Male Sterilisation

Sexual & Reproductive Health

 

What is male sterilisation (vasectomy)?
The surgical procedure is known as vasectomy and may be performed under local or general anaesthetic.

How does a vasectomy work?
One or two incisions are performed on each side of the scrotum so that the vas deferens may be located. By cutting the vas deferens sperm is unable to be ejaculated and a man will become infertile once the vas deferens is clear of sperm, which takes about 3 months. Therefore, alternative contraception will be required for about 3 months following the procedure. Once two consecutive negative sperm counts have been obtained, the use of another form of contraception may cease.

How effective is a vasectomy?
A vasectomy is a highly effective form of contraception. Its immediate failure rate is 1 in 1000; the late failure rate is between 1 in 3000 and 1 in 7000. Although very rare, vasectomies can fail, which is thought to be due to re-canalisation of the vas deferens.

How is a vasectomy carried out?
A vasectomy involves cutting the vas deferens, which is the tube that transports sperm from the epididymis in the testes to the seminal vesicles.
There are two types of vasectomy:

  • A conventional vasectomy using a scalpel
  • A no-scalpel vasectomy (ligature)

 

 

Conventional vasectomy

  • Your medical practitioner cuts 2 small incisions with a scalpel in both sides of your scrotum to reach the tubes which carry the sperm – the vas deferens.
  • Each tube is cut and a small section is removed. The ends of the tubes are then closed, either by tying or sealing them.
  • The cuts are stitched with a dissolvable stitch.

No scalpel vasectomy

  • Your medical practitioner makes tiny puncture holes in your scrotum to reach the tubes.
  • This way, he can feel each of your vas deferens under your scrotum and either cut or clamp to hold it in place.
  • No stitches are needed in this procedure.

Before the operation
A vasectomy requires counselling, preferably with both partners, as this is a decision which will permanently affect both parties. As this is a permanent method of contraception, the couple should be sure of their decision, and aware that this is very difficult to reverse. Reversal of a vasectomy is easier than reversal of female sterilisation. During counselling, couples are often asked to consider certain scenarios, e.g. how they would feel if their partner died, would they want to have children with someone else? Or if one of the children died, would they want to have more? If they have not had children, is there a likelihood they will change their mind? Sometimes couples have not considered major life events and their effects, and during counselling decide to delay such a permanent decision.

After the operation

  • Post-operation: It is common to have some mild discomfort, swelling, and bruising of your scrotum after the vasectomy. Some blood in your semen may also be present in the first few ejaculations. You can wear tight-fitting underwear for support during the day and night at first.
  • Work and activities: Full recovery will be attained within a week from the procedure, during which the person will be instructed to take things gently and avoid heavy lifting, strenuous exercise, and sexual intercourse.
  • Hygiene: Your medical practitioner will guide you when it is safe to have a bath or shower after your operation.
  • Having sex: You can have sex again as soon as you feel comfortable. You must use additional contraception for the next 8 to 12 weeks. This is important as some of the semen will remain in your vas deferens (tubes). Persons are often concerned about their ability to maintain erections and have sexual intercourse following a vasectomy. Some men see a vasectomy as similar to castration, and become anxious that their ability to function as a man will be impaired. However, a vasectomy does not affect libido, erections, or orgasm, and the ejaculate will look the same - it will however no longer contain sperm.
  • Psychological effect and relationship: After undergoing a vasectomy, some people may experience signs of grief over their loss of fertility and perceived loss of sexuality. This will depend on how the man feels about his decision; if he feels forced or coerced into the decision then he may feel anger and sadness over his loss. On the other hand, some men see a vasectomy as their opportunity to do something, especially after their partner has had children. This can enhance their relationship and bring them closer, reducing anxiety over further pregnancy.

Other medical considerations post-operation

  • Rising temperature, pain or swelling because of infection
  • Haematoma and bruising from internal bleeding
  • Pain and swelling if sperm leaks into surrounding tissue (sperm granuloma)


Is a vasectomy reversible?
Reversing a vasectomy is not easy and does not always work. Before going into this procedure, it is important to understand that you may not be able to reverse it, and you may therefore never be able to have children in the future.

Who can go for a vasectomy?
Most men can do a vasectomy. However, this may not be suitable for you if have or had:

  • Serious physical disability
  • Urological problems
  • Relationship problems
  • Indecision by either partner


What are the advantages?

  • Highly effective at preventing pregnancy
  • Removal of anxiety of unplanned pregnancy
  • Safe and simple procedure
  • It does not affect your hormones, sex drive, or interfere with sex


What are the disadvantages?

  • Alternative contraception is required until two consecutive clear sperm counts are obtained
  • A minor surgical procedure is required
  • Local or general anaesthesia is required
  • Not easily reversible
  • Does not protect you from STIs
  • Very rarely, the vas deferens tubes can reconnect


What are the risks?

  • Swelling
  • Bruising
  • Bleeding inside the scrotum
  • Blood in the semen
  • Infection
  • Rarely, fluid build-up in the testicle, chronic pain
  • Pregnancy – in the very uncommon event that a vasectomy heals, your sexual partner may be at risk of getting pregnant if no additional contraception is used


How often should I go for a check-up?
Your medical practitioner will give you guidance on your next appointment.

However, do not wait for the next appointment if you:

  • think you may be pregnant
  • could have an STI or HIV/AIDS
  • feel severe pain in lower abdomen
  • experience excessive bleeding


If I had a vasectomy, am I protected from Sexually Transmitted Infections?
No, only male and female condoms (when used correctly and consistently) protect you from STIs.