Male Sterilization

(Vasectomy)
Vasectomy

Vasectomy for Men

About vasectomy:
• Works by keeping sperm out of semen. Tubes that carry sperm are
• Simple surgical procedure cut.
• During procedure man stays awake and gets injection to prevent
pain (local anaesthetic).
• Usually can go home in a few hours.
• May hurt for a few days.

• Permanent. For men who • Usually cannot be reversed.

• “Please consider carefully: Might you want more children in future?
will not want more children. What if you could no longer father children?”
• Ask about partner’s preferences or concerns.
• Can also consider female sterilization. Vasectomy is simpler and
safer to perform and slightly more effective.

• Very effective • One of the most effective family planning methods.

• Very safe
• No effect on sexual ability
• No protection against STIs or
HIV/AIDS
Next Move:
“Would you like to know more about vasectomy, or talk about a different method?”
If client wants to know more about
vasectomy, go to next page.
• Not effective immediately. Must use condoms or partner must use
an effective method for 3 months after. “Would this be difficult?”
• Check for concerns, rumours:
“What have you heard about vasectomy?”
Explain common myths:
• NOT castration. Can still have erections. Can still ejaculate.
• Does NOT affect masculinity. Does NOT make men more feminine.
• For STI/HIV/AIDS protection, also use condoms.
To discuss another method, go to a new
method tab or to Choosing Method tab.
V1
 Procedure
• Through a small incision (conventional) or alternatively
through a puncture (no-scalpel) in the scrotum, the
lumen of the vas deferens is disrupted to block the
passage of sperm from the testes.
• No-scalpel = less pain / bleeding, faster operation time and
recovery, fewer complications
No-Scalpel Method
Sharp, curved hemostat
Rigged clamp
Occluded by thermos cautery
Shave!
Antiseptic!
Anesthesia Vasal Nerve Block
Vas is stripped from its
sheath and artery
VIDEO
 Indications
• For males who do not wish to have children, or any more
children, but who wish to have sexual intercourse.
 Contraindications
• Local infection
• Coagulation disorders
• Inability to palpate and elevate both vasa
• Marked stress from a recent event, such as divorce or
financial setback (relative)
• Lack of adequate informed consent
 Advantages
• Safer than tubal sterilization because it is less invasive
and is performed with local analgesia.
• female tubal sterilization has a 20-fold increased complication
rate, a 10- to 37-fold failure rate, and costs three times as much.
 Disadvantages
• Sterilization following vasectomy is not immediate.
• Spermatozoa normally mature in the vas deferens for
around 70 days before ejaculation  sterility cannot be
assumed until ejaculates are found to be completely
free of sperm (3 months or 20 ejaculations) (Obstetrics
Williams)
• Post-vasectomy semen analysis should be performed before
unprotected intercourse.
 What happens after inside?
• Although sperm production continues in the testes, sperm
can no longer reach the exterior. (Tortora)
• The sperm degenerate and are destroyed by phagocytosis.
• Because the blood vessels are not cut, testosterone levels
in the blood remain normal  vasectomy has no effect on
sexual desire or performance.
 Complications
• Wound hematomas = most common, self-limited
• Troublesome scrotal pain may develop = “post-vasectomy pain syndrome”.
• Increased incidence of testicular cancer = lack of evidence.
• Occasional and unlikely spontaneous recanalization (1%), the occasional
development of a spermatocele, epididymitis, and the possible
development of antisperm antibodies.
• Recanalization = vas deferens manages to “grow back”  if the re-grown channel is
still smaller  still infertile
• Atrophy of the testes may result if the vasculature is inadvertently ligated.
 Failure rates
• The failure rate for vasectomy during the first year is 9.4
per 1000 procedures but only 11.4 per 1000 at 2, 3, and 5
years.
• Failures result from:
• unprotected intercourse too soon after ligation,
• incomplete occlusion of the vas deferens,
• or recanalization
 Restoration of fertility
• Vas deferens reanastomosis is a difficult and meticulous
procedure that is costly and has only a 50% success rate.
• With reversal, results are superior using microsurgical
techniques.
 References
• Benson Pernolls Handbook of Obstetrics Gynecology
• Obstetrics Illustrated (7th edition)
• Obstetrics and Gynecology at a Glance 4th edition
• Williams Obstetrics, 23rd edition (2009)
• Anatomy & Physiology Tortora