Vasectomy

• Male sterilisation is carried out by means of a surgical procedure called a vasectomy
• The principle of a vasectomy is to prevent the sperm from entering the fluid which is ejaculated during orgasm
• This is achieved by cutting and tying off the tubes – vas deferens – through which sperm pass
• It is a simple operation carried out under local anaesthetic in a surgeon’s office
• There is a small failure rate, usually in the first year, because the tubes grow back
• Complications are rare and are generally associated with infection

Alternative names

Male sterilisation

Which men should consider sterilisation?
 

Male sterilisation, carried out by means of a vasectomy, is a form of permanent birth control for men.

It should be considered only if you and your partner do not want children or if your family is complete.

It should be considered as a permanent procedure.

How does vasectomy work?

Vasectomy is a simple operation. The principle is to prevent sperm from entering the fluid which is ejaculated during orgasm.

Sperm are produced in the testicles. They pass through tubes called the vas deferens to other glands where they mix with other fluids to form semen.

Vasectomy blocks the vas deferens and keeps sperm out of the seminal fluid. The sperm are instead absorbed by the body.

A vasectomy is usually carried out in a surgeon’s office under local anaesthesia. A small incision is made in the upper part of the scrotum under the penis. The vas deferens are tied off and cut apart. The skin incision is stitched and closed. Normally, you can return home immediately.

How effective is vasectomy?

There is a small failure rate in the first year if the tubes grow together again. This happens in around one in 1000 cases.

Vasectomy does not offer immediate protection against pregnancy since sperm remain in the system beyond the blocked tubes. You must use some other form of birth control until all these sperm are used up. This usually takes between 15 and 20 ejaculations. A simple semen analysis will show when there are no more sperm in the seminal fluid.

What complications can occur after vasectomy?

Generally, complications are rare. Those that do occur are usually associated with infection after the operation. Warning signs include:

• A fever
• Blood or pus oozing from the incision
• Excessive pain or swelling

Other possible problems include:

• Bleeding into the skin during surgery which may cause bruising. This will get better on its own.
• Fluid around the testes occurs in less than one out of 100 cases and generally clears up within a week.
• Sperm leak from the tubes may cause a small lump under the skin near the site of the operation in about 18 out of 100 cases.
• Mild infections occur in up to seven out of 100 cases. Rarely, an abscess may develop.
• Very rarely, the cut ends of the vas deferens grow back together (recanalisation). If this happens, it is usually within four months of the operation.
• Decreased sexual desire or inability to maintain an erection can occur in around four in 1000 cases. This is usually an emotional problem since there is no physical reason why this should happen after a vasectomy.

There has been no proven association between vasectomy and prostate cancer. However, all men between 50 and 70 should be screened for prostate cancer every year.

Can a vasectomy be reversed?

Sometimes it is possible to reverse a vasectomy, but success is not guaranteed. Around 16 to 19% of men with reversed vasectomies will successfully father a child.

In general, you should not consider vasectomy if you want to know about reversal.

When to see your doctor

If after the operation you experience:

• Excessive pain and swelling around the incision or in your testicles
• Any blood or pus oozing from the incision
• If you develop a fever

Reviewed by Dr Pieter J le Roux MBChB, FRCS(Eng), FRCSI, FCS(SA)Urol Consultant Urologist, Tygerberg Hospital and the University of Stellenbosch Medical School.