Introduction

For reproduction to occur, sperm must leave the body and unite with another person's egg, which involves several stages. Firstly, as puberty begins, sperm are produced and develop in the testis, which is a structure located within the scrotum, behind the penis and in front of the anus. From the testis, sperm move through tubules to the epididymis, a crescent-shaped structure which is attached to the testis, where they will structurally develop further and are stored. During ejaculation, as a result of muscular contractions, sperm are propelled from the epididymis to a long tube called the vas deferens, also known as the ductus deferens.¹

From here, sperm move through the spermatic cord to the ejaculatory duct, where they mix with a clear sugar-containing that is released from the seminal vesicle. This mixture moves from the ejaculatory duct, passing through the prostate, thickening as it travels through the region, creating semen. Semen will move through the urethra, a tube which allows it to exit the body through the penis and enter the vagina where it can go on to unite with an egg.² Some of those assigned male at birth may decide that they would no longer like to retain their reproductive ability and, therefore, may undergo a vasectomy, a surgical procedure, that prevents the flow of sperm through the vas deferens, thus preventing the reproduction process and pregnancy from occurring.³

Indications for a vasectomy

A vasectomy is indicated for patients assigned male at birth, who feel certain that they do not want to have more children. Patients should only undergo a vasectomy if they feel convinced that this decision is suitable for them. Furthermore, this procedure is for patients who want to halt their reproductive abilities permanently, as opposed to temporarily.³

Preparation for a vasectomy

Before a vasectomy takes place, you will have a consultation with a physician, who will delve into your medical history. Here, the physician may ask about conditions you have been diagnosed with, medications that you have taken, past procedures you have undergone, your sexual history, experience with pregnancy, and social habits. There will be a focus on questions related to conditions of the genitals and urinary system. This consultation is also an opportunity for you to ask any questions you may have about having a vasectomy.³

Following a medical history, a physical examination will take place. Said physical examination will focus on the genital region. The physician will look for any abnormalities, such as hernias, varicoceles, spermatoceles, masses in the testes, and tenderness of the testes. Before the vasectomy is performed, a discussion will take place where the physician will emphasise the risks and benefits of undergoing the procedure and request your consent to undergo a vasectomy.³

The procedure of a vasectomy

During a vasectomy, a patient may be offered a narration of the procedure but can choose silence instead, or listen to something else, such as music. The procedure typically begins with the scrotum being shaved and then washed with an antimicrobial wash. Following this, an anaesthetic will be injected into the scrotal region to prevent any pain during the procedure.^3,4 

The skin overlying the scrotum is then cut open and the vas deferens is isolated. The sheath that surrounds the vas deferens is then opened, so that, the vas deferens can be cut, and subsequently, removed. Said procedure is then repeated on the opposite side. Surgical wounds get covered with an antibiotic ointment and gauze. This surgery takes about 20 minutes to perform. After the procedure is completed, you may have to stay in the hospital for a short period so you can be monitored for any potential bleeding or swelling of the scrotum.^3,4

Care following a vasectomy

Pain management

You may experience some pain following undergoing a vasectomy. Several strategies can help minimise this pain. Holding ice over the scrotal region can help. Wearing supportive undergarments can also help to reduce discomfort. Medication can be taken, with paracetamol and ibuprofen being helpful medicines for relieving the pain. If said medications do not alleviate the pain, your physician may prescribe stronger medication.³

Lifestyle changes

For a short period following a vasectomy, you may have to make some lifestyle changes. For around three to five days, you should abstain from intensive physical activity, including aggressive sexual activity. Though you can shower immediately after a vasectomy, the scrotum should not be submerged in water, such as in baths or swimming pools, for five to seven days.³

Semen analysis

A semen analysis, also referred to as a sperm count, will often be done approximately three months after a vasectomy is performed to confirm that the procedure has been successful. For a semen analysis to take place, you will be asked to ejaculate in a container. This semen sample will then be sent to a laboratory to be analysed with a microscope.³ 

The vasectomy will typically be deemed as successful if the semen analysis finds that there are less than 100,000 sperm per millilitre of semen. If the amount of sperm in semen exceeds said amount, then a repeat semen analysis will be done, within six months of the vasectomy being performed. If said semen analysis still shows that there is an excessive presence of sperm in the semen, then a repeat vasectomy would need to be performed. Though, this occurs in a small minority of cases, 0.24 percent of cases specifically.³

Complications of a vasectomy

Nausea and lightheadedness

Some patients may experience nausea, and lightheadedness, as a vasectomy is taking place. However, these typically subside once the vasectomy has been completed.³

Bleeding, pain, and swelling of the scrotum

You may experience some bleeding, pain, and swelling of the scrotum after a vasectomy. However, this typically lasts about two days and then begins to improve. About one percent of patients will experience pain for longer.^3,5

Hematomas and infection

Hematomas appear as bruises, and they are a result of a blood vessel being broken during surgery. Most hematomas resolve by themselves. About one to two percent of people having a vasectomy will experience a hematoma or infection following doing so.^3,5

Unsuccessful procedures

A vasectomy is successful in halting reproductive abilities and preventing pregnancy in the vast majority of cases. However, 0.24 percent of those who undergo a vasectomy require a repeat of the procedure. Furthermore, the risk of pregnancy occurring is one in 2000 for those with a negative semen analysis.^3,5

FAQs

Is a vasectomy permanent?

A vasectomy is considered to be a permanent method of halting reproductive abilities and preventing pregnancy. However, a vasectomy reversal can be performed to undo the outcomes of a vasectomy.³

How long does a vasectomy take to perform?

A vasectomy takes about 20 minutes to perform. However, you may need to stay in the hospital a little while longer after the procedure is completed so a physician can check for complications, such as bleeding or swelling of the scrotum.^3,4

Is a vasectomy painful?

Anaesthetic is used during a vasectomy to ensure you do not experience pain. However, you may experience some pain after the procedure, which typically subsides within a couple of days, though medication can be used to help manage it. About one percent of patients will experience pain for longer durations.³

When can I resume sexual activity following a vasectomy?

You can resume sexual activity as soon as you feel ready to do so following a vasectomy. However, aggressive sexual activity should be abstained from for three to five days after the procedure. A semen analysis must be used to confirm whether a vasectomy has been successful around three months after a vasectomy, so using contraception during this period is advisable.³

What is the success rate of a vasectomy reversal?

A vasectomy reversal is successful in about 85 to 90 percent of cases. But it is important to highlight that after the reversal of the procedure, in circa 60 percent of the cases, the couples get pregnant.⁵ 

Summary

A vasectomy is a surgical procedure that prevents the flow of sperm through the vas deferens, thus, preventing the reproduction process and pregnancy from occurring. This surgery is indicated for those assigned male at birth who want to permanently halt their reproductive abilities. Before a vasectomy takes place, you will have to see a physician, who will delve into your medical history, perform a physical examination, and explain the risks and benefits of the procedure. 

Furthermore, after a vasectomy takes place, certain measures will need to be taken, such as pain management, short-term lifestyle changes, and a semen analysis. Sometimes, vasectomies can lead to complications, including nausea, lightheadedness, bleeding, swelling of the scrotum, hematomas, and infection. Vasectomies are usually successful, but a small minority of patients, about 0.24 per cent, will require a repeat of the procedure.