Vasectomy is the cutting of the vas deferens of the male with the aim of permanent infertility. The main reason for the procedure is the patient’s desire for contraception without the aid of other aids or medications. Vasectomy rarely leads to complications and is usually much less risky than female sterilization.
What is vasectomy?
A vasectomy is the cutting of a man’s vas deferens with the goal of permanent infertility. In a broader sense, vasectomy in medicine refers to the surgical removal of a vessel from the body. The narrow term vasectomy (or equivalently vasoresection) denotes male sterilization as a method of permanent contraception. Today, the procedure is part of the standard repertoire in urology. Under local anesthesia or while the patient is in twilight sleep, the doctor cuts the vas deferens in the scrotum. In the classic vasectomy, the skin of the scrotum is opened with the help of a scalpel, but there is an alternative to this type of surgery: the skin can be pierced with a needle and the resulting hole carefully stretched to reach the vas deferens, which are then exposed with the help of special clamps. The advantage of the classic method is the good visual control over the entire surgical field. The needle method only punctures the skin, so it usually heals on its own and in many cases a shorter regeneration process can be expected. With exceptions where there is a medical indication, vasectomy is one of the patient’s elective services that is not reimbursed by health insurance companies and therefore must be billed privately.
Function, effect and goals
The main use of vasectomy is the patient’s desire for permanent sterilization and the associated consequence of avoiding pregnancy during sexual intercourse without additional contraceptive measures such as condoms. Men often undergo the procedure for their partner as well: if family planning is complete or no children are planned for other reasons, male sterilization is a solution often performed if the woman would like to avoid taking hormones. The safety of contraceptive measures is quantified with the so-called Pearl Index, which indicates the number of unwanted pregnancies that occurred despite contraception in 1000 couples within one year. At 0.1, sterilization has the second-best value of all possible contraceptive methods after the female hormone implant, which is why this operation is often the ideal solution for couples who do not wish to have children. For many couples, safety also influences sexual intercourse, which can be particularly carefree – without additional contraceptives and, above all, without fear of possible pregnancy. This safety of male sterilization comes from the complete severing of the vas deferens. This blocks the sperm‘s natural path to the ejaculate, so that fertilization is no longer possible. To make sure that the operation was really 100 percent successful, the ejaculate is examined for sperm about two to three months after the vasectomy. Until this time, the men, whose hormone production is not changed by the operation, are advised to use contraceptive measures during sexual intercourse. The operation is one of the routine urological procedures. It is usually performed on an outpatient basis, either with local anesthesia of the genital region or with twilight sleep. The incisions (in classic vasectomy) are made either in pairs on the right and left or as a central incision. A small piece – about one to three centimeters – is removed from the vas deferens to make it impossible for sperm to pass through. These are reabsorbed by the body instead. The remaining two ends of each vas deferens can either be sclerosed, or they are folded over and sutured with a thread that cannot dissolve on its own.
Risks, side effects and dangers
The risks of vasectomy are very low – especially compared to female sterilization, which can be fraught with more common complications. During the procedure and afterwards, there may be pain, which is usually mild and can be well controlled with medication.In up to eight percent of cases, post-vasectomy pain is observed in the area of the epididymis, for which irritation of nerves or unnatural pressure on the epididymis is assumed. Other possible, but rather rare complications are the development of hematomas and the formation of infections in the surgical area. On the other hand, side effects with regard to the fears often expressed by men, such as lack of libido, reduction of erectile function, as well as inability to experience orgasm, are unfounded. The professionally performed vasectomy has no influence on any of these processes, so that lovemaking is unrestricted and – due to the no longer necessary contraceptive methods such as the pill and condom – even often much more relaxed. Since hormonal production is also not affected by the vasectomy, a renewed check for sperm in the ejaculate (due to possible recanalization of the vas deferens) is necessary at the latest one year after the procedure. However, this is very rarely the case. The continued sperm production is also the reason why – which is often sought with a new partnership – a refertilization, i.e. the reversal of the operation realized by means of microsurgery, has a good chance of success. The chances of successful refertilization and thus pregnancy of the partner are particularly high if the procedure is performed in the first five years after vasectomy.
