As reversing a vasectomy is possible but not easy, speaking with your partner (if you have one) and your physician or urologist is vital to make sure it’s right for you. Here’s what to consider.
1. When Is a Vasectomy the Right Choice?
Performed about 500,000 times per year in the United States, according to the American Urological Association, vasectomies should be considered permanent birth control.
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You should only choose one when you (and your partner) are sure that your family has reached the size you’re both comfortable with.
“This is really a personal decision, and one you shouldn’t just jump into. Some people say it’s not a good time to do it if you have a newborn because you’re sleep-deprived and you may later regret it,” says Sarah Vij, MD, a urologist with Cleveland Clinic in Avon, Ohio. “Others say that if you’re a younger childless male, you really shouldn’t do it, even if you feel pretty confident you don’t want kids. But I believe that any adult male who has the ability to make his own healthcare decisions can make a decision about contraception.”
2. Doesn’t It Make More Sense for My Partner to Deal With Birth Control, Since She Is the One Who Might Get Pregnant?
People often see contraception as the woman’s problem, but for a woman, effective birth control often entails birth control pills or an intrauterine device. “We always say that a vasectomy is an act of love. It’s wonderful to see so many men taking responsibility for the reproductive health of themselves and their families, and not asking their partner to bear the total burden,” says Dr. Masson.
The equivalent of a vasectomy for women is tubal ligation, or “getting your tubes tied.” In comparison, vasectomies are safer, simpler, more effective, and less expensive, and they are an outpatient procedure.
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3. Is a Vasectomy 100 Percent Effective?
Keep in mind when family planning that no birth control is totally fail-proof. “The failure rate, depending on the study you look at, is about 1 to 2 in 1,000. That’s over 99 percent effective, which is pretty comparable or exceeds pretty much all forms of birth control that we have,” says Dr. Vij.
4. Am I Sterile Immediately Following the Procedure?
No, a man has to ejaculate after the procedure in order for the sperm to clear, and the rate at which different patients clear varies tremendously. “Some guys might clear all the sperm in three ejaculations, and some might still be fertile after 30 or 40 ejaculations,” Vij explains. “I generally have patients get a semen test at three months, because the great majority of men will have cleared by then. A man should not consider himself sterile — and needs to continue using birth control — until he’s had confirmation from his doctor that he’s had clearance.”
5. I Get Squeamish Just Hearing About It. Does a Vasectomy Hurt?
This is a minimally invasive procedure that takes place on a same-day, outpatient basis and lasts about 15 minutes.
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There are two types of procedure — one that uses an incision and one that doesn’t. You will receive local anesthesia and light tranquilizers.
You will be sore in the area for a few days afterward, but the discomfort can be managed with rest, nonsteroidal anti-inflammatory drugs, and an ice pack.
Fun fact: Surgeons have started referring to the NCAA March Madness basketball tournament as Vas Madness, because so many men elect to have their vasectomies right before the tournament, so that they can relax on the couch with their ice pack and watch a lot of TV as they recover.
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6. What Are the Risks of a Vasectomy?
The complication rate is less than 1 percent and includes bleeding, infection, inflammation, or ongoing pain, says Masson. “However, a small percentage of patients may have ongoing pain beyond just the recovery process. Should this happen, it’s important to regroup with your physician who performed the procedure.” He adds there is a 1 in 2,000 chance of recanalization, whereby the tubes reconnect, making the man fertile once again.
The risks of a vasectomy may include:
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- Post-Vasectomy Pain Syndrome This may lead to long-term testicular pain, pain during ejaculation, and psychological distress, and its underlying cause is unclear. It affects between 1 and 2 percent of people after a vasectomy, but it is treatable.
- Sperm Granuloma This is a hard lump that can develop from the leakage of sperm from the snipped vas deferens. Sometimes, it can cause pain. However, the body almost always breaks it down and absorbs sperm granulomas, and they’re not dangerous. Pain relief can help, and compression shorts or jock straps can support the scrotum can reduce reduce symptoms.
- Scrotal Congestion This is a sense of pressure or an uncomfortable feeling in the testicles, the epididymis (the tube behind each testicle that stores and carries sperm), or the lower vas deferens. Scrotal congestion may develop between 2 and 12 weeks following a vasectomy, but it usually gets better over time.
7. Will a Vasectomy Affect My Sexual Performance? Will Sex Feel Different?
“It doesn’t impact sexual functioning at all,” Masson says. “Erections are going to be completely unaffected, and you will still have orgasms and ejaculations. The reason behind that is that only a small percentage of the ejaculate comes from the testicles. Most of it comes from the prostate and seminal vesicles,” he explains. “Thus, everything will still look and feel the same; just microscopically, there will be no sperm in the semen.”
8. If I Change My Mind Later, Can a Vasectomy Be Reversed?
Yes, it can, but it’s a more complex procedure that requires a surgeon experienced in microsurgery. Insurance may not cover vasectomy reversal, making it prohibitively expensive for many people.
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Also, while success rates are high, they are not 100 percent. The good news for older men is that a study found the same reversal success rate in men over 50 years of age as in younger men.
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9. Is There Any Other Way to Father a Child After a Vasectomy?
Men who are interested in paternity after a vasectomy can choose to undergo surgical sperm extraction. The pros: It’s usually a lot faster than a reversal, and some techniques can take minutes and occur as an outpatient procedure.
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The cons: “These sperms can only be used in context with in vitro fertilization (IVF). It’s never going to be able to swim to or penetrate the egg. Then the partner must undergo the IVF process,” explains Masson. You can also bank sperm before the procedure.
