What a urologist wants men to know about vasectomies

CNN

5 days ago

As a urologist, I've performed countless vasectomies. They are my profession's bread and butter. When I'm not doing the procedure, I'm seeing men either alone or with their partners to discuss its safety, simplicity and effectiveness. Like many men, I've found myself contemplating whether it's time to get one, too.
Maybe it's the recent US Supreme Court decisions on reproduction prompting more men to actively consider their role in birth control. Or perhaps it's part of a larger cultural shift toward shared family-planning responsibility. Then again, as a urologist who sees a growing number of men seeking vasectomy consultations, I'm more attuned to how common this conversation has become.
An estimated 500,000 men in the US choose vasectomies as a form of contraception every year. And if you are like me and considering a vasectomy — or if you're just curious about this procedure as a form of birth control — here are the top things you should know.
A vasectomy is typically a minor office-based procedure that requires minimal preparation. You can eat the day of the procedure, wear your T-shirt and shorts, and try to be relaxed. (If you choose to have the vasectomy done in an operating room, more preparation may be needed.) Once you're in the doctor's office, it takes 10 to 20 minutes to perform.
After numbing the scrotal skin with a local anesthetic, the urologist makes a small opening in the skin, often so small that no stitches or scalpels are needed. From there, the doctor will find the vas deferens — the tube that carries sperm (made in the testicle) from a tightly coiled duct called the epididymis to the urethra prior to ejaculation. The vas deferens feels a bit like a piece of cooked spaghetti.
The tube is brought out through the small opening, cut, sealed or blocked, preventing sperm from mixing with semen. The procedure is done on both sides, on both vas deferens, in a similar fashion. The cut ends are placed back into the scrotum, and the openings may be sealed with skin glue. Then you can go home and rest.
Expect some soreness in the scrotum and surrounding areas. I advise patients to rest for one or two days, wear supportive underwear, and apply an ice pack to the scrotum for about 20 minutes every hour. For pain or discomfort, I suggest taking over-the-counter ibuprofen or acetaminophen if needed. Avoid heavy lifting or strenuous exercise for about one to two weeks, or however long your doctor recommends.
Post-vasectomy complications are rare but possible and include minor bruising, swelling and temporary discomfort around the area where the procedure was done. Though uncommon, infections can occur and are typically resolved quickly with antibiotics if caught early. Around 1% to 2% of men can experience chronic post-vasectomy pain, which usually improves over time but in rare cases may persist and require further treatment.
An important point to remember is that you won't be sterile immediately. It typically takes several weeks — and around 30 ejaculations — to clear out your remaining sperm. Your urologist will confirm your sterility with a semen analysis, which can be done at a lab or using new at-home testing kits. Until you're officially cleared, though, continue to use another form of contraception — it takes only one sperm to achieve pregnancy, so making sure you are sterile is vital.
I've heard all the myths about vasectomies, so I want to share the answers to some of the most common questions men ask me during our consultations.
Many men worry that after a vasectomy they will have lower testosterone levels, sex drive or sexual function. Not true. In fact, many couples report increased sexual activity and satisfaction after a vasectomy since they no longer have to worry about pregnancy. You will still have an ejaculate — almost the same volume and sensation — but now you'll be 'shooting blanks,' since your semen no longer contains sperm.
Despite what you've heard, March Madness isn't the only good time for a vasectomy. Many men choose to recover while binge-watching football or even their favorite show. The truth is, you can safely book the procedure whenever it fits your schedule.
Some men assume vasectomies are expensive or not covered by insurance, but most insurance plans fully or partially cover the procedure. Even if you're paying out-of-pocket, the cost is often less than $1,000, though prices can range from $500 to $3,000 depending on your location and whether you opt for anesthesia. It's worth shopping around, but always choose a qualified urologist who is board-certified and experienced in performing vasectomies — your safety is never worth compromising just to save a few dollars. But let's face it: Compared with the monthly cost of diapers alone (about $100 per month until your child is potty-trained), a vasectomy is a financial win.
Though it's less common, I'm seeing more men without children choosing to get a vasectomy. Why? Often it's a firm lifestyle decision, because of concerns over passing certain genetic conditions, or simply being absolutely sure that fatherhood is not in their future. During our consultation, we openly discuss the motivations for making this decision, and I review the pros and cons. One big con is the permanent nature of the procedure. Yes, vasectomy reversals exist — and I do them myself for patients — but I don't advise undergoing a vasectomy assuming it's temporary. Reversal procedures are expensive and not always successful. If you're not sure whether you want children, pause and seriously reconsider the decision. Ultimately, it remains your personal choice.
Men who need birth control can use condoms or avoid sex altogether. There is also research on male birth-control pills, injections and 'switches,' which could be a long time away from being offered to men.
For women, there are birth-control pills, intrauterine devices (IUDs), implants, injections, patches, vaginal rings and tubal ligation.
Each of these methods has its own pros, cons and effectiveness rates, so a detailed discussion with your health care provider and partner can help you make the best choice.
Deciding on a vasectomy isn't easy. I should know, because I'm right there with you. My advice is don't rush it. Talk with your partner, ask your doctor all the questions you have during your consultation and think through what this means for your future. Whatever decision you make, though, make sure it feels right for you.
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