Male sterilisation (vasectomy)
Introduction
You have decided to have a vasectomy. There are different ways to prevent an unwanted pregnancy (e.g. the contraceptive pill, condoms, the IUD). The primary difference between these methods and vasectomy is that the latter must be considered as a permanent contraceptive method, i.e. sterilisation is irreversible in principle. Sterilisation is therefore only a good choice if you are certain that you do not want any (more) children.
By blocking the vasa deferentia, the sperm cells are prevented from reaching the seminal fluid before discharge. Sterilisation is a simple operation and does not affect your sex life. Sterilisation is a safe form of contraception.
Preparation
You should take the day of the operation off work. The operation must be performed under sterile conditions to prevent infection. Therefore, it is necessary to shave the scrotum completely before the operation. You should do this the evening before the operation.It is not necessary for you to fast before the operation. If you are taking a blood-thinning agent e.g. Ascal (Carbasalaatcalcium), Persantin (Dipyridamol) Plavix/Iscover (Clopidogrel) or Aspirine (Acetylsalicylzuur), you should stop taking this medicine 2 weeks before surgery, in consultation with the doctor concerned.
If you use Sintrom/Sintromitis (Acenocoumarol) or Marcoumar (Fenprocoumon) for which you are being monitored by the Thrombosis Department, your urologist may prefer to operate under general anaesthetic in the operating theatre.
Take along tightly fitting underwear or swimming trunks to wear after the operation, which you will have to keep on for at least 24 hours after the operation. You are advised against driving a car immediately after the operation; we recommend that you arrange for other transport home.
Information
In the Urology Outpatients' Department at Bronovo Hospital (1st floor), you will first be given an informative talk by one of our nurses. During this talk, the following topics will be discussed:
- the permanent nature of the operation;
- the operation itself;
- the procedure after the operation;
- the possible complications;
- completing and signing the questionnaire
Operation
The vasectomy is performed under local anaesthetic in the Outpatients’ Department. After disinfection of the scrotum, the doctor will move the sperm ducts to one side directly under the skin with his fingers. There a local anaesthetic will be injected. After this, the doctor will make a small incision in the anaesthetised skin whereby a small portion of the sperm ducts will be isolated. The sperm duct will be cut through and a short piece will be removed and the cut ends tied off. The same procedure is subsequently carried out on the other side.
The incision is then closed with quick-dissolving stitches, that dissolve after about one week and therefore do not have to be removed. The urologist may also decide to access both vasa deferentia via an incision in the middle of the scrotum.
During the operation, you may possibly experience a painful twinge in the region of the groin, because the vas deferens runs through the inguinal canal.The operation takes about 10 minutes.
After surgery After the operation, the wounds will be covered with a plaster.
We advise you to wear tight-fitting underwear or swimming trunks.
To prevent bleeding, it is best to take it easy for the rest of the day. You may shower again after one day; having a bath is permitted after five days. Once the anaesthetic has worn off, the scrotum and groin region may feel sensitive. You can take a painkiller for this (e.g. paracetamol).
In general, you can go back to work the the day after the operation. During the first few days after the operation, you should avoid doing heavy work. We advise you to refrain from cycling, doing sports, swimming or lifting heavy loads for about five days. After five days you can have sex again.
Fertility You will still be fertile after the operation as some sperm cells are still released into the seminal fluid in the first few months after the operation. Therefore, in this period, you must continue to use some form of contraception.
After at least 15 - 20 ejaculations, which you should have within three months after the operation, most of the sperm cells will have disappeared. After this period a sperm sample will be examined. This test is essential to establish infertility. You will be given a small receptacle that you should return with a sperm sample. This sample must be submitted within two hours after ejaculation. Please telephone the secretariat of the Urology Outpatients' Clinic for the results.
If the sperm sample cannot lead to a natural pregnancy according to international norms, you will be informed accordingly and you can stop using contraceptives.It is possible that you might have to submit a sperm sample several times, until the results show that no more sperm cells are present.
Complications A slight bluish discoloration of the scrotum and/or the base of the penis often occurs. Some oozing of blood or fluid from the incisions is normal and generally stops quite soon of its own accord.
Further bleeding or wound infection rarely develop. Pain after surgery occurs frequently and is associated with a bruised feeling in the testicles or pain while walking. This usually persists for only a few days.
You must contact your doctor if you become feverish (temperature above 38.5˚C), if the scrotum becomes very swollen, the wound continues to bleed or if you are in a lot of pain.
A sensation of “damming up” can also occur after sterilisation; this can lead to painful sensations preceding ejaculation, but this is rare and usually temporary.
Spermagranuloom formation
Before an operation on the sperm ducts, there has never been any contact in your body between seminal fluid and the immune system. Due to the operation, this can occur for a short time at the site of the operation. Your body may react with excessive scar formation that can cause a sensitive swelling in the scrotum. Sometimes this has to be surgically removed to alleviate the discomfort.
Hydrocéle formation Both sperm ducts are suspended in the scrotum, each with a separate space containing several millilitres of fluid. This protects the testicles against external forces. Following sterilisation, a sterile or bacterial infection may occur. As a result of this infection, the amount of fluid around the testicles may increase. This is visible/noticeable as a unilateral swelling of the scrotum. Sometimes surgical correction is the best solution.
Painful testicles
3-6% of men develop chronic sensitivity in the testicles.
What you also need to know After sterilisation there is a small chance that the cut ends of the sperm ducts can grow together and form a passage again resulting in fertility. This can happen almost immediately after the operation.
If tests on your sperm samples following sterilisation show that they do not comply with sterilisation norms, it may alas be necessary (no sooner than one year after the operation) to consider a re-sterilisation. However, male sterilisation does remain the most reliable form of contraceptive.
Theoretically speaking, vasectomy is a permanent intervention. If the occasion should arise, a sterilisation may be reversed. The chance of spontaneous pregnancy occurring after surgically re-suturing the ends of the sperm ducts together is 50%, provided this is done within 5 years of sterilisation.
The operation does not affect the mechanism or the sensation of ejaculation. After sterilisation, the sperm cells still produced in the testicles are broken down by the body.
If you examine a sperm sample with the naked eye, you cannot see whether someone has been sterilised or not. After sterilisation, the sample mainly consists of prostate fluid.
Deciding which of the partners is going to be sterilised is a personal choice. The advantage of vasectomy is that it is a relatively simple operation (does not enter the abdominal cavity) that can be conducted in an Outpatients’ Department under local anaesthesia. Vasectomy does not provide any protection whatsoever from sexually transmitted diseases (e.g. AIDS, gonorrhoea or syphilis). To reduce this possibility, it is always advisable to use a condom.
What should you do if you are ill or unable to come for the operation?
If you are not able to keep your appointment due to illness or some other hindrance, please contact the Urology Outpatients' Department as soon as possible. Another patient can be attended to in your place.
FinallyThis brochure contains general information and is intended to supplement your discussion with the doctor in attendance or the nurse practitioner. Special circumstances can lead to changes in this information.
Telephone number Urologie ‘Outpatients Department: 070 – 312 41 33 (Monday/Friday from 08.00 - 13.00 hours).