Considering a vasectomy or vasectomy reversal? What you should know

A vasectomy is one of the most effective forms of birth control for men, and in the U.S. approximately 500,000 men a year get one. Should you?

That’s a question only you can answer, but if you’re thinking about it or talking it over with your partner, you likely have questions: What’s it really like? Does a vasectomy increase my risk of developing prostate cancer? What if I change my mind about having children later on — can the procedure be reversed? (Hint: In many cases, it can.)

Mark Anderson, MD — a board-certified urologist at MultiCare with specialized training in microsurgery and vasectomy reversals — answers those questions and more.

What is a vasectomy and how does it prevent pregnancy?

A vasectomy is a minor surgery that prevents men from being able to make someone pregnant. While it is possible to reverse the procedure — more about that later on — a vasectomy is only something you should consider if you are looking for a permanent way to prevent pregnancy.

So how does it work exactly? There are two tubes, known as the vas deferens, that carry sperm from the testicles to the prostate, which connects to the tube inside the penis called the urethra. During a vasectomy, the vas deferens are cut and closed off so that sperm can’t exit the body during ejaculation. Instead, the sperm eventually hit the closed end of the tube, disintegrate and are reabsorbed.

“Some men wonder whether a vasectomy affects their ability to produce testosterone,” Dr. Anderson says. “It doesn’t, because testosterone is released through your testicle’s blood vessels, not the vas deferens. A vasectomy is a low-risk procedure that has no bearing on your ability to produce hormones, have an erection, ejaculate or urinate. Vasectomies also do not increase your risk of getting prostate cancer. The only thing that changes after a vasectomy is that there will no longer be sperm in your semen, preventing pregnancy.”

What happens during and after a vasectomy?

There are two ways to perform a vasectomy. Both are done in an outpatient setting, such as a provider’s office or clinic, and both take about 20 minutes.

“The traditional way to perform a vasectomy is to make a small incision in the scrotum, the sac that holds the testicles,” Dr. Anderson says. “The second method — sometimes referred to as the no-scalpel vasectomy — involves using forceps to puncture the skin instead of an incision. There isn’t really much of a difference between the two methods in terms of effectiveness or recovery.”

Regardless of which method you choose, a vasectomy is typically covered by health insurance, but it’s best to confirm with your individual insurer ahead of time.

In addition to insurance coverage, another pressing question for most men is: Does it hurt?

“I often tell people that getting a vasectomy is in the same ballpark as undergoing a dental procedure, in the sense that you walk in, we give you a local anesthetic — an injection that numbs you but doesn’t put you to sleep — we perform the procedure and then you walk out the same day,” Dr. Anderson says. “The numbing medication stings a little, but within a few seconds you shouldn’t feel any pain.”

After a vasectomy, there may be some mild swelling, bruising and soreness in the groin area, so it’s a good idea to take it easy for a few days. Most men resume full activities, including sexual intercourse, within one to two weeks. However, it’s important to continue to use an additional birth control method for about three months after the procedure.

“It’s normal for some sperm to remain in the vas deferens after a vasectomy, and they are cleared out through ejaculation. At about the three-month mark, we’ll check the sperm count to ensure it’s at zero,” Dr. Anderson says.

What about vasectomy reversals?

It is possible to reverse a vasectomy, which means undoing the procedure by reconnecting the vas deferens. Most men who choose to undergo a vasectomy reversal do so because of a change in life circumstances, such as having a new partner and deciding to have more children. In rare cases, a reversal is performed to alleviate pain in the scrotum after a vasectomy.

“Scrotal or testicle pain is a very rare complication that can occur after a vasectomy,” Dr. Anderson says. “Of the hundreds of vasectomy reversals I’ve performed, less than five have been done to relieve scrotal pain.”

A reversal differs from a vasectomy in a few ways. Rather than being a minor outpatient procedure, a reversal is performed under general anesthesia in the operating room. The recovery period is longer, about two to three weeks before full activities can resume, and the procedure is not typically covered by insurance.

Most of the time, a vasectomy reversal can be successfully performed, but a successful surgery doesn’t guarantee a pregnancy will follow.

“One reason is that about eight to 10 years after a vasectomy, sperm production tends to take a dive,” Dr. Anderson says. “So even if we successfully reconnect the vas deferens, a man’s sperm count may be on the low side. Plus, there may be other issues at play, such as a partner’s age and fertility. The pregnancy rate after a vasectomy reversal is around 50 percent.”

How can I get a vasectomy or a vasectomy reversal?

Dr. Anderson is one of the few urologists in the Puget Sound region who performs vasectomy reversals. To learn more about this procedure, contact MultiCare Urology Puyallup for a consultation.