Vasectomy

A vasectomy (pronounced va-SEK-tuh-mee) is a surgical procedure performed as a method of birth control in men. It involves cutting the tubes (the vas deferens, pronounced VAS DEF-uh-renz) that carry sperm from the testicles.

Only about 15 of every 10,000 couples get pregnant in the year after the man has a vasectomy.1

As part of a program of research on the safety and effectiveness of male contraceptives, the NICHD supports studies and other activities advancing understanding of vasectomy.

Common Name

  • Vasectomy

Medical or Scientific Name

  • Vasectomy

Citations

  1. American Pregnancy Association. (2003). Overview: Birth control. Retrieved May 23, 2012, from http://americanpregnancy.org/preventing-pregnancy/birth-control-failure/ External Web Site Policy.

Vasectomy: Condition Information

A vasectomy is a surgical procedure performed as a method of birth control. It involves cutting the vas deferens (pronounced VAS DEF-uh-renz) in order to close off the tubes that carry sperm from the testicles (there is one vas deferens per testicle). If a man has a successful vasectomy, he can no longer get a woman pregnant.1

Sperm are made in the two testicles, which are inside the scrotum. Sperm is stored in a tube attached to each testicle called the epididymis (pronounced ep-i-DID-uh-mis). When a man ejaculates, the sperm travel from the epididymis, through the vas deferens, and then mix with seminal fluid to form semen. The semen then travels through the urethra (pronounced yoo-REE-thruh) and out the penis. 

Before a vasectomy, semen contains sperm and seminal fluid. After a vasectomy, sperm are no longer in the semen.2 The man's testicles will make less sperm over time, and his body will harmlessly absorb any sperm that are made.3

Citations

  1. MedlinePlus. (2010). Vasectomy. Retrieved May 22, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm
  2. American Urological Association Foundation. (2011). Vasectomy. Retrieved May 22, 2012, from https://www.urologyhealth.org/educational-materials/vasectomy External Web Site Policy
  3. FamilyDoctor.org. (2010). Vasectomy: What to expect. Retrieved May 22, 2012, from http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html External Web Site Policy

How is a vasectomy done?

A vasectomy is usually performed in the office of urologist, a doctor who specializes in the male urinary tract and reproductive system. In some cases, the urologist may decide to do a vasectomy in an outpatient surgery center or a hospital. This could be because of patient anxiety or because other procedures will be done at the same time.1

There are two ways to perform a vasectomy. In either case, the patient is awake during the procedure, but the urologist uses a local anesthetic to numb the scrotum.

With the conventional method, the doctor makes one or two small cuts in the scrotum to access the vas deferens. A small section of the vas deferens is cut out and then removed. The urologist may cauterize (seal with heat) the ends and then tie the ends with stitches. The doctor will then perform the same procedure on the other testicle, either through the same opening or through a second scrotal incision. For both testicles, when the vas deferens has been tied off, the doctor will use a few stitches or skin "glue" to close the opening(s) in the scrotum.

With the "no-scalpel" method, a small puncture hole is made on one side of the scrotum. The health care provider will find the vas deferens under the skin and pull it through the hole. The vas deferens is then cut and a small section is removed. The ends are either cauterized or tied off and then put back in place. The procedure is then performed on the other testicle. No stitches are needed with this method because the puncture holes are so small.2,3

After a vasectomy, most men go home the same day and fully recover in less than a week. 

Citations

  1. American Urological Association Foundation. (2011). Vasectomy. Retrieved May 22, 2012, from https://www.urologyhealth.org/educational-materials/vasectomy External Web Site Policy
  2. FamilyDoctor.org. (2010). Vasectomy: What to expect. Retrieved May 22, 2012, from http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html External Web Site Policy
  3. MedlinePlus. (2010). Vasectomy. Retrieved May 22, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm

How effective is vasectomy?

Vasectomy is one of the most effective forms of birth control. In the first year after a man has a vasectomy, a few couples will still get pregnant. But the number is far lower than the rates of pregnancy among couples using condoms or oral contraceptive pills.1

However, a vasectomy is not effective right away. Men still need to use other birth control until the remaining sperm are cleared out of the semen. This takes 15 to 20 ejaculations, or about 3 months. Even then, 1 of every 5 men will still have sperm in his semen and will need to wait longer for the sperm to clear.2

A health care provider will check a man's semen for sperm at least once after the surgery. Once the sperm count has dropped to zero, it is safe to assume that the vasectomy is now an effective form of birth control.2,3 Until that time, men need to use another form of birth control to make sure their partner does not become pregnant.

Citations

  1. American Pregnancy Association. (2003). Overview: Birth control. Retrieved May 23, 2012, from http://americanpregnancy.org/preventing-pregnancy/birth-control-failure/ External Web Site Policy
  2. Urology Care Foundation. (2011). Vasectomy. Retrieved May 22, 2012, from https://www.urologyhealth.org/educational-materials/vasectomy External Web Site Policy
  3. U.S. Centers for Disease Control and Prevention. (2012). Reproductive health: Contraception. Retrieved May 22, 2012, from http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm

What are the risks of vasectomy?

Although vasectomy is safe and highly effective, men should be aware of problems that could occur after surgery and over time.1

Surgical Risks

After surgery, most men have discomfort, bruising, and some swelling, all of which usually go away within 2 weeks. Problems that can occur after surgery and need to be checked by a health care provider include:

  • Hematoma. Bleeding under the skin that can lead to painful swelling.
  • Infection. Fever and scrotal redness and tenderness are signs of infection.2

Other Risks

The risk of other problems is small, but they do occur. These include:

  • A lump in the scrotum, called a granuloma. This is formed from sperm that leak out of the vas deferens into the tissue.3
  • This is called postvasectomy pain syndrome and occurs in some men.4
  • Vasectomy failure. There is a small risk that the vasectomy will fail. This can lead to unintended pregnancy. Among 1,000 vasectomies, 11 will likely fail over 2 years; and half of these failures will occur within the first 3 months after surgery.5 The risk of failure depends on a number of factors. For example, some surgical techniques are more likely to fail than others.6 Additionally, there is a very small risk that the two ends of the vas deferens will grow back together. If this happens, sperm may be able to enter the semen and make pregnancy possible.7
  • Risk of regret. Vasectomy may be a good choice for men and/or couples who are certain that they do not want more or any children. Most men who have vasectomy, as well as spouses of men who have vasectomy, do not regret the decision.5 Men who have vasectomy before age 30 are the group most likely to want a vasectomy reversal in the future.6

Citations

  1. U.S. Centers for Disease Control and Prevention. (2012). Reproductive health: Contraception. Retrieved May 22, 2012, from http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm
  2. American Urological AssociationFoundation. (2011). Vasectomy. Retrieved May 22, 2012, from https://www.urologyhealth.org/educational-materials/vasectomy External Web Site Policy
  3. FamilyDoctor.org. (2010). Vasectomy: What to expect. Retrieved May 22, 2012, from http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html External Web Site Policy
  4. Christiansen, C. G., & Sandlow, J. I. (2003). Testicular pain following vasectomy: A review of postvasectomy pain syndrome. Journal of Andrology, 24, 293-298.
  5. U.S. Centers for Disease Control and Prevention. (2012). Reproductive health: Contraception. Retrieved June 25, 2012, from http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm
  6. Dassow, P., & Bennett, J. M. (2006). Vasectomy: An update. American Family Physician, 74, 2069-2074.
  7. American Academy of Family Physicians. (2010). Vasectomy: What to expect. Retrieved June 25, 2012, from http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html External Web Site Policy

Will vasectomy affect my sex life?

Vasectomy will not affect your sex life. It does not decrease your sex drive because it does not affect the production of the male hormone testosterone. It also does not affect your ability to get an erection or ejaculate semen. Because the sperm make up a very small amount of the semen, you will not notice a difference in the amount of semen you ejaculate.1,2

Citations

  1. American Academy of Family Physicians. (2010). Vasectomy: What to expect. Retrieved June 25, 2012, from http://familydoctor.org/familydoctor/en/prevention-wellness/sex-birth-control/birth-control/vasectomy-what-to-expect.html External Web Site Policy
  2. American Urological Association Foundation. (2011). Vasectomy. Retrieved June 25, 2012, from https://www.urologyhealth.org/educational-materials/vasectomy External Web Site Policy

Vasectomy: NICHD Research Goals

NICHD research efforts on vasectomy fall within the Institute’s broad and long-standing goal of developing safe, effective, easy-to-use, and long-lasting contraceptive methods in order to prevent and reduce unintended pregnancies.

To this end, the NICHD continues to refine, improve, and evaluate vasectomy and other established contraceptive methods. Notably, increasing efforts to develop acceptable male contraceptives beyond the vasectomy and condom is among the NICHD’s scientific goals for reproductive health (PDF - 2 MB). 

Presently, NICHD research activity on male contraception is largely focused on developing new contraceptive methods that employ hormonal and nonhormonal agents as well as on supporting research and development that may lead to new methods for reversibly inhibiting sperm production or function.

Vasectomy: Research Activities and Scientific Advances

The development of effective, safe, and acceptable contraceptive methods for men is an important part of preventing and reducing unintended pregnancies. NICHD invests in male contraceptive research and development, including studies of vasectomy.

Institute Activities and Advances

Most NICHD research on vasectomy is supported through the institute's Contraceptive Research Branch (CRB), formerly the Contraceptive Discovery and Development Branch (CDDB). Branch-supported vasectomy research has focused on the procedure's long-term safety and effectiveness as well as on the development and evaluation of less-invasive surgical techniques. For example:

  • CRB supported a large, national population-based case-control study in response to some studies published in the early 1990s suggesting that vasectomy might increase the risk of prostate cancer. Several other studies found no increased risk of prostate cancer among vasectomized men. Despite this conflicting evidence, urologists had been concerned enough to increase screening for prostate cancer among vasectomized men and to discourage vasectomies in men with a family history of prostate cancer. The results of the branch-supported national case-control study, published in 2002 in the Journal of the American Medical Association, were considered definitive evidence that prostate cancer was not linked with vasectomy1 (PMID: 12069674).
  • CRB provided support through Family Health International for Cochrane Reviews of scalpel versus no-scalpel incision for vasectomy.

Vasectomy research is one piece of CRB’s portfolio in male contraception research and development. In addition, the branch leads the Preclinical Contraceptive Development Program to encourage and support basic, applied, and clinical studies on topics such as mechanisms that regulate sperm maturation and motility and identification of new therapeutic targets for male contraception. A group of scientists also supported by CRB are building on the promising results of their work from 2004, when they demonstrated complete and reversible contraception in male monkeys immunized with Eppin, a protein found only in the testes and epididymis (PMID: 15539605).

Additionally, CRB funds the Biological Testing Facility and Chemical Synthesis Facility through contract mechanisms. These facilities support research on the identification and development of male and female contraceptive agents.

A study supported by the Fertility and Infertility (FI) Branch evaluated the role of epididymal dendritic cells in male reproductive function. The study could have implications for both contraceptive development and treating male infertility (Project number: 1R01HD069623-01).

Other Activities and Advances

NICHD was actively involved in the 2001 and 2003 Expert Consultations on Vasectomy, interagency workshops that included more than 50 experts from 24 organizations, institutions, and universities. The 3-day workshops prioritized future research related to vasectomy techniques and developed guidelines for techniques in diverse health care settings. Attendees reviewed recent clinical research findings and discussed their programmatic implications. Participants also reviewed key steps needed to improve vasectomy services in Africa, Latin America, Asia, and other areas of the world.

Citations

  1. Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2006). New study finds vasectomy does not increase prostate cancer risk. Retrieved May 24, 2012, from http://www.nichd.nih.gov/news/releases/Pages/vasectomy.aspx
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