Vasectomy

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

A vasectomy is a purely mechanical interruption of the vas deferens preventing sperm from entering the ejaculate. Therefore, a vasectomy has no influence on the production of the male sex hormone. There are no expected changes in sexual desire (libido), erections, and feeling of orgasm. Nevertheless, in individual cases positive or negative changes in masculinity may occur. The underlying causes for this are not yet clearly understood.

First, a local anaesthetic is applied on both sides of the upper part of the scrotum. Two small incisions are made in the skin to expose the vas deferens, which have a similar thickness to a spaghetti. The vas deferens is tied on both the bottom and the top. The segment of the vas deferens lying between the knots (approx. 1 cm long) is removed. The free ends of the vas deferens are forced to coagulate using electrocoagulation. The skin is then closed with self-dissolving sutures.

Before the procedure, only a physical examination is required. In individual cases where there have been previous surgeries, an ultrasound examination may also be necessary.

The procedure is performed on an outpatient basis. The ejaculate is examined at monthly intervals to rule out the presence of fertile sperm that entered the seminal ducts prior to the vasectomy. Full contraception is only present when no sperm can be detected twice in a month. Until that time, additional contraceptive measures should be taken to avoid a pregnancy.

A vasectomy is basically an irreversible intervention, although in individual cases a microsurgical refertilisation procedure can be performed if the patient wishes to have children after sterilisation. However, there is no certainty that fertility will be restored. In individual cases, a vasectomy may cause pain in the testicles (known as post-vasectomy syndrome). This is a rare complication which can be avoided as much as possible during the procedure by careful preparation of the vas deferens. Scientific literature has described individual cases of spontaneous coalescence of the vas deferens. This risk is extremely low if the surgical technique is correct (ligation of the vas deferens at the top and bottom, additional coagulation of the ends of the vas deferens through electrocoagulation, resection of an approx. 1 cm long part of the vas deferens). Positive and negative changes in erectile function and sexual sensation are occasionally observed following a vasectomy. The general risks of any operation, such as risk of bleeding, inflammation, or injury, are very rare for a vasectomy.

If in individual cases the patient would like to have children, a vasectomy can be reversed by an experienced urologist. In this case, microsurgery is used to reconnect the vas deferens. This procedure is known as a vasovasostomy. However, the operation is very complex and not always successful. A vasectomy should always be carefully considered as it is not easily reversable.