Ligation of the vas deferens after completed family planning (vasectomy)

If family planning has definitely been completed, vasectomy is a simple, permanent and, above all, reliable method of permanent contraception.

Vasectomy is a purely mechanical ligation of the vasa deferentia so that fertile sperm can no longer enter the ejaculate. Vasectomy therefore has no influence whatsoever on the production of the male sex hormone. For this reason, no change in sexual desire (libido), erection or orgasm sensation is to be expected. Nevertheless, in individual cases, changes in masculinity can occur in both a positive and a negative direction. The underlying causes have not yet been clearly explained.

First, local anaesthesia is administered on both sides in the upper part of the scrotum. The vasa deferentia, which are about as thick as spaghetti, are exposed via two small skin incisions. The vas deferens is ligated above and below. The segment of the vas deferens lying between the ligatures (approx. 1 cm) is removed. The free ends of the vas deferens are additionally cauterised by electrocoagulation. The skin is then closed with self-dissolving sutures.

Before the operation, only a physical examination is required, and in individual cases an ultrasound examination if there have been previous operations.

The procedure is performed on an outpatient basis. The ejaculate is examined at monthly intervals in order to rule out the presence of fertile sperm that had already entered the seminal ducts before the vasectomy. Complete contraception is only achieved when no sperm at all can be detected twice at monthly intervals. Until then, additional contraceptive measures must be taken.

Vasectomy is fundamentally an irreversible procedure, although in individual cases a microsurgical refertilisation operation can be performed if there is a renewed wish to have children. However, there is no certainty that fertility will be restored. In individual cases, testicular pain can occur after vasectomy (so-called post-vasectomy syndrome). This is a rare complication that should be avoided as far as possible during the operation through extremely careful dissection of the vas deferens. Individual cases of spontaneous rejoining of the vasa deferentia have been described in the scientific literature. This risk is extremely low with proper surgical technique (ligation of the vas deferens above and below, additional cauterisation of the ends of the vas deferens by electrocoagulation, resection of an approx. 1 cm long section of the vas deferens). Changes in erectile function and sexual sensation are occasionally observed after vasectomy. These can involve an improvement but also a deterioration in erectile function and sexual sensations. The general risks of any operation (risk of bleeding, inflammation and injury) are very rare with a vasectomy.

If, in individual cases, there is a renewed wish to have children, a vasectomy can be reversed by an experienced urologist. In this case, the vasa deferentia are reconnected microsurgically. This procedure is called vasovasostomy. However, the operation is quite complex and not always successful. For this reason, a vasectomy should be carefully considered.