Frequently asked questions

What is Vasectomy?

Permanent sterilization for men. It is done by cutting the vas deferens tubes between your testicles and your groin, and sealing them either with stitches or heat sealing (cauterization). The procedure is usually done under local anaesthesia. There are several procedure types practiced - see later in this FAQ.

How long has the procedure been around?

Since the late 19th century. The first published study into the effects of ligating the vas deferens was published in London in 1830. It didn't start out as family planning - it started out as a method of controlling unwanted sections of society such as "Delinquents, degenerates, drug habitues and idiots".

The procedure first started to be regularly performed for the purposes of family planning in the USA in the 1940's, and in the majority of the West it came into common use in the late 1960's.

In the 1890's vasectomy was suggested as an alternative to the current practice of castration for an enlarged prostate. In 1918 it was also called "Steinarching", and used to provide a hormone boost that was "proven" to increase intellect and sexual performance. Sigmund Freud and William Butler Yeats were amongst those "Steinarched". It was reported that the closer to the testes the ligation was, the more hormone production was stimulated. It was also used to "Cure" excessive masturbation! For a fuller version click here.

Does it hurt?

Most men report the procedure as "Uncomfortable". The worst part for most is the anaesthetic being administered (about the same as an injection at the dentist) and the hair growing back afterwards itches. More information can be found in our checklist, or in our online survey.

What's the difference between male and female sterilisation?

Vasectomy is usually done under a local anaesthetic, and a tubal ligation is done under a general. Vasectomy is less intrusive, statistically more reliable, and has less long term complications. The Royal College of Obstetricians and Gynaecologists guidelines discuss counselling and performing male and female sterilisation. These are the 2004 guidelines, and you can view the full version (1.16Mb), the summary document or the patient information leaflet.

Another informative paper is available from womenshealth.about.com that discusses the differences.

How popular is vasectomy?

The results vary from country to country. New Zealand seems to have the highest rate of vasectomised men (23%), US/Europe approx 11%, and the lowest is China and India on 7-8%.

The 2002 statistics for the UK state that some 18% of men between 16 and 69 have had a vasectomy, and that proportion has remained similar over time. A further 1% of men had become sterile as a result of another operation. Around 30% of men aged 40-64 have had a vasectomy. 30% of men aged 40-44, 32% of men aged 45-49, 30% of men aged 50-54 and 26% aged 55-64. Only 1% of men aged 16-29 had had a vasectomy. The trend is that men between 40 and 49 were 50% more likely to have a vasectomy than a woman was to have had a tubal ligation.

A recent US national survey found that 12% of married men between 20 and 39 have had a vasectomy, and of this 12%, nearly a quarter are in the 35 to 39 age group. Worldwide some 50 million men have undergone the procedure - this represents about 5% of married couples of reproductive age. More stats

Do men ever regret having had it done?

The satisfaction with the procedure is generally high. The chief causes of regret are:- The results of an ill-considered decision (often due to making the decision under pressure), Changes in circumstances some years later (such as the death of a child or remarriage), and "Post vasectomy pain syndrome" (PVP). It's worth adding that satisfaction rates are highest amongst men who were the ones who suggested vasectomy first. Our online survey has more on this.

What procedures are available?

The most widely performed procedures are the conventional procedure (one or two incisions, cut the vas deferens, tie or cauterize the ends) or the NSV (No-Scalpel Vasectomy) technique where a puncture tool is used to gain access to the vas deferens, cut and cauterize. There is a variation on these procedures that is gaining in popularity called the "Open ended technique". More information can be found in our medical journals section, or here.

There is a fourth method, performed only in Marie Stopes clinics (as far as I can ascertain). With this method, a segment of the vas deferens isn't removed as with the other methods. The vas deferens is cauterized to seal it.

Is there a difference in reliability between the available procedures?

Skill and experience of the surgeon may play a part in the overall success rate of vasectomy, but there is a method of sealing the ends and burying them in a different layer of tissue known as fascial interposition that many doctors regard as being the most reliable method.

I've hear there is something new called "Vasclip" on the market - what's that all about?

Vasclip was given FDA approval in August 2002, and was launched in the US in April 2003. The device doesn't have approval for use in countries outside the US at present. As of the end of July 2007, the Vasclip site is down, and I'm not getting any response to my enquiry emails from Vasclip.

Vasclip is a clip about the size of a grain of rice that is placed over the vas deferens to seal it instead of cutting it. Apart from this one difference, the technique used is otherwise very similar to standard NSV vasectomy.

Using a clip does not mean that Vasclip is more likely to be reversible. Vasectomy clips were first trialled back in the 1950's and it was found that scar tissue formed over the clip, meaning that it wasn't just a simple matter of un-clipping it to restore fertility. Vasclip do not claim it's any easier to reverse than conventional techniques, and like conventional techniques men considering it should view it as permanent sterilisation.

There isn't much data available on how reliable Vasclip is compared to conventional techniques. The only data at present comes from the Vasclip original clinical trial of 124 men. More information on the FDA approval and insurance companies policies on Vasclip.

There is an interesting article on vasweb.com. It's written by a physician who regularly practices conventional vasectomy, and offers Vasclip in addition.

Are there alternative male contraceptives other than vasectomy or condoms?

Research has been ongoing into male contraceptives for some years now. We have a page of links to research into alternative methods of contraception for men. It has links to other sites that keep up to date with ongoing research efforts in the field, and articles on alternatives.

How does it compare to other contraceptive methods for risks/benefits?

No contraceptive method is totally risk free. Maybe not having sex is the exception - and I guess someone's done research into the harmful practice of sexual abstinence! This comparative table lists the risks and benefits of the various contraceptive and sterilization methods. For many of us vasectomy represents the least risk alternative.

Will a vasectomy protect me against venereal disease, HIV or other sexually transmitted diseases?

No. To protect yourself and partner against these diseases you need to use condoms.

Can it reverse itself again making me fertile again?

It's possible, but the statistics available suggest the chances of this happening are very low - specifically in 0.030% of cases (according to the "Well connected" link in the useful links sections). Another study by the BCMA says that "DNA-confirmed paternity with apparent azoospermia after vasectomy has been documented with an incidence of approximately 1 in 4000". We have a page that discusses the topic in greater detail.

Vasectomy is the most reliable form of birth control available. The advice of the newsgroup is "If it worries you, get regular semen analysis done to give you peace of mind".

Will I still produce something when I ejaculate?

Yes. What you ejaculate contains normally 3-5% sperm. The rest is seminal fluid produced by the seminal vesicles/prostate gland. After vasectomy you ejaculate about 95-97% of what you did prior to vasectomy. For men's experiences of this see our online survey.

Will I still feel like a real man afterwards hormonally?

Yes. Your testes still produce testosterone so there is no reduction in your masculinity. Some major studies indicate that the level of testosterone in vasectomised men seems to decrease more slowly with age, so vasectomised men seem to have higher levels of testosterone longer into their lives than the non-vasectomised. This led to the fear some years ago that vasectomy may lead to increased incidence of prostate cancer. Later and more comprehensive studies have removed this fear.

The U.S. Department of Health And Human Services have a good fact sheet that discusses the issues and accumulated medical evidence.

As the vas deferens is cut during the procedure, will my balls dangle lower because they are unsuspended?

Unlikely. Some diagrams suggest the vas deferens are the only things connecting our testicles to the rest of us. In fact, the vas tubes are just one part of a complicated group of structures called the spermatic cord. The spermatic cord is not severed during vasectomy. The spermatic cord contains arteries and veins, the cremasteric muscles (which cause your testicles to pull up when you are cold or anxious), bunches of nerves, lymphatic vessels, etc. as seen in this illustration. It is these structures together that support the testicles in the scrotum. The vas deferens are thin, hard tubes mixed up in all of this, and they are the only things cut during vasectomy. We have a detailed explanation of the spermatic cord structure, and www.maleinfertility.com have an excellent video clip of the NSV procedure that clearly shows exactly how the vas deferens is separated from the rest of the spermatic cord prior to cutting it. You may need RealOne player installed.

So if the vas deferens is sealed during the procedure, what happens to the sperm still being produced?

Most websites say they are "Harmlessly re-absorbed into the body". This doesn't answer the question that still remains in peoples minds - "How, exactly?". ALL men (vasectomised or not) produce sperm that are reabsorbed back into the body. In fact 40%-50% of sperm you produce is reabsorbed. Sperm go from the Testicle to the Epididymus for storage and maturing. It takes about a month to mature them. Whilst in the Epididymus, excess fluid content is re-absorbed through membranes, and solid content is broken down and reabsorbed through the membranes by macrophages (Cell eaters present in all organs and the blood).

If you cut your finger your body reacts to this to protect itself. The same happens if the flow through the vas deferens is obstructed (either by vasectomy or a medical condition). To compensate for the additional sperm, the membranes increase in size to absorb more fluid, and additional Macrophages are recruited from the bloodstream to deal with the solids. We also have a more detailed explanation.

Does vasectomy alter the taste or smell of semen?

NO KIDDING! This question has been asked a few times in the newsgroup, and is in the top ten keywords used to search this site! The threads in the newsgroup came to the conclusion that there is no difference, except for one lady who said her husband's sperm smelled different after he had had a reversal. We also address the questions of volume, colour and consistency of semen after a vasectomy in our on-line survey along with many other important issues. Basically men who have had a vasectomy say that it doesn't affect the qualities mentioned, nor does it affect the consistency or adhesive properties. I.E. it will still stick to dresses, body hair and gum up shower trays and make just as much mess as it always used to.