Contraception: male sterilisation (vasectomy)
What is male sterilisation?
Male sterilisation, or vasectomy, is a form of surgical contraception that involves cutting and tying the 2 tubes (each called a vas deferens) that carry sperm from the testes (testicles) to the penis. Vasectomy provides permanent contraception.
In Australia, about 15,000 men have vasectomies every year. About one-quarter of Australian men older than 40 years have had a vasectomy.
How does vasectomy work?
A vasectomy works by preventing sperm from entering the seminal fluid (semen).
The absence of sperm in the semen (ejaculate) means that pregnancy cannot occur. The sperm, which are still produced by the testicles but can’t travel along each of the cut vas deferens, are reabsorbed by the body.
Sperm makes up only 2-5 per cent of ejaculated fluid, so having a vasectomy will not noticeably affect the amount of seminal fluid (which is produced in the seminal vesicles and prostate) that is ejaculated. Ejaculation will also feel the same as before having the vasectomy.
How effective is male sterilisation?
Male sterilisation is greater than 99 per cent effective at preventing pregnancy.
Vasectomy has a very small failure rate – about 1 in 700 to 1000 couples have a pregnancy after vasectomy, almost always in the first year after the procedure.
How is a vasectomy done?
Vasectomy is a minor surgical procedure that can be carried out under local anaesthetic by specially trained general practitioners (GPs), urologists (specialists in male reproductive organs and urinary tract) or general surgeons. You may need to get a referral from your local doctor or Family Planning Clinic.
The procedure is usually done as a day procedure in a clinic, hospital or at your doctor’s surgery.
In a conventional vasectomy, the surgeon makes a tiny incision on each side of the scrotum (or a single incision in the middle), and then cuts both vas deferentia, sometimes removing a small segment. The ends of the vas deferens are then tied or sealed, and the skin of the scrotum is closed with a stitch. The procedure takes less than 30 minutes.
A newer vasectomy technique – called no-scalpel vasectomy– uses a special instrument to access each vas deferens, which is pulled through a tiny opening made in the scrotum. As with conventional vasectomy, the vas deferens is then cut and tied or sealed, but no stitches are needed in the skin of the scrotum. This newer technique is thought to be less painful and associated with fewer complications that conventional vasectomy.
It takes about 2-3 months (or 16-20 ejaculations) for all sperm to be cleared from each vas deferens. Three months after the operation, the man should give a semen sample which is tested to see if sperm are still present. Tests are repeated every few weeks until there are no sperm detected. Another method of contraception should be used until semen analysis confirms the absence of sperm.
Can I change my mind after having a vasectomy?
Male sterilisation should be regarded as a permanent form of contraception, as it can be difficult to reverse the surgical procedure. However, a vasectomy reversal procedure can be performed, which involves microsurgery to re-join the ends of the vas deferens.
Couples where the man has had a vasectomy reversal have a success rate of pregnancy of about 50-70 per cent. The chances of a successful vasectomy reversal are higher the more recently the vasectomy was performed. An alternative to vasectomy reversal is a sperm extraction procedure followed by in-vitro fertilisation (IVF).
What are the advantages of male sterilisation?
Some of the advantages of male sterilisation are that:
- it is reliable and permanent;
- it does not interfere with erection, sexual potency, hormone production or ejaculation;
- it does not interfere with spontaneity of sex; and
- it is a quick and simple procedure.
What are the disadvantages of male sterilisation?
Some of the disadvantages of male sterilisation include the following.
- It is not effective immediately, and may take 2-3 months (or 16-20 ejaculations) before all sperm have been cleared from each vas deferens.
- There may be short-term discomfort such as pain, bruising or swelling following the procedure.
- There may be complications such as bleeding, infection or an inflammatory reaction to sperm leakage.
- In very rare cases, the ends of the vas deferens may re-connect and the man may become fertile again. In these cases, the vasectomy operation can be repeated.
- It can be difficult to reverse – men considering having a vasectomy should feel sure that they do not want to father any children in the future, even if their personal circumstances change. While vasectomy reversal is possible, this procedure is not always successful in restoring fertility.
Also, remember that vasectomy does not protect you from sexually-transmissible infections (STIs). To help protect yourself from STIs, you should also use condoms.
Side effects and complications of male sterilisation
There may be some discomfort or mild pain for a few days following the procedure. In some cases, there may be minor bruising or swelling of the scrotum.
You may notice a small amount of blood in your semen the first couple of times you ejaculate after having a vasectomy. See your doctor if you are concerned or if the bleeding persists.
As with most types of surgery, there is a small risk of infection or bleeding/bruising associated with having a vasectomy.
Sperm antibodies can develop following a vasectomy, where the immune system produces antibodies to its own sperm. This may possibly affect pregnancy rates following vasectomy reversals.
Very rarely, ongoing discomfort or testicular pain can affect some men. This may need further treatment with medicines or surgery.
Self-care after a vasectomy
You can manage any short-term pain or discomfort with painkillers (such as paracetamol) and gentle application of ice packs. Wearing supportive underwear may also help relieve some discomfort after the procedure.
A day or 2 of rest is usually recommended after having a vasectomy. Exercise, strenuous activities and heavy lifting should be avoided for 7 days after the procedure. All activities, including sexual activity can usually be resumed after a week. Remember to use an alternative form of contraception until your doctor has confirmed from a sample that your semen no longer contains sperm.
2. Family Planning NSW. Sterilisation (updated May 2013). https://www.fpnsw.org.au/health-information/contraception/sterilisation (accessed Sep 2016).