Vasectomies
Quick jump:
Sterilisation or contraception
Steriliastion, him or her?
Vasectomy and effects on the body
How vasectomy works
What happens to the sperms after vasectomy?
What'ts so special about NSV
Preparing for vasectomy
About the procedure
Recovery
Post Vasectomy complications
Changing your mind!
Because sterilization is so difficult to reverse, it is essential to be as sure as one can be that you really do want sterilization rather than contraception. If there is any possibility that you may want to have more family then do visit your GP for contraceptive advice. There may be contraceptive methods that will suit you as a couple and leave your options open fir the future. For example, modern coils (IUCD – intra-uterine contraceptive devices) are very effective and well tolerated. Couples who attend for vasectomy usually go through the process of contemplating vasectomy then put this to the back of the mind for some months or years. Then, an event, usually a late period! concentrates the mind and crystallizes the decision to seek vasectomy.
The couple contemplating sterilization will usually think that vasectomy is the best way forward and they are correct. The pros and cons of his and hers sterilization are set out in this table
Venue Time to discharge Anaesthetic Failure rate Time off work / away from family Complications- infection/haematoma
Vasectomy wins which ever way you look at it.
Vasectomy and possible effects on the body
Over the last twenty years vasectomy has been linked with a rise in the incidence of heart attacks, testicular and prostate cancer. Fortunately none of these alleged links has been proven indeed a very large study of nurses and their husbands in the USA showed that vasectomised husbands lived longer! It is true however that prostate cancer is becoming more common in the whole population so routine checking particularly in the over 50s and vigilance in all men who have a change in urinary flow is recommended.
‘Vas’ ‘ectomy’ means literally removal of part of the vas as shown in the diagram below. Sperms are generated in the testis and spend at least 2 months making their way along the epididymis, maturing as they go and acquiring a tail and motility. The sperms and their fluid comprise only 3% of the fluid ejaculated, the remaining 97% being transport medium containing nutrients for the journey such as fructose. It is because the sperms form such a tiny proportion of the ejaculate that there is no noticeable change in the fluid passed during intercourse after vasectomy.
What happens to the sperms after vasectomy?
After vasectomy sperms carry on being produced just as normal. They swim
along the epididymis and up the vas to the site of the vasectomy blockage
where they survive for some days then die off. The dead sperms are broken
up and absorbed by the body’s white cells which enter the vas through
the blood supply to this tube.
What’s so special about no-scalpel vasectomy (NSV)?
NSV patients are pain and discomfort free after just 12-24
hours whereas after conventional vasectomy pain and discomfort typically
lasts for 3 days or so. So why the difference ?
NSV= keyhole surgery.
With NSV the surgeon locates and holds the vas directly under the skin
with a pair of special forceps so and with the other hand makes a puncture
through the overlying skin right through into the center of the vas. He
then lifts the vas up through the puncture hole and leaves in place all
the tissues surrounding the vas. The vessels supplying blood to the vas
are gently pushed back from the vas and preserved rather than cut as in
conventional vasectomy. All pain sensitive tissues are covering the vas
are gently removed and the vas then occluded with application of heat,
a Titanium clip and removal of a 1cm segment. The ends then return to
the scrotum without the need to stitch the skin. As in all the best keyhole
surgery minimal disruption of tissues leads to quickest and complication
free recovery. In summary NSV
• Preserves the blood supply to the vas
• Avoids damage to pain sensitive tissues
• Avoids cutting and stitching
Large scale trials have shown that the incidence of complications after
NSV are a fraction of those following conventional vasectomy. Infection
and swelling due to bleeding into the tissues occur in approximately 1/500
patients. This is because the blood vessels are not cut in the NSV procedure
as the following diagrams show:
Relax. The NSV procedure really is as near to painless and possible,
yet many patients are irrationally scared of the operation. Usually once
the office or workmates hear that you are going for ‘the snip’
the horror stories start pouring out. Ignore these! If true at all they
refer to vasectomy performed years ago and not by the NSV method. Infection
and swelling are almost unheard of with NSV.
Shaving. We ask patients to remove the hair on the scrotum and up towards
the base of the penis. Depilatory creams such as Immac Sensitive can be
used but check that you do not react to this by trying some on a non sensitive
area first.
Bring an escort. In this clinic we administer a small dose of very welcome
pre-med sedative a few minutes prior to the vasectomy. We see the patients
face relax, even smile about 10 seconds after giving this. This treatment
also relaxes the skin of the scrotum and makes the vasectomy even easier.
BUT you will not be able to drive or make decisions until the next day
so make sure you are accompanied to the clinic. Most wives join husbands
in the operating room, we welcome this.
The No-Scalpel Vasectomy procedure
There many sites on the net that show pictures of the NSV being performed of which www.maleinfertility.com is one of best. After administering anaesthetic, special ring forceps are used to hold the vas directly under the skin. Then, using another specially sharpened pair of forceps, a puncture hole is made through the skin and into the vas. This exposes the bare vas which is hooked upwards and brought through the skin. Thereafter the vas is cut and sealed as shown above. The ends retract through the skin leaving a tiny puncture wound that is almost invisible. It takes usually 10-15 minutes at most.
Recovering from NSV – back to work the next day.
Immediately afterwards. We offer our patients strong coffee
or tea and biscuits and advise a few minutes rest in the waiting room
before leaving for home.
At home. Patients vary, but most will put the feet up for
a couple of hours then will feel able to leave the house in the evening
and return to all but the most physical job the next day. Bruising is
minimal and all aching is usually gone by the next day.
Pain relief. If needed, use Ibuprofen or Paracetamol.
Sex.We recommend no sex for 7 days after NSV. This is to
allow the vas to heal completely after the heat sealing treatment. Ejaculation
leads to a pressure rise equal to that of your blood pressure and if the
vas is not fully healed this can cause a tender swelling called a granuloma.
After 7 days we recommend frequent sex – around three
times per week until the post vasectomy samples are submitted. This is
to clear away all the millions of sperms that remain in the tubes after
vasectomy. Approximately 25-30 ejaculations are required to clear all
sperms in most cases although some patients require more than this.
Better sex. Almost all couples report better sex after vasectomy
with the lifting of the worry of unwanted pregnancy. Couples should not
seek vasectomy to improve their sex life however.
There has not yet been devised any operation that does not carry some
risk of some kind of complication. The advanced NSV procedure performed
by skilled hands has all but abolished the complications of bleeding and
infection.
Mild ache.Probably the commonest reported effect of vasectomy
(probably 2-3%) is a mild aching sensation in the testes that appears
maybe one to three weeks after vasectomy. This may be accompanied by a
feeling of swelling in the epididymis (see diagram above). This sensation
is caused by a slight pressure rise in the vas and mild distension of
the epididymis following the blockage of the vas. The discomfort rapidly
settles down as the body readjusts. The surgeon has a part to play in
minimizing this. By choosing to perform the vasectomy in the upper third
of the scrotal vas we minimize the pressure rise in the system thus reducing
the chance of post vasectomy ache.
Granuloma. This is a firm lollipop shaped swelling on the
cut testicular end of vas. Sometimes caused by returning to sex too soon
before the vasectomy has fully healed. Usually goes unnoticed. Very occasionally
causes discomfort and can be cured by merely trimming off the affected
end in a further minor procedure.
Early recanalisation. This is the formation of a minute
track between the ends of the vas which is microscopic in size but can
allow a tiny number of sperms to re-appear in the semen. Occurs in approximately
one per thousand patients and is detected by the post vasectomy semen
tests. The remedy is simply to re-do the vasectomy.
Late recanalisation is the extremely rare process of microscopic
rejoining of the ends of vas after the all clear has been given by passing
two clear semen samples. We have never had one case of this in 8000 cases
in this clinic but it has been reported.
Changing your mind!(www.vasectomyreversals.co.uk)
It is a fact that in the UK 1-2 % of patients will change their minds
and in the USA up to 6% do so. Of course there is counseling from the
GP, friends, family and colleagues and ourselves, but life often takes
an unexpected turn. (Incidentally, approximately 15% of reversal requests
arise because couples made the vasectomy decision when they were knee
deep in nappies and probably tired and struggling financially. When the
children are ‘grown-up’ and going to school and parents perhaps
better off and less sleep deprived, they turn to a vasectomy reversal
request. The remaining 85% of reversal requests come from couples who
are in a second relationship and wish to enrich their lives with further
family).
Vasectomy reversal is a lot more likely to succeed where the vasectomy
has been performed without using diathermy and where care has been taken
to operate on the vas in the correct area. A large part of my practice
consists of vasectomy reversal, so I know!
I hope you enjoy browsing this site. I would be delighted to hear comments
from interested parties, professional colleagues and patients.
Call the clinic on 00 44 (0)1429 282800 or
email on info@no-scalpelvasectomy.co.uk
Dr Andrew Dawson