Vasectomy

Vasectomy is an operation designed to sterilise a man. This permanent form of contraception involves cutting and blocking off the tubes in the groin that carry sperm from the testicles to the penis

Anatomy

Sperm are produced by the testicles, which are located in the scrotum. Once produced, the sperm exit the testicle through the epididymis where they mature. The tail of the epididymis drains into the vas deferens which is incorporated within the spermatic cord and travels through the inguinal region into the retroperitoneal space.

The vas eventually empties into the ejaculatory duct within the prostate, along with the seminal vesicles. At orgasm, semen is produced and is made up of sperm and fluid from the prostate and seminal vesicles. Volume wise, the sperm represent a small portion of the seminal fluid, and after vasectomy there is no noticeable decrease in the volume of the ejaculation. Sperm are still produced in the testicle after vasectomy, however they can no longer pass through the vas deferens since it has been divided with vasectomy. The sperm die within the testicle and are reabsorbed.

Vasectomy

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Preoperative Counselling

Patients need to understand that vasectomy is a rather permanent procedure, although we do have reversal techniques such as vasovasostomy. With a vasovasostomy, the ends of the vas deferens are reconnected-usually with the aid of a microscope. This is a much more involved and costly procedure, so patients should be sure of their decision before proceeding with vasectomy.

Vasectomy is obviously the best choice for permanent birth control. The chances of pregnancy after having a vasectomy are around one in 1,000. However, it can take some time for the existing sperm to clear after a vasectomy. It is important to use another form of contraception until tests show zero sperm in the ejaculate. This usually takes three to four months but can occasionally be up to six months.


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The operation

Usually, the operation is performed using local anaesthetic, although some men prefer a general anaesthetic. The testicles are shaved. A small cut is made on either side of the scrotum and the surgeon then loops out each vas deferens. A small piece from each vas deferens is then removed and both end tied and the lumen is sealed with heat using a diathermy machine.

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After the operation

The scrotum will most likely be bruised and tender after the operation. It is important to rest for a couple of days and avoid running, swimming or any other physical activity. Sex can be resumed after about a week.

If the testicles become swollen or painful, or if the wound sites start to weep, there may be an infection. Treatment options include antibiotics and dressings.