Introduction
In most cases, the term “vasectomy” refers to the cutting of the male vas deferens. Vasectomy is a simple surgical procedure with few complications, which leads to very safe contraception. The number of procedures is increasing; in the USA it is already one of the most frequently used contraceptive measures. Vasectomies are also increasingly being sought in Germany, as they involve hardly any risks compared with other contraceptive methods. Even a re-operation with the restoration of fertility is often possible with vasectomy.
What can be the side effects of a vasectomy?
Although vasectomy is a low complication procedure, it is still an invasive surgical procedure that can be associated with potential side effects. As a rule, the skin is incised under local anaesthetic at one or two points on the testicles. The subsequently exposed spermatic ducts of both testicles are severed and a short piece is removed to prevent the severed ends from growing together again.
The loose ends of the vas deferens are then either sclerosed with electrodes, sutured with sutures, or stapled with metal. Manipulation of the tissue can lead to the typical side effects of an invasive surgical procedure, such as pain, bleeding and infection. Infections can develop on the surface of the skin incision or spread to the surrounding tissue.
Depending on the circumstances, theoretically all complications from redness of the skin to inflammation of the testicles can occur. Very rarely, minor errors in the operation can lead to further complaints. If the vas deferens is not carefully distinguished and separated from the rest of the tissue, surrounding structures such as blood vessels or epididymis can be injured.
The most common side effect of a vasectomy is postoperative pain. Pain can occur for various reasons. In most cases, it is a typical, harmless wound pain caused by the skin incision and surgery on the spermatic cord.
Even this is relatively rare and minor in vasectomies. Only about one third of patients report pain after the operation. Under certain circumstances, pain can also be caused by injury or inflammation of other structures in the surgical area.
The pain then often occurs with a delay of a few days. Depending on the cause, further symptoms such as swelling and redness may then occur. Very rarely, a so-called “post-vasectomy syndrome” can also occur.
This describes a longer lasting pain condition whose cause is unknown. Presumably, this is also caused by nerves or the epididymis. The affected patients complain of constant pain in the surgical area for weeks.
Occasionally, post-operative bleeding may occur during vasectomy. Through the skin incision and the incisions at the sperm duct, increasingly smaller blood vessels are injured and cut through. During the operation, smaller bleedings are stopped by compresses or by obliterating the vessels with electrodes.
These smaller bleedings occur during all surgical procedures. Post-operative bleeding can occur because many small blood vessels are injured and the bleeding is not stopped. Even blood vessels that have already been obliterated can bleed again after the operation.
More rarely, larger blood vessels, for example the supplying vessels of the testicles, can also be injured in the area of the operation. If the bleeding is not noticeable during the operation, it can subsequently lead to secondary bleeding with severe effusions and swelling. In case of post-operative bleeding, it is important to find out whether the bleeding can be stopped externally or whether another operation is necessary.
First measures are compression and cooling. Under certain circumstances, the bruise may have to be removed and the damaged vessel sutured or sclerosed in another operation. Epididymitis is the most common deep and dangerous infection after a vasectomy.
The procedure itself is performed on the spermatic duct just above the epididymis, which is why the epididymis is at increased risk of injury and inflammation due to the close proximity. The typical signs of inflammation are redness, swelling, pain and overheating. In addition, fever, burning sensation when urinating and blood in the urine and ejaculate can occur.
A typical symptom of epididymitis, as distinct from other diseases of the testicles, is a decrease in pain when lifting the testicles. In most cases the inflammation must be treated with antibiotics.As a complication, epididymitis can lead to a permanent reduction in sperm quality, which can cause problems in conception if the spermatic ducts are subsequently restored. Significantly less frequently, however, an inflammation of the testes, also known as “orchitis”, occurs after a vasectomy.
The inflammation of the testes is similar to an epididymitis. Here too, swelling, redness, overheating, pain and sometimes fever and discomfort when urinating occur. The doctor can often distinguish the two types of inflammation by the exact location of the pain and swelling.
Testicular inflammation can also lead to unwanted, irreversible infertility independent of vasectomy. In addition to antibiotic therapy, swelling and pain can be reduced by cooling. The surgical procedure is always accompanied by minor tissue injuries.
In order to expose the vas deferens, smaller incisions must also be made in the connective tissue. The body cannot completely heal these smaller injuries and forms scar tissue in these areas. This rarely leads to symptoms and is not a problem.
From time to time, however, the scar tissue can grow. Those affected often feel hard, knotty changes above the testicles. The bulging and hard scars can cause pain by pulling on the connective tissue and by displacing growth.
Normally the scar tissue can be lived with, but in very rare cases the scar tissue has to be split and removed in another operation. A granuloma is an accumulation of benign immune cells that center themselves in an inflammatory reaction at one point and lead to tumor-like growth. During vasectomy, it is mainly sperm that emerge during the procedure that trigger the formation of granulomas (sperm granulomas).
The immune system recognizes the sperm, which leads to an accumulation of immune cells. Similar to excessive scar tissue, granulomas can be conspicuous as hardening on the spermatic cord. Those affected often fear the development of a malignant tumor.
Except for a potential slight pressure pain, however, the granuloma is completely harmless and requires no treatment. The vascular injury of the testicle is a very rare complication of vasectomy. The blood vessels supplying the testicle are relatively large and usually out of danger.
However, if the blood supply to the testicle is damaged and cut off unnoticed, permanent damage to the testicle may occur. In the long term the testicle may shrink and lose its functions. In addition to permanent inability to procreate, this includes the restriction of the testicle’s hormone production. More rarely, cardiovascular problems or erectile dysfunction can occur. As a rule, however, both testicles are not affected, which is why hormone disorders are often compensated for by the adjacent testicle.
