Vasectomy is effective at preventing pregnancy, though it is only the fourth most common form of birth control used in the United States, behind condoms, oral contraceptives, and tubal ligation. A vasectomy is faster, safer, cheaper, and just as effective as tubal ligation with fewer complications, however, yet it remains less popular.
Sperm is produced in the testicles. From there, it travels to the epididymis, a coiled tube that connects to the vas deferens. Sperm mature and gain motility as they travel through the epididymis. The vas deferens propels the sperm through the urethra, where it joins with other glandular fluid for ejaculation as semen. During a vasectomy, the vas deferens is divided, partially removed, scarred, or clipped so that the tube closes.
There are two types of vasectomy. In a conventional vasectomy, the doctor makes small incisions on either side of the scrotum to reach the vas deferens. In a no-scalpel vasectomy, the doctor makes a small incision in the skin and gently stretches the opening to reach the vas deferens. The no-scalpal method heals faster and leaves little scarring.
Vasectomy is considered permanent, though about 0.24 percent of men require a second surgery. A man is not considered sterile until a semen analysis shows that it contains no sperm or only rare non-motile sperm. Although negative semen analysis is an indication of sterility, the risk of pregnancy is still one in 2000 after a successful vasectomy.
A man can resume normal sexual activity soon after the procedure, but doctors recommend using another form of birth control. Sperm may stay in the vas deferens for months after surgery, and the only way to be sure that the man is sterile is to test the semen. Sterility is usually confirmed about three months after surgery.
Although vasectomy is considered permanent, reversal is possible. About six percent of all men who get a vasectomy eventually want it reversed. There are many reasons for this. Often, it is because they have a new partner and have changed their minds about wanting children. Or, sometimes, a couple decides that they do want more children after all. Vasectomy reversal reopens the vas deferens so that sperm can once again travel through it.
Vasectomy is an elective procedure that causes male sterility. Although vasectomy reversal is possible, it is not always successful, especially if it has been several years since the initial procedure. Vasectomy has significant ramifications, and men are encouraged to communicate with their partners when deciding whether to have one.
After a vasectomy, there are fertility options other than reversal. Sperm retrieval and in vitro fertilization is possible as the testicles still produce sperm, but this can be expensive and is not always successful. Before choosing vasectomy, couples should consider the reproductive status of the female. If her chances of getting pregnant are low, then the need for a vasectomy is reduced.
There are no contraindications to having a vasectomy. That said, there are more concerns about vasectomies performed in the doctor's office than in an operating room. These can arise if the doctor has difficulty isolating the vas deferens during the evaluation exam or if the patient has had previous testicular surgery or malignancy. Some physicians also have ethical concerns about performing the procedure on young men who have no children or who have a partner who is currently pregnant or does not agree with the decision.
Vasectomy is a safe procedure, but it does have some risks. Some men have an inflammatory reaction called sperm granuloma that can cause a tender lump to form under the skin. The testicles and surrounding area may become sore or tender. While this usually resolves within the first year after surgery, it lasts much longer for some men. Rarely, the vas deferens grows back, which can result in an unplanned pregnancy.
Vasectomy is an outpatient procedure, which means men can return home right afterward. Men are to rest the day of surgery and to avoid any strenuous activity or heavy lifting. Most men can go back to work within one to three days and return to normal activity in a week. Regular sexual activity can resume about a week after surgery, but remember that the couple should use an additional form of birth control for a few months.
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