[Photo:MFCap12, Caption: No stitches are required for a No-Scalpel Vasectomy. The tiny puncture in the skin is covered with a bandaid after surgery.]
What happens to sperm after a vasectomy?
A vasectomy creates a blockage or “dead end” in the scrotal portion of the vas. The sperm get to the point of blockage and can go no further. They age and then die. The sperm degenerate and the body breaks the sperm down into component protein molecules as it does for dead cells elsewhere in the body. These protein molecules are then reabsorbed into the bloodstream and are eliminated.
When am I considered sterile?
Sperm can still live in the vas upstream from the vasectomy site (in the scrotum) for weeks to months. It could easily take between 6 weeks to three months for these sperm to die off or get flushed out of the reproductive tract. Men are not sterile immediately after a vasectomy, so you must practice contraception until there are 2 consecutive semen analyses that show no living sperm in them. We begin checking semen specimens after 20 ejaculations post vasectomy.
Can a vasectomy be reversed?
While vasectomy is considered permanent sterilization it can certainly be reversed. Roughly 5% of men who have had vasectomies change their mind each year and want to re-establish their fertility. Options available include vasovasostomy, reconnecting the vas at the vasectomy site and sperm harvesting from the epididymis or testicle combined with in-vitro fertilization.
Neither of these techniques are 100% effective so those men who may still want more children should not have a vasectomy. Click here for more information about vasectomy reversal. [link to vasectomy reversal page]
Will a vasectomy cause me to have problems with erection or libido?
Having a vasectomy should not cause any problem with erections or libido from a physiological standpoint, barring any complications. It is possible for some men to have a psychological reaction to having their vasectomy as they might to having any surgical procedure, and that can affect libido. This is a very uncommon scenario that we have not encountered in any patient in whom we have performed a vasectomy.
Is there an increased risk of prostate or testicular cancer because I had a vasectomy?
In the early 1990’s a concern was raised that men who had a vasectomy were at greater risk for getting prostate cancer, a disease that will affect 1 out of 6 American men. This concern sparked great interest and research that concluded that vasectomy is not a risk factor for prostate cancer, testicular cancer, or any other disease.
What are anti-sperm antibodies and what do they have to do with a vasectomy?
Antibodies are molecules produced by the immune system to fight off anything that the immune system perceives as being foreign. After a vasectomy, many men begin making antibodies to their sperm that can be detected in their bloodstream. When present, antibodies can attach to the sperm and prevent them from moving (decrease motility) or from penetrating an egg. It has become clear that only antibodies present on the sperm may cause a problem in certain situations. Very few men actually have antibodies detected on their sperm after vasectomy reversal.
What is the Post Vasectomy Pain Syndrome?
Most men who undergo vasectomy have no difficulties, but a small group of men develop chronic testicular or epididymal pain after the procedure. This pain can start immediately after surgery and is usually due to a sperm granuloma (inflammation at the vasectomy site) or infection and most cases resolve with the appropriate medical therapy.
Occasionally, pain may develop years after the vasectomy and be exacerbated by ejaculation. This pain is thought to be the result of back pressure building up in the epididymis and is known as an ”epididymal blowout” or “post vasectomy pain syndrome.”
While it must be stressed that these are fairly uncommon occurrences after vasectomy, they are frustrating and difficult to deal with for both the patient and the physician. We offer a range of treatments for these syndromes including non-surgical treatments, vasectomy reversal, open-ended vasectomy, and chemical sterilization. Most patients with this problem, which has been ignored for so long, need not suffer.
What is an open-ended vasectomy?
An open-ended vasectomy is a vasectomy that is performed in the exact same fashion as a standard vasectomy, except that the surgeon leaves the testicular end of the vas unclipped. This is thought to reduce the back pressure build-up on the epididymis and testicle, making a future vasectomy reversal easier, and possibly further reducing the already-low chance of developing post-vasectomy pain syndrome.
The problem with the open-ended vasectomy is twofold: there is a greater likelihood of the vasectomy not working, and because the end is open, sperm can leak out and cause a granuloma (inflammatory mass) to form at the end of the vas. The granuloma can sometimes be the cause of pain after a vasectomy.
We do not routinely recommend open-ended vasectomy but will certainly perform one if it is requested.
What are the alternatives to vasectomy?
The alternatives to permanent male sterilization include permanent female sterilization by tubal ligation or tubal blockage, and reversible contraception with condoms, birth control pills or IUD. Many researchers have been working on a “male birth control pill,” but none of the current formulations are very effective or consistent.
Message from Dr. Phil Werthman
“I believe that medicine and surgery should be practiced the “old-fashioned” way, by giving personal, individualized attention to each patient. I spend as much time as needed educating you as patients on all the possible options, procedures, alternatives and risks regarding vasectomies and reversals.
“We are not ‘running a mill,’ and will only schedule a limited number of procedures a day so that patients will get my complete attention.
“I personally perform your surgery myself. I have no interest in using your vasectomy to train resident physicians, junior partners, or passing your care off to a less experienced associate because I am too busy.
“All my patients receive both my home and cellular phone numbers after surgery so you can reach me anytime. This approach has worked very well for our patients and has resulted in our being one of the premiere places on the West Coast to have a vasectomy.
“We routinely care for many movie and television celebrities, recording artists and professional athletes, CEO’s of Fortune 500 companies and physicians and their families. People who can get their care anywhere come to us from around the world and trust us with their most personal and important problems because of the success we achieve and the environment we create, combining Skill, Service, and Compassion.
“We have consciously made an effort to keep the surgical fees reasonable, even though there are surgeons with much less experience and success charging more than twice as much for a vasectomy. I want the opportunity of high quality no-scalpel vasectomy to be affordable to most couples.
“We hope that you find the presented information valuable. We look forward to meeting you and to the privilege of taking care of you. If you have any questions or would like to speak with me directly, please don’t hesitate to call.”
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