In June 2022, the United States Supreme Court released its decision to overturn Roe v. Wade, which protected abortion access for women through the second trimester of pregnancy. This decision increased interest in birth control and reproductive health care, including vasectomy procedures.
Google Trends shows that internet searches related to vasectomy procedures surged after the initial leak of the Supreme Court’s decision and its official announcement. Many medical centers have reported increased vasectomy consultation requests.
- Vasectomy Questions to Consider
- What is a vasectomy?
- Types of vasectomies
- Anatomy of a vasectomy procedure
- How long is vasectomy recovery?
- Does having a vasectomy hurt?
- What are the risks involved?
- Are vasectomies reversible?
- How effective is a vasectomy?
- Who should get a vasectomy?
What Is a Vasectomy?
A vasectomy is a surgical form of male birth control which prevents sperm from exiting the body. Sperm are the male reproductive cells produced in the testicles. They travel through several small tubes and organs within the male reproductive system.
During a vasectomy, a doctor will cut and seal one of these tubes, called the vas deferens, permanently blocking the pathway for sperm to exit the body. Currently, vasectomy procedures and condom use are the only two widely available and effective options for male contraception.
Types of Vasectomies
Dr. Philip Werthman, a former assistant clinical professor of urology at the University of Southern California School of Medicine and a men’s health, male fertility, and vasectomy reversal specialist based in Los Angeles explains that the “easiest way” to perform a vasectomy is to block the vas deferens as it runs through the scrotum.
“In a traditional vasectomy,” Werthman says, “they make a cut in the skin to go through all three layers” of the wall of the scrotum. This traditional method of vasectomy can require weeks of recovery.
But there’s an easier, less invasive way to do the same thing, Werthman explains.
Instead of cutting open the scrotum and working on the vas deferens inside of the body, doctors can “bring the vas deferens directly up under the skin.” All that’s necessary is a small puncture hole. “I cut about a quarter to half an inch of the vas out and cauterize the edges. The hole is so small it seals by itself,” explains Werthman.
This way, the procedure’s recovery is much easier. Werthman says only “once in a blue moon” does he have to place a single stitch. He’s been performing vasectomies this way for nearly 27 years at his private practice and clinics like Planned Parenthood.
Anatomy of a Vasectomy Procedure
Werthman wants people to know that “nobody should think that (getting a vasectomy) would affect their manhood or their sexual function.” Getting a vasectomy won’t change someone’s ability to have sex or the way that they ejaculate. About 95% of the volume of the ejaculation will continue through the reproductive system after a vasectomy, but none of that fluid will contain sperm.
To better understand what happens during a vasectomy and how it prevents pregnancy, consider the pathway of sperm cells, the male reproductive cells necessary to create a pregnancy.
Sperm are made inside of the testicles, then travel into a coiled organ called the epididymis, where sperm are stored. Sperm then migrate through the vas deferens, the cut and sealed tube in a vasectomy procedure. Normally, sperm would continue from the vas deferens into a gland called the seminal vesicle and then through the prostate. Still, a vasectomy blocks the tube before it reaches the seminal vesicle.
How Long Is Vasectomy Recovery?
Vasectomies are outpatient procedures, meaning you can expect to leave the doctor’s office the same day.
Dr. Sarah Vij, assistant professor of surgery in the department of urology at the Cleveland Clinic, says that most vasectomy patients can expect to spend the rest of that day and the next day resting, icing, and generally taking it easy. She recommends Tylenol or Advil for any discomfort as needed and says she never gives narcotics for the pain. She tells people, “one week of holding off from any real vigorous activity or sexual activity” is best.
While vasectomy recovery is relatively straightforward, Vij schedules most vasectomies on Fridays “by design, so they have a weekend to recover.” She says, “unless they have a very physical job, they’re back to work Monday.”
Does Having a Vasectomy Hurt?
Dr. Amin Herati, director of male infertility and men’s health and assistant professor of urology at the Johns Hopkins University School of Medicine, says patients often tell him the procedure was “easier than going to the dentist.” Generally, he uses a local anesthetic to numb the area before the procedure and injects lidocaine into the site before the surgery.
Herati also says that a “rare fraction” of his patients request general anesthesia if they have “either significant anxiety or if they pass out when they’re stressed or uncomfortable.”
What Are the Risks Involved?
As with any other surgical procedure, there’s a small risk of infection associated with a vasectomy procedure, but the risk will be lower with the less-invasive approach. Herati advises his patients against shaving their scrotal area before the procedure to decrease the risk of post-surgical infection.
Werthman acknowledges the risk of complication overall is very minimal. In his nearly three decades of experience performing the no-scalpel procedure, the rate of complication for his patients is “between one in 1,000 and one in 2,000.”
Herati also warns that “the rate of chronic scrotal pain after a vasectomy is estimated at 1% to 2%. One question that patients should ask their surgeon if they’re going for consultation is how they can potentially protect against that risk, or what that surgeon specifically does to make that risk as low as possible.”
He says that 80% to 90% of patients with chronic pain eventually have their pain effectively treated, but a very small minority of patients could end up with chronic pain.
Are Vasectomies Reversible?
Yes, you can get a vasectomy reversed. Werthman says his success rate of reversal procedures is about 98%. But there are a few caveats to that rate. He says this success rate “is not a 98% chance of getting pregnant because other issues go into restoring flow in the tube.”
For patients hoping for a reversal 12 to 15 years after their initial vasectomy, that success rate may be reduced if they’ve developed a second blockage or rupture in the tube. In that case, the rupture would have to be repaired or bypassed, and the success rate would fall closer to 60-65%. While Werthman says that patients who have had vasectomies more recently have a better chance of a successful reversal, he also said that sometimes men who have had a vasectomy 20 or more years ago haven’t developed this second blockage.
In a typical vasectomy reversal, a large cut is made in the scrotum, the testicle is removed from the sac, and a doctor will find the two cut ends of the vas deferens and sew them together.
Werthman explains that he can perform a vasectomy reversal by making a smaller cut over the area where the vasectomy scar is. He uses the same instrument used in the original vasectomy to find the loop where the vas deferens was cut. Under a microscope, he cleans the scar and sews the channel together with microstructures.
He warns, though, patients should be careful and research before choosing a reversal center. Because there isn’t a huge need for vasectomy reversal, many doctors don’t have as much experience.
If you’re considering this procedure, research the center and doctor, and don’t be afraid to ask your doctor any questions you have. They will be able to tell you whether they recommend any pre-procedure preparation and answer any questions about how your medical history might affect the surgery or recovery. You can also ask them how long the typical recovery time is, confirm that they accept your insurance, and inquire about follow-up visits.
How Much Does a Vasectomy Cost?
Herati says insurance will often cover a vasectomy procedure. When insurance does not cover it, or a person is uninsured, the cost of a vasectomy procedure is usually around $1,000. One important consideration, though, is the cost of a reversal. Most health insurance companies will not cover the cost of a vasectomy reversal, and Herati says that vasectomy reversal can cost up to $10,000.
How Effective Is a Vasectomy?
Compared to other forms of birth control, vasectomies are highly effective. Birth control pills, when used perfectly, can be up to 99% effective. However, given the difficulty of taking them consistently, their average effectiveness at preventing pregnancy drops to 91%. Vasectomies and condom use are the only currently available male birth control options. However, researchers are presently moving through the clinical trial stages for a promising experimental male contraceptive gel.
Like IUD devices, which are over 99% effective, vasectomies do not require any continued protective action like taking a pill. While anecdotally, there are occasionally stories about men having children after a vasectomy, they are over 99% effective in preventing future pregnancy.
However, it is important to wait to get your sperm count tested after having the procedure to confirm that you no longer have sperm in your ejaculation. At his office, Werthman will test a patient’s ejaculation for sperm at least twice to be sure they’re entirely infertile. Typically, Werthman says, it takes somewhere between six weeks and three months for someone to be sure that all of their sperm has been flushed out.
Who Should Get a Vasectomy?
According to Vij, a vasectomy is a “really good form of birth control for a man who does not want to father any more children. We need to do a better job of making people know that it’s a good option.” While “historically, people felt uncomfortable doing a vasectomy on men with no kids,” in her opinion, “if a patient wants sterilization, they should have that option as long as they know what they’re doing to their body.”
Other methods of birth control fall primarily on women, and Vij notes that “a lot of the contraception discussion in our society tends to occur with women.” Many women are asked about birth control at their gynecologist or postpartum doctors visits, and “there’s not really an equivalent for a 28-year-old male.”
Overall, it’s essential to have an open and honest conversation with your doctor and understand that vasectomies are only recommended for men who do not want to be able to have biological children.
For those who do not want children and have had a conversation with their doctor about the procedure, the risks are relatively minimal, and the procedure itself is effective.
