Sperm passes from the testes to the penis in tubes called the vas deferens. A vasectomy is a surgery that blocks these tubes. This makes a man unable to make a woman pregnant.
Get answers to some of the most commonly asked questions about vasectomies from Ryan P Smith, MD, a UVA expert in male reproductive medicine and men’s health.
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Answering Common Questions About Vasectomies
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Ryan P Smith, MD
Dr. Ryan Smith is fellowship-trained in male reproductive medicine and surgery, and his specialties include male infertility, fertility preservation and testosterone therapy.Learn more about Dr. Ryan Smith
Transcription:
Answering Common Questions About Vasectomies
Melanie Cole (Host): A vasectomy is a surgical procedure for male sterilization or permanent contraception, but how do you decide if this is the right procedure for you? My guest today is Dr. Ryan Smith. He's fellowship trained in male reproductive medicine and surgery and his specialties include male infertility, fertility preservation and testosterone therapy at UVA Health Systems. Welcome to the show, Dr. Smith. People hear that word, men recoil. What is a vasectomy? What is it intended to do?
Dr. Ryan Smith (Guest): Well, you're exactly right, and thank you, again, for having me. So, a vasectomy, just like you said, is meant to be a permanent form of contraception. That is first and foremost something that we reiterate to patients time and again to make sure that this is something that they understand is permanent and they want permanent contraception. The procedure, in itself, essentially what we're doing is that the vas deferens is the tube that carries the sperm, essentially from the testicle and epididymis out through the remainder of the reproductive tract. So, when you do a vasectomy--and there are different modes of performing this--but in its simplest form, you're occluding that vas deferens so that the sperm cannot make the transition from the reproductive tract out the urethra.
Melanie: So, I guess the first question that men would want to know is, is this a painful procedure?
Dr. Smith: So, in general, most men are very comfortable with doing this procedure in the office. We often liken it to going to the dentist in terms of you get a local anesthetic and we're able to do all of the procedure through that. Some patients who may be nervous about it, we will give some oral sedation, whether that's Valium or Xanax, or something like that. On a very rare occasion, would IV sedation be necessary for the procedure. So, in general, patients are very comfortable during it and that's our goal is to maintain their comfort throughout.
Melanie: So, when should a man look at doing this because there is that discussion among spouses; should the woman do it? Should the man do it? And, how do they come to that conclusion?
Dr. Smith: Well, I think, just as you said, for a couple, it's a conversation that's often ongoing for even years. We know from a lot of the studies that multiple couples will have that conversation, but won't commit to something for several years after discussing it. I think one of the biggest conversations when couples are discussing permanent contraception is whether to pursue a vasectomy or a tubal ligation. In general, when you compare those two as options, they're equally effective, but a vasectomy is faster, safer, only requires local anesthetic, and so it's overall more cost effective compared to a woman undergoing general anesthesia for a tubal ligation, which has other risk factors involved.
Melanie: So, for the woman, this is a bigger surgery and for the man, this is something that's just a little bit quicker. How much quicker? What's the recovery like?
Dr. Smith: In general, we tell guys to expect a couple of days of discomfort. So, in general, it's very popular for men to have the procedure say, on a Friday, and by Monday, you can generally return to work for those who maybe don't have an extremely strenuous job. In general, we recommend them you not doing any aggressive or vigorous physical activity, maybe even for upwards of a week, but the recovery time is really just those two days are the crux of it.
Melanie: Is this a reversible procedure?
Dr. Smith: It is reversible. Part of that is dependent on the timeframe from when the individual had the vasectomy, but certainly even within the first ten years, you have greater than a 95% chance, in most cases, of a successful reversal in terms of returning sperm to the ejaculate, if that is what the patient desires.
Melanie: So, what are the odds, I mean, is it an effective procedure? Is there a chance the woman can still get pregnant?
Dr. Smith: Yes. So, one of the things that we talk about, and every patient gets a pre-procedure consultation where we review risks and benefits, and this is one of the things that we discuss is that you know, no contraception, essentially, is 100% reliable. In terms of a vasectomy failure, a repeat vasectomy is required in less than 1% of cases and we define a failure as when a man still has moving sperm present six months following the procedure. And, again, that's less than or equal to 1% of the time. So, the other way to think about failure is a longer-term failure meaning that the patient followed through and had a post-vasectomy semen analysis, which is essential to show that the procedure is effective. If the patient had no sperm present on that post-procedure analysis and then down the road had a pregnancy, that's about a 1 in 2,000 chance.
Melanie: Does it ever have to be re-done?
Dr. Smith: It can be re-done. In the scenario that I mentioned where a patient still has moving sperm at 6 months, at that time, you'd have to have a conversation about potentially repeating the procedure if that was something that the patient desired because that would indicate there continues to be a risk of pregnancy when there's moving sperm at that six month mark.
Melanie: So, Dr. Smith, is there a time when certain men cannot have that? Are there certain men that you just say, “No, this is not the right procedure for you”?
Dr. Smith: Sure. So, any time someone comes in for that pre-procedure consultation and there's some hesitancy there or a great deal of uncertainty, or someone who may be saying "Well, I want to make sure that I can reverse this," or "Can I bank sperm before the procedure?" or something like that that may indicate they're not quite ready for a permanent form of contraception. We generally advise those patient that maybe this is not the right time for them to pursue this as a procedure. The only other time where we may counsel someone against pursuing vasectomy is someone who has chronic underlying discomfort in the scrotum for whatever reason that may be, in which case we'll generally advise them that vasectomy may not be the best choice for contraception for them.
Melanie: So, are there some disadvantages and then, what if you feel, if you as a doctor get the feeling they're being pressured into this?
Dr. Smith: Sure. So, in general, sometimes couples will come together for their consultation visit. If we felt like there was a lot of outside pressure it may be something that we may discuss with the couple together in that regard. I think most of the men we tend to see are there because they want to participate in the discussions and the procedure with their significant other. So, they've already had those conversations like we talked about initially. And if they go back home after our visit and discuss with their spouse or whomever and decide it's not right for them, well, they ultimately don't return for the procedure. But, you know, as with anything, part of our conversation is again, those risks and benefits and there are some potential side effects of the procedure.
Melanie: So, what might some of those be?
Dr. Smith: In general, we talk about hematoma. That would be essentially significant bruising and swelling in the scrotum or a blood clot that forms in the scrotum. There's about a 1-2% chance of that occurring. It generally does not require any sort of secondary procedure, but the patient may be uncomfortable for a longer period of time, even a few weeks for all that hematoma reabsorbs. The infection risk is low--1% or less, and most patients don't need antibiotics for the procedure because of that low infection risk. One other item that we counsel them about is something called “post-vasectomy pain syndrome” and what that is, is kind of chronic discomfort that can linger in the scrotum for even months or a year following the procedure. It's not well-defined but it’s estimated that 1-2% of men may notice that. There's been research done to look at anything that predisposes men to develop that or if there's something procedurally that can be done to alleviate that risk and nothing's really borne out in the literature to show that it's effective in eliminating that risk. It's something that we just counsel patients about so that they're aware of it. You can perform a vasectomy reversal for a patient who had chronic discomfort following a vasectomy and in approximately 79% or more of case, patients will report improvement in discomfort following a reversal.
Melanie: So, in just the last few minutes, Dr. Smith, tell us what you tell patients every single day--couples, men individually, and their spouse--about vasectomy. What you really want them to know about this procedure.
Dr. Smith: Sure. So, there's a very good guideline that we use as urologists that's put out by the American Urologic Association and so some of the points that we stress in that consultation visit are that this is meant to be a permanent form of contraception; it's not immediate; that patients need to use another form of contraception until they're cleared by a post-vasectomy semen analysis, which is done approximately 8-16 weeks following the procedure. They must do that semen analysis. Only 50% of patients ultimately follow-through in doing it, but without that semen analysis, we can't provide them with any sort of reassurance that the procedure was effective. I also tell them that the procedure is not 100% reliable, just as I mentioned before, and that a repeat vasectomy is necessary in 1% or less of cases; and that there's still a 1 in 2,000 chance of pregnancy even when a semen analysis has shown no sperm or just a few non-moving sperm following the procedure. And then, just the general procedural complications that we talked about: , the risk of hematoma, infection, and chronic pain are things to be noted, as well. There’s not been any substantial risk in terms of to men's health in general like cancer risk, or heart disease. There have been studies in the past that have called some of that into question; however, those have been reviewed by the American Urologic Association and no substantial risks have been shown to men's health overall.
Melanie: And, Dr. Smith, why should men choose UVA for their urology and men's health care needs?
Dr. Smith: Well, UVA is very unique in that we have two fellowship-trained providers who do vasectomies and also male infertility care and we have an andrology lab here that does a lot of research as well. So, we have a very unique sub-specialized, multi-disciplinary approach at UVA that's only available at a handful of centers around the country. So, our patients and we are very fortunate to work in an environment like that.
Melanie: Thank you so much for being with us today, Dr. Smith. It's really important information. You're listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole, thanks so much for listening.
Answering Common Questions About Vasectomies
Melanie Cole (Host): A vasectomy is a surgical procedure for male sterilization or permanent contraception, but how do you decide if this is the right procedure for you? My guest today is Dr. Ryan Smith. He's fellowship trained in male reproductive medicine and surgery and his specialties include male infertility, fertility preservation and testosterone therapy at UVA Health Systems. Welcome to the show, Dr. Smith. People hear that word, men recoil. What is a vasectomy? What is it intended to do?
Dr. Ryan Smith (Guest): Well, you're exactly right, and thank you, again, for having me. So, a vasectomy, just like you said, is meant to be a permanent form of contraception. That is first and foremost something that we reiterate to patients time and again to make sure that this is something that they understand is permanent and they want permanent contraception. The procedure, in itself, essentially what we're doing is that the vas deferens is the tube that carries the sperm, essentially from the testicle and epididymis out through the remainder of the reproductive tract. So, when you do a vasectomy--and there are different modes of performing this--but in its simplest form, you're occluding that vas deferens so that the sperm cannot make the transition from the reproductive tract out the urethra.
Melanie: So, I guess the first question that men would want to know is, is this a painful procedure?
Dr. Smith: So, in general, most men are very comfortable with doing this procedure in the office. We often liken it to going to the dentist in terms of you get a local anesthetic and we're able to do all of the procedure through that. Some patients who may be nervous about it, we will give some oral sedation, whether that's Valium or Xanax, or something like that. On a very rare occasion, would IV sedation be necessary for the procedure. So, in general, patients are very comfortable during it and that's our goal is to maintain their comfort throughout.
Melanie: So, when should a man look at doing this because there is that discussion among spouses; should the woman do it? Should the man do it? And, how do they come to that conclusion?
Dr. Smith: Well, I think, just as you said, for a couple, it's a conversation that's often ongoing for even years. We know from a lot of the studies that multiple couples will have that conversation, but won't commit to something for several years after discussing it. I think one of the biggest conversations when couples are discussing permanent contraception is whether to pursue a vasectomy or a tubal ligation. In general, when you compare those two as options, they're equally effective, but a vasectomy is faster, safer, only requires local anesthetic, and so it's overall more cost effective compared to a woman undergoing general anesthesia for a tubal ligation, which has other risk factors involved.
Melanie: So, for the woman, this is a bigger surgery and for the man, this is something that's just a little bit quicker. How much quicker? What's the recovery like?
Dr. Smith: In general, we tell guys to expect a couple of days of discomfort. So, in general, it's very popular for men to have the procedure say, on a Friday, and by Monday, you can generally return to work for those who maybe don't have an extremely strenuous job. In general, we recommend them you not doing any aggressive or vigorous physical activity, maybe even for upwards of a week, but the recovery time is really just those two days are the crux of it.
Melanie: Is this a reversible procedure?
Dr. Smith: It is reversible. Part of that is dependent on the timeframe from when the individual had the vasectomy, but certainly even within the first ten years, you have greater than a 95% chance, in most cases, of a successful reversal in terms of returning sperm to the ejaculate, if that is what the patient desires.
Melanie: So, what are the odds, I mean, is it an effective procedure? Is there a chance the woman can still get pregnant?
Dr. Smith: Yes. So, one of the things that we talk about, and every patient gets a pre-procedure consultation where we review risks and benefits, and this is one of the things that we discuss is that you know, no contraception, essentially, is 100% reliable. In terms of a vasectomy failure, a repeat vasectomy is required in less than 1% of cases and we define a failure as when a man still has moving sperm present six months following the procedure. And, again, that's less than or equal to 1% of the time. So, the other way to think about failure is a longer-term failure meaning that the patient followed through and had a post-vasectomy semen analysis, which is essential to show that the procedure is effective. If the patient had no sperm present on that post-procedure analysis and then down the road had a pregnancy, that's about a 1 in 2,000 chance.
Melanie: Does it ever have to be re-done?
Dr. Smith: It can be re-done. In the scenario that I mentioned where a patient still has moving sperm at 6 months, at that time, you'd have to have a conversation about potentially repeating the procedure if that was something that the patient desired because that would indicate there continues to be a risk of pregnancy when there's moving sperm at that six month mark.
Melanie: So, Dr. Smith, is there a time when certain men cannot have that? Are there certain men that you just say, “No, this is not the right procedure for you”?
Dr. Smith: Sure. So, any time someone comes in for that pre-procedure consultation and there's some hesitancy there or a great deal of uncertainty, or someone who may be saying "Well, I want to make sure that I can reverse this," or "Can I bank sperm before the procedure?" or something like that that may indicate they're not quite ready for a permanent form of contraception. We generally advise those patient that maybe this is not the right time for them to pursue this as a procedure. The only other time where we may counsel someone against pursuing vasectomy is someone who has chronic underlying discomfort in the scrotum for whatever reason that may be, in which case we'll generally advise them that vasectomy may not be the best choice for contraception for them.
Melanie: So, are there some disadvantages and then, what if you feel, if you as a doctor get the feeling they're being pressured into this?
Dr. Smith: Sure. So, in general, sometimes couples will come together for their consultation visit. If we felt like there was a lot of outside pressure it may be something that we may discuss with the couple together in that regard. I think most of the men we tend to see are there because they want to participate in the discussions and the procedure with their significant other. So, they've already had those conversations like we talked about initially. And if they go back home after our visit and discuss with their spouse or whomever and decide it's not right for them, well, they ultimately don't return for the procedure. But, you know, as with anything, part of our conversation is again, those risks and benefits and there are some potential side effects of the procedure.
Melanie: So, what might some of those be?
Dr. Smith: In general, we talk about hematoma. That would be essentially significant bruising and swelling in the scrotum or a blood clot that forms in the scrotum. There's about a 1-2% chance of that occurring. It generally does not require any sort of secondary procedure, but the patient may be uncomfortable for a longer period of time, even a few weeks for all that hematoma reabsorbs. The infection risk is low--1% or less, and most patients don't need antibiotics for the procedure because of that low infection risk. One other item that we counsel them about is something called “post-vasectomy pain syndrome” and what that is, is kind of chronic discomfort that can linger in the scrotum for even months or a year following the procedure. It's not well-defined but it’s estimated that 1-2% of men may notice that. There's been research done to look at anything that predisposes men to develop that or if there's something procedurally that can be done to alleviate that risk and nothing's really borne out in the literature to show that it's effective in eliminating that risk. It's something that we just counsel patients about so that they're aware of it. You can perform a vasectomy reversal for a patient who had chronic discomfort following a vasectomy and in approximately 79% or more of case, patients will report improvement in discomfort following a reversal.
Melanie: So, in just the last few minutes, Dr. Smith, tell us what you tell patients every single day--couples, men individually, and their spouse--about vasectomy. What you really want them to know about this procedure.
Dr. Smith: Sure. So, there's a very good guideline that we use as urologists that's put out by the American Urologic Association and so some of the points that we stress in that consultation visit are that this is meant to be a permanent form of contraception; it's not immediate; that patients need to use another form of contraception until they're cleared by a post-vasectomy semen analysis, which is done approximately 8-16 weeks following the procedure. They must do that semen analysis. Only 50% of patients ultimately follow-through in doing it, but without that semen analysis, we can't provide them with any sort of reassurance that the procedure was effective. I also tell them that the procedure is not 100% reliable, just as I mentioned before, and that a repeat vasectomy is necessary in 1% or less of cases; and that there's still a 1 in 2,000 chance of pregnancy even when a semen analysis has shown no sperm or just a few non-moving sperm following the procedure. And then, just the general procedural complications that we talked about: , the risk of hematoma, infection, and chronic pain are things to be noted, as well. There’s not been any substantial risk in terms of to men's health in general like cancer risk, or heart disease. There have been studies in the past that have called some of that into question; however, those have been reviewed by the American Urologic Association and no substantial risks have been shown to men's health overall.
Melanie: And, Dr. Smith, why should men choose UVA for their urology and men's health care needs?
Dr. Smith: Well, UVA is very unique in that we have two fellowship-trained providers who do vasectomies and also male infertility care and we have an andrology lab here that does a lot of research as well. So, we have a very unique sub-specialized, multi-disciplinary approach at UVA that's only available at a handful of centers around the country. So, our patients and we are very fortunate to work in an environment like that.
Melanie: Thank you so much for being with us today, Dr. Smith. It's really important information. You're listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole, thanks so much for listening.