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When we talk about birth control, we often think of women. But, while there are far more contraceptive options for women, men do have the option of one of the most effective: vasectomies.
Read on as consultant urologist, Dr Elon Thompson gives us the rundown on this male contraceptive method!
What is a vasectomy?
A vasectomy is a form of male birth control that cuts the supply of sperm to the semenial fluid. It is considered to be a permanent form of birth control, similar to tubal ligation in women.
Sperm vs Semen
Though the two are sometimes used interchangeably, sperm and semen are not the same thing.
Sperm is the male reproductive cell made by the testes and stored in the epididymis (a tube attached to each testicle). On the other hand, semen is the male reproductive fluid, created by both the prostate and seminal vesicles.
For the rest of this article, we will use 'seminal fluid', when referring to 'semen with no sperm' and 'semen' when referring to 'semen with sperm'.
What happens during ejaculation?
During ejaculation, mature sperm is expelled from the testes through a muscular tube called the vas deferens, while seminal fluid is expelled from the vesicles. They combine when they enter the ejaculatory duct, creating semen, then travel together through the urethra and out of the penis.
So how do vasectomies work?
Vasectomies work by cutting or sealing the vas deferens preventing sperm from reaching the ejaculatory duct and mixing with seminal fluid. The body will continue to produce sperm, but “the sperms are reabsorbed by the body a few weeks after vasectomy,” says Dr Thompson.
The ability to produce semen, get and maintain an erection and ejaculate are also unaffected.
What happens when you get a vasectomy?
“Vasectomies are usually a day case procedure,” explains Dr Thompson, meaning the procedure can be done and the patient discharged on the same day.
First, anaesthesia is required. “This can be local anaesthesia in the office or sedation with local anaesthesia or general anaesthesia in the operating room, depending on patient preference.”
While traditional vasectomies are performed with a scalpel, most vasectomies today are performed using the no-scalpel method. After locating the vas deferens under the skin, a specially designed tool is used to create and widen a small puncture in the scrotum. The vas deferens are then carefully extracted to be cut and tied off or cauterized. Once this is completed, the vas deferens are retracted through the puncture, which closes without the need for stitches.
What are the risks?
While the no-scalpel method carries fewer risks than the traditional method, like all surgical procedures, some risks remain. “Scrotal swelling can occur from a collection of blood or fluid in the scrotum,” explains Dr Thompson. “Infections can also happen.”
Another critical element to consider is that vasectomies should be considered to be permanent. “Reversal is possible but not in our local setting,” Dr Thompson notes. “Further, the results for reversal are variable and not very encouraging.”
It is therefore important for men to be counselled prior to the procedure and certain they want to proceed. “Vasectomies are discouraged in younger men who have no children, as they may change their minds in the future.”
Effectiveness of Vasectomies
With an efficacy rate of over 99%, “vasectomies are very effective when a man has satisfied fecundity or fertility,” explains consultant urologist, Dr Elon Thompson.
Effectiveness, however, is not instantaneous. “There may still be sperm circulating (at the vasectomy site),” says Dr Thompson. Until that sperm is reabsorbed by or leaves the body, pregnancy can still occur. As such, Dr Thompson notes, “it’s best to just wait until after three months (to stop using contraception).”
While rare, vasectomies can fail, “If the duct recanalizes then sperm can get into the ejaculate (seminal fluid),” says Dr Thompson, but this is rare. "The majority of patients will have no sperm in their semen by 12 weeks after vasectomy.”
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