A PERMANENT DECISION

A vasectomy is a safe, simple, and effective surgical procedure that makes a man sterile (unable to father a child). "No-scalpel" is a special technique for performing a vasectomy. That often results in less swelling and pain than the traditional method. Any vasectomy is a serious step to take and should be considered irreversible. You and your partner must be absolutely sure that you won't want children in the future.

Preparing For the Procedure

Don't take any aspirin for three to five days before your vasectomy, and ask your doctor about any other medications you take. The day of your surgery, shower and thoroughly clean your scrotum. Your doctor may also ask you to shave your scrotum. Bring a pair of clean cotton briefs or an athletic supporter with you to the doctor's office or hospital. If you're nervous before your surgery, you may be given some medication to help you relax.

THE PROCEDURE

The no-scalpel procedure is similar to a traditional vasectomy in many respects, but it's done without incisions or stitches. This generally results in faster healing.

During the Procedure

You're asked to undress and lie on the exam table. Sterile drapes are placed over you to help prevent infection. You're given injections of anesthetic into your scrotum or lower groin to prevent you from feeling pain. Once the anesthetic takes effect, the doctor makes one puncture in the scrotum with a pointed clamp. Each of the two vasa deferentia is lifted through this puncture. The vasa are cut, and a section of each may be removed. You may feel a pulling sensation during this process. The two cut ends are sealed by heat (cauterized) and may also be tied or clipped. The puncture heals naturally without stitches.

After the Procedure

If you've been given medications to help you relax, you'll need to have someone drive you home. The local anesthetic begins to wear off after an hour or so. Any discomfort you feel is usually very mild. If you need it, a pain reliever may help.

Healing

Recovery time after a no-scalpel vasectomy is usually less than after a traditional vasectomy. Once you're home, you can do several things to aid your recovery:

• Stay off your feet as much as possible for the first day to lessen the chance of swelling. An ice pack can also help keep swelling down.
  
• Wear snug cotton briefs for support.
  
• Avoid heavy lifting or exercise for at least 5 days.
  
• Ask your doctor when you can return to work.
  
• Ask your doctor when you can begin having sex again. Note: You must use some form of birth control until your doctor says you're sterile.

Vasectomy Risks and Complications

Men who've had no-scalpel vasectomies usually have less swelling and bleeding than do men who've had traditional vasectomies. However, certain problems can occur with any vasectomy. If you have any of the following or other symptoms you're concerned about, call your doctor.

Problems that may occur during the first few days after your surgery include:

Infection. Some signs are fever, chills, drainage, and pain.
Internal bleeding in the scrotum (usually within two days of surgery). Symptoms include increasing pain, excessive swelling, a large black-and-blue area, or a growing mass.

Problems, though rare, that may occur in the first few months after your surgery include:

• Sperm granuloma. A lump where either vas deferens is tied off, caused by leaking sperm.
  
• Congestion. Inflammation in the testicles that may cause some aching about 3 to 12 weeks after surgery.
  
• Sperm antibodies. Antibodies produced by the body in response to absorbed sperm.
• Antibodies are not harmful, but can make fertility difficult to restore if that's later desired.
  
• Testicular discomfort (rare). Discomfort that lasts several years after the procedure.
  
• Spontaneous return of fertility (very rare). When sperm travel between the cut ends of the vas deferentia and cause fertility to return.

YOUR REPRODUCTIVE SYSTEM

To understand how a vasectomy works, you need to know how sperm are produced and released by your reproductive system.

Before vasectomy, sperm are released out of the penis during ejaculation.

After vasectomy, the cut vasa prevent sperm from reaching the penis. Note: For several months after the procedure, some sperm may remain in the upper portion of the vasa.

How a Vasectomy works

When you have a vasectomy, the two vasa deferentia are cut to keep sperm from traveling from the testes to the penis. This is the only change in your reproductive system. The testes still produce sperm, but since the sperm have nowhere to go, they die and are absorbed by your body. Your prostate and seminal vesicles still produce fluids, so your semen doesn't look or feel any different. Your male hormone level remains the same, so your hair distribution, the pitch of your voice, and your sexual drive don't change.

UNTIL YOU'RE STERILE

Because sperm are often trapped in the upper part of the vasa, it takes a few months before you're sterile. A postoperative semen exam can tell you when no sperm are left in your semen. This exam is done about six weeks after and again about three months after surgery. It's absolutely essential that you continue to use another method of birth control after your vasectomy until your doctor tells you that your sperm count is zero.

Consultant:
Raul Hernandez, MD, Urology
With contributions by:
Karen M. Bolton, MD, Family Medicine
Joanne G. Brake, RN
Conrad C. Maitland, MD, Urology