A Safe and Stress-Free Option for Family Planning
By Samay Sappal, MD
Persistent apprehension about the vasectomy process has left many men reluctant to consider a simple and effective form of permanent birth control.
Unlike tubal ligation, vasectomy is an outpatient procedure with an extremely low risk of complications. Depending on a patient’s anatomy, the average length of the procedure is 15 minutes. Most men only need over-the-counter pain medications and can return to work, with minimal restrictions, within 48 hours.
Once patients are referred to a urologist for vasectomy consultation, we initiate a focused pre-operative consultation that appropriately screens patients, solidifies informed consent, and ensures a safe and successful vasectomy.
Because a vasectomy is a permanent sterilization method, men should feel confident that they do not want future biological children by natural conception. While surgical reversal is possible, data on success rates vary significantly and are dependent on time delay from vasectomy and surgeon expertise. Reversals also are expensive and typically not covered by insurance.
For the procedure itself, patients can choose the setting in which they feel most comfortable. While all options include a local anesthetic to completely numb the scrotal contents, some patients may choose to have the procedure in the operating room, where sedation medications allow for a very “non-memorable” experience. However, patients can’t drive themselves home, and there may be additional out-of-pocket cost considerations.
Second, patients may opt for sedation with nitrous oxide in a clinic setting, which leaves them relaxed but not fully asleep. With this option, patients can drive themselves home. Depending on their health insurance policy, they may also find this method more affordable.
The third and generally most cost-conscious approach is to use an oral anxiolytic in addition to local numbing medications in a clinic setting. Although these patients need to have a driver with them, they remain relatively alert yet comfortable.
All vasectomies are done with minimally invasive techniques. Incisions are almost always one centimeter or less; most surgeons even offer no-scalpel procedures. After dissecting the vas deferens, surgeons may either sever the duct or excise a small piece to prevent sperm migration. They then use a combination of lumen cauterization, metal clip or permanent suture ligation, and/or fascial interposition, to permanently occlude the cut ends.
Men are counseled to wear scrotal support underwear and avoid strenuous exercise, heavy lifting and sexual activity for one week. After three months, a post-vasectomy semen analysis is obtained to ensure no sperm remains in the ejaculate. Home-based services such as Fellow® allow patients to collect this sample in the comfort and privacy of their home.
Historical data reveals that the risk of pregnancy after a successful vasectomy is approximately one in 2,000. The risk of vasectomy complications such as visible hematoma, chronic scrotal pain or infection is between 1 and 2 percent. In any case, additional surgery is rarely required.
Improving understanding of and access to vasectomy will allow more men to take on the responsibility of family planning with this low-risk, reliable procedure.
Dr. Sappal is a Board eligible Urologist at Urology of Virginia, based in its Suffolk office. www.urologyofva.net
