, a one in 2,000 risk of an unwanted pregnancy can occur has been reported in the literature. I do many different techniques to minimize that from occurring. So, we'll disconnect typically about a centimeter of the vas deferens. I'll use permanent clips or sutures. And we'll place a small end of tissue over the butt end of the vas deferens, kind of like closing the garage on a car door to really minimize that risk of recannulization.

Melanie Cole, MS: I imagine that when men are scared to come see urologists anyway, right, Dr. Asanad? I mean, we have to push them in to their PSA checked and to get their prostate checked. But as far as vasectomy goes, I think the biggest fear is going to be side effects. Can you clear up some of those myths for us and misconceptions about whether vasectomy causes impotence or incontinence or erectile dysfunction?

Kian Asanad, MD: Yeah, I mean, I hear that all the time. It's an incredibly common question and concern. And it really doesn't cause prostate cancer. It doesn't cause erectile dysfunction. It doesn't really change the volume of the ejaculate. It's simply a disconnection of the tube that carries sperm. The sperm is only about 3-5% of the volume of the ejaculate. Most of the ejaculate volume comes from the prostate and the seminal vesicles. So, you really don't see any sort of difference in the volume of the ejaculate for men. It is not associated with changes in your testosterone levels. It does not cause erectile dysfunction. You know, it's an incredibly common procedure. And nowadays, men with no kids are coming into the office and want a vasectomy because they're incredibly confident and sure that they do not want children in the future. I mean, I see that all the time now.

Melanie Cole, MS: I know that we're not supposed to go into a procedure like this thinking that one day we might want to change our minds. I mean, certainly women get a hysterectomy, we can't change our minds. Is this a reversible procedure? Is it something that if something changes down the line that they can get that reversed?

Kian Asanad, MD: Yeah, it's a really good question. So, vasectomy is meant to be permanent. It can be reversed. However, the reversal process is not as simple and straightforward as a vasectomy. There's only a few people around the country or in your local area that could really do that sort of work. I've specialized in microsurgery. It's a microsurgical procedure. It's done in the operating room. It takes three to four hours. We use very fine suture to reconnect the vas deferens either to the other side of the vas deferens, which is a vas to vas connection or to the epididymis, which is a vas to epididymis.

The success rates from a reversal are actually really high as well. Only about 5-6% of men will seek a reversal. Some of the most common reasons have to do with a new partner in life, such as a separation and a remarriage. Rarely, it can be due to death of a child. The men who are more likely to seek a reversal are typically younger men less than the age of 30. And if they have less number of children, maybe a single child or two children are more likely to want to seek a reversal in the future again. But that's only about 5-6% of guys who do get reversals.

Melanie Cole, MS: And as we were saying, it's not something that you would like patients to go into thinking that, "Oh, one day I can just go back." But there are certain circumstances in which a reversal might be requested. Now, what about insurance? Does that take care of vasectomy?

Kian Asanad, MD: Vasectomy is typically covered by insurance. Yes, usually not an issue. On the contrary, a reversal is almost always not covered by insurance, and vasectomy reversal procedures because they're incredibly time-consuming, tedious, and really require expert microsurgical skill can range from 8,000 to 12,000 depending on who you're seeing, where it's being done and that sort of thing.

Melanie Cole, MS: That's so interesting, Dr. Asanad. What do you tell patients? I mean, you must talk about this every day with your patients. What do you tell them? Certainly, probably couples come in to talk to you about this sort of thing together because it is an important decision to be made as partners. What's your best advice? When they come in, they're asking all these questions we're discussing here today, what do you tell them?

Kian Asanad, MD: Most of the time, if a guy makes it to the office to talk about a vasectomy, they're already 98% convinced that they're ready to do the procedure. It's very rare when a couple or a man comes in to just learn about a vasectomy. They're there to get the procedure done, schedule it, they have their children, very confident they don't want any more children. And we really don't spend a lot of time talking about whether we could reverse it, and "Are you sure you don't want kids?" That part is really kind of set up from the get-go. I think if there's couples and they bring it up that, "Hey, you know, is it reversible? We have two kids. I doubt we want a third, but what if we did?" Sometimes I'll counsel them to freeze sperm as an option prior to surgery. They could bank sperm. That sperm could be used for in vitro fertilization or IVF down the road, or it could be reversed. And I give them that confidence that if they were to come back and see me, I could do that for them as well. And I think that gives them some ease.

Melanie Cole, MS: Well, I think that you make a good point, that's what podcasts like this are all about, is that we're giving them that lesson so they don't have to come in and ask you all of these same questions just to see if they want to do it when they come in to you. And if they come in to you, because it's not easy, as we said at the beginning, to get men to go in to see any doctor, much less a urologist. But once they come and see you, then they're pretty well set and they just want some information. Now, give us your final thoughts here. What would you like couples, men to know that are considering vasectomy, the most important bits and key takeaways from today?

Kian Asanad, MD: So, I think the takeaways is in terms of recovery after the procedure, most guys' reaction is, "Oh, that was it? That was pretty quick." It's kind of like going to the dentist. When you're done, you're like, "It wasn't that bad." Most guys just need Tylenol for pain. I'll instruct them to ice the scrotum for 24 hours. They'll wear a tight-fitting supportive underwear for about a week after the procedure. Light activity is fine, you know, the next one to two days.

Really, the only limitations I tell guys are to refrain from any sexual activity or heavy exercise or weightlifting for about a week. And then, the last point is a vasectomy does not cause you to be immediately sterile. It takes most guys two to three months to clear the remaining sperm that are still present in the tube. So after about 25 ejaculations or two and a half months, whichever is first, they'll drop off a semen sample into the lab and we have to check to make sure there's no sperm. Sometimes there's some lingering sperm around, the clock resets, another 25 ejaculations or two and a half months. So, it's really a process to confirm that the man is sterile, but the actual procedure itself is pretty quick. It's pretty easy. I'll get you in and out of the office with really minimal discomfort and back to work within a day or so.

Melanie Cole, MS: That's great information. And I'm so glad you mentioned that they come back in to check and make sure because really that's important to know. And thank you, Dr. Asanad, for joining us. You're a great guest as always. And if you wish to book a consultation with Dr. Asanad, you can always call 661-839-1809. You can also visit the free health information library of Henry Mayo Newhall Hospital at library.henrymayo.com. That concludes today's episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.