Is Vasectomy Right for You?

By Beth Levine
Medically Reviewed by Robert Jasmer, MD

These answers to 9 common vasectomy questions will help you know if you are a good candidate.

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There is a lot of misinformation out there about vasectomies, a surgical procedure to ensure male sterility or provide male contraception. Some men fear it will worsen sexual performance and prevent ejaculation, or that a reversal later on down the line will be easy-peasy.

If you are considering whether a vasectomy is right for you, here top experts answer nine questions about the reality of the procedure:

1. When is a vasectomy the right choice?
This should be considered permanent birth control, so only go for it when you (and your partner) are sure you are done growing your family. “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; others say, if you're a younger childless male, you really shouldn't do it, even though you feel pretty confident you don't want kids. However, I believe that any adult male who has the ability to make his own healthcare decisions can make a decision about contraception. It’s a completely personal call,” says Sarah Vij, MD, a urologist with the Cleveland Clinic in Avon, Ohio.

2. Doesn’t it make more sense for my partner to deal with birth control? She is the one who might get pregnant.
People often see contraception as the female’s problem, but that can often entail being on birth control pills or having an intrauterine device (IUD). “We always say that a vasectomy is almost like 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 Puneet Masson, MD, the director of male reproductive medicine and surgery at University of Pennsylvania Medicine in Philadelphia.

3. Is a vasectomy 100 percent effective?
No birth control is totally fail-proof. “However, the failure rate, depending on the study you look at is about 1 to 2 in 1000. 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 before all the sperm 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. 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 need to continue using birth control — until he's had confirmation from his doctor that he’s had clearance,” says Vij.

5. I get so squeamish just hearing about the old snip-snip, I can’t even think about it. Does it hurt?
This is a minimally invasive procedure, done on a same-day outpatient basis and takes about 20 minutes. Vasectomies entail cutting tubes called the vas deferens, located inside the scrotum. This prevents sperm from being released into the semen. There are two types — 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 after that; discomfort can be managed with complete rest, nonsteroidal anti-inflammatory drugs (NSAIDS), and an ice pack. (Fun fact: Surgeons have started referring to the NCAA March Madness basketball tournament as Vas Madness, because they have noticed that so many men elect to have their vasectomies right before the championship so they chill on the couch with their pack of ice and watch a lot of TV.)

6. What are the risks?
The complication rate is less than 1 percent for risk of bleeding, infection, inflammation, or ongoing pain, says Dr. Masson. He adds that there is a 1 in 2000 chance of recanalization, whereby the tubes reconnect, making the man fertile.

7. Will a vasectomy affect my sexual performance? Will sex feel different?
“It doesn’t impact sexual functioning at all. 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,” explains Masson.

8. If I change my mind later, can a vasectomy be reversed?
Yes, it can, but it is a much more complicated procedure, necessitating a surgeon who is experienced with microsurgery. This is generally not covered by insurance, making it prohibitively expensive for many. Also, while success rates are high, they are not 100 percent.

9. Is there any other way to hedge my bets?
Patients who are interested in returning potency after a vasectomy can choose to undergo surgical sperm extraction. The pros: It's a lot faster than a reversal (about 20 minutes), and can be done as an outpatient procedures. The cons: “These sperms can only be used in context with in vitro fertilization to achieve effect. 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.

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