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Vasectomy

When I walk into an exam room for a vasectomy consult, I'm usually met by a man with the anxiety level of 15 on a 1 to 10 scale.  Typically, his blood pressure is slightly high and he's sitting there sweating just a little.  And why wouldn't he be nervous! It's not like he has any experience having this procedure before to gauge anything, and sometimes his friends/family members haven't given him anything to be at ease about.  All the horror stories come out... but we start talking and by the time it's over, he's not as scared.

I use a no scalpel technique that originated in China in the 1974 and then was brought back to the USA.  I learned this technique in residency starting 2001 and have been doing vasectomies ever since.  There are benefits doing a vasectomy this way - less pain, bruising, bleeding risks and faster recovery time.  Sounds perfect!  I ALWAYS do a consultation visit first, with an exam, to be sure all questions are answered and that the vas are easily palpated on each side so that the procedure is easy - for both my patient and me.  It's also a good time to let guys know that every month they should be doing a self testicular exam.  Be mindful, and make sure you don't feel any lumps or bumps on the testicles themselves.  Most look at me with big, wide eyes and aren't aware they should be checking for anything!  There are blips of higher rates of testicular cancer in ages 20-40's and then again 60-80's.  So don't forget to check yourself every month!

The day of the procedure, please eat and drink water! We start an IV to deliver anti-anxiety medication and another medicine that prevents the blood pressure drop that can happen with the anti-anxiety medicine.  Like I tell everyone, I am NOT the adrenaline junkie in my family.  The next steps are to use a surgical soap to clean the area and then drape the area to make a sterile field.  Then, I numb up an area on the front side of the scrotum thru which I do everything else.  That's the most uncomfortable part - the first shot.  I put more numbing medicine on either side by each vas deferens and then I perform the procedure.  

How long does it take me to do the procedure?  Usually it takes me about 30 minutes to do a vasectomy.  I schedule 1.5hrs for the procedure, because we start the IV, I make sure you don't have any other questions, you get the medication, I set all my instruments up, make sure you're not anxious any more, drape everything, and THEN get started.  There's no need to rush, so I just set aside a good amount of time.  

How do I separate the vas deferens?  I use three ways to interrupt the delievery of sperm.  I cut the vas.  I cauterize one end.  And then I put that cauterized end into the sheath of tissue surrounding the vas and use a surgical clip to close it in there, away from the other end that is still outside of the sheath.  This way, I hope to minimize a process called recanulization (a continued path for sperm in the vas via small channels in the healing tissue).

What's the recovery time?  I ask everyone to take it easy for 2-3 days afterwards.  Go from the couch to the kitchen, couch to the bathroom, etc. No heavy lifting (>20 pounds) for a week.  I recommend that men who have strenuous jobs (delivery, construction, etc) to not work or only perform light duty desk work for a week.  Those that have desk jobs or just a bit of walking around, can go back to work 2-3 days after the procedure.  So I typically do this on a Friday afternoon, and you can go back on Monday.  

How much pain is there?  Typically there is not a lot of pain.  I do give a back up prescription for a few pain pills, but most men only need Tylenol or Advil.  And ice... use ice many times a day for the first few days!  There is a low risk of infection or inflammation of either the testicle or epididymis, so if you aren't improving day by day, then you need to let me know.  

Will the pain stay forever? You can find reports of men that have chronic pain after a vasectomy.  In my experience, no one has reported this to me.  It is not typical to have continued pain.

Will sex be different after a vasectomy?  Nope.  There is nothing I am doing to sexual function.  That includes testosterone levels - having a vasectomy will not lower testosterone levels.  Whatever your function is before your vasectomy, love it or hate it, that will be your function after your vasectomy.  You'll wait 1 week before resuming intercourse and there may be a little blood in the ejaculate the first couple of times - DON'T WORRY - it's normal and will go away.

When can you stop using other methods of birth control?  Three months after your procedure, you should bring a specimen into the office and I will look under the microscope for sperm.  I will tell you then if you can stop using other birth control.  The highest rate of failure is in those first 3 months - so consider yourself fertile until I tell you otherwise.  After these first 3 months, the failure rate drops to 0.3%.  

Any other long term risks involved? Not really.  There is no increased risk of testicular cancer.  There is not evidence that having a vasectomy causes prostate cancer.  

Hopefully this has answered a lot of questions and cleared up any confusion.  If you'd like to set up your consultation, please call the office.  I'll go through this information, and much more, at your appointment time.  

Author
Dr. Raye-Anne Ayo

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