Ask the Doctor

From Christopher:-
My question is this: due to medical reasons on behalf of my wife, in June 2004 I had a vasectomy after having two children. In 2005 I was in Iraq with the United States Marine Corps, and when I returned we decided to have one more. I had a reversal done, and our third son was born in February 2008. We have decided this is our last child and are talking about birth control. I am considering getting a vasectomy again, but she is worried about all the scar tissue in my scrotum area from the previous two surgeries. Would it be safe for me to go through the vasectomy procedure again or should we opt for a different form of birth control. Thank you for your time in this matter.

Vasectomy after a successful vasectomy reversal is not an uncommon occurrence. Many couples will desire only one additional child after their vasectomy reversal and enjoy the dependability of the vasectomy procedure in preventing an unwanted pregnancy. Most vasectomy reversal specialists are comfortable in performing repeat vasectomies. There shouldn’t be any greater risks with a repeat vasectomy if performed by an experienced surgeon.

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From Jennifer:-
I have a question about vasectomy reversal. My husband (32yr.old) had a vasectomy reversal in November 2007. It had been 8 years since his initial vasectomy. He also has 2 children from a previous relationship and we are interested in having 2 or 3 more children. The urologist who performed the procedure came highly recommended, has been performing reversals for over 3 years and usually performs at least 2/wk.

Knowing that his vasectomy was done only 8 years prior and he had fathered 2 children before, and I being only 27, I really thought our chances of
conceiving were very high. If his next semen analysis in May does not show sperm, what are our options? Does it make sense to get another reversal?
The reversals are expensive (approx. $5,000). We have good insurance that covers a lot of infertility procedures and I am wondering if it makes more
sense to do sperm aspiration however I would really like to have a child naturally.

Vitamin B and Co Q 10 have been shown to increase sperm production and motility in clinical trials. However, in a man who has had a vasectomy reversal with proven fertility prior to his vasectomy the most concerning cause of absence of sperm in the ejaculate is a failed vasectomy reversal. If sperm were identified at the time of vasectomy reversal then there should be at least a few sperm in the ejaculate after a vasectomy reversal, regardless of the degree of diminished sperm production. Clomiphene citrate or Clomid is a prescription medication used to stimulate the testicles to produce sperm. However, this would only be of benefit if the vasectomy reversal was successful as evidenced by some sperm in the ejaculate. Despite the disappointing results of the surgery, the published literature has shown that vasectomy reversal is still the most cost-effective way of achieving pregnancy even in the setting of a re-do vasectomy reversal.

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From Jeff:-
I actually have two questions.
1. Will a vasectomy affect my ability to get and maintain an erection? The reason I ask is because I have been living with a low testosterone level for several years and occasionally I have problems maintaining an erection during intercourse. 2. I am a weightlifter and workout with heavy weights 4 times a week. What precautions would I need to take after the operation and how long would I need to wait before lifting heavy again?

Vasectomy will not have any effect, adverse or positive, on a man’s erection. Low testosterone levels do have an adverse effect on erections. Decreased erectile rigidity is one of the diagnostic symptoms for low testosterone, hypogonadism. Hypogonadism can be a problem in the aging male or in men who have previously used anabolic steroids. There are very effective treatment options available for low testosterone that can help restore a man’s normal testosterone level.

The recovery period after a vasectomy is variable and highly dependent on a surgeon’s experience. There is no right answer and most vasectomy surgeons make recommendations based on their own personal experience. The period of abstinence ranges from a few days to a few weeks. People who engage in strenuous physical activity should try to follow their surgeon’s guidelines to ensure a smooth post operative recovery.

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From Sharon:-
My husband is considering a vasectomy for purposes of keeping an erection during intercourse. A friend told him about this. Should this be a real
reason to have one? He is in perfect health. His age is in the mid forties.

Vasectomy is a permanent but reversible form of contraception for men and should be performed only for men who are no longer interested in having children for the purposes of preventing an unwanted pregnancy. However, some men do have considerable anxiety about failure of alternative birth control methods which can have an adverse impact on their sexual performance. Vasectomy can offer these men the security of knowing that they are utilizing the most reliable form of birth control, alleviating their anxiety and improving sexual performance. It is important to understand what is meant by “keeping an erection”. It can mean that the man can’t maintain a fully rigid erection for the entire act of intercourse or it can mean that the man prematurely ejaculates before the female partner has reached her climax. These situations oftentimes have other organic etiologies and should be evaluated by a physician prior to consenting to deciding on a vasectomy.

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From Shelley:-
My husband and I are both 39 and have 3 kids together 12, 14 and 16. 12 years ago after the birth of our 3rd baby in 4 years our heads and wallets
told us 3 was enough so my husband had a vasectomy. Unfortunately my heart never agreed with that decision so on Feb 8 2008 he had the vasectomy reversed. The doctor gave us the highest success rate because we already have 3 kids together and all 3 were conceived the first month trying. March 10 was his first sperm check and the doctor reported that there was sperm but not as much as he would have liked to see. The next appt. was on April 21st and we were shocked to hear that he had no sperm on this visit. The doctor gave him a prescription for an anti-inflammatory and booked another appt. for 5 weeks down the road.

My question is this, my husband has a very hard time providing these “samples”, he finds it very stressful and can only get a small amount of semen. Is it possible that his stress could be affecting the sperm count?

The fact that sperm were present during the first semen analysis is an encouraging sign that the right surgery was done during a vasectomy reversal. The presence of sperm on the semen analysis represents a patent reproductive tract. Unfortunately, the absence of sperm on subsequent semen analysis may represent scarring at the vasectomy reversal site. This can also be a temporary phenomenon related to swelling in the vas deferens lumen which should resolve with time or anti-inflammatory medication treatment. Sometimes, steroidal anti-inflammatories are required. However, if sperm are not present 3-6 months after vasectomy reversal this likely represents a failed surgery. The amount of semen volume should not have any impact on the presence or absence of sperm so long as there is a seminal ejaculate present. Sperm are uniformly found in the ejaculate and should be present even with very small ejaculate volumes.

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From Al:-
Hi, This is going to come as a real dumb question, but I am really concerned about it. I recently had my Urethra reconstructed by taking skin from inside my mouth. It is healing. My question to you is if I should ejaculate too much or have sex too much will it scar up again.

Urethroplasty with a buccal mucosa graft is a surgery done to repair long urethral strictures of the urethra. The post operative recovery is very dependent on the exact type of urethral reconstruction and the surgeon’s observations during surgery. If the surgeon has cleared the patient for sexual intercourse and ejaculation then there shouldn’t be any complications.

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I am a 47 year old male who was scheduled for a bilateral vasectomy on March 27. Because of an undecended testicle on my left side I was scheduled for outpatient surgery. While under general anesthetic the vasectomy was performed successfully on the right side but my left testicle was to high to perform the vasectomy. My question is “What will be done now to insure that I am not fertile and will a vasectomy be repeated on the left side?” As a sub note I did not have this condition as a young child or man – this has only been as ofthe last 5 - 10 years.

Undescended testicle is a congenital condition. Approximately 3% of boys are born with one or both testicles undescended. The majority of boys will have spontaneous descent of their testicles by the age of one so that only 0.8% of boys will have persistence of this condition and require surgical intervention to replace the testicle in a normal dependent position. Vasectomy can be successfully performed on men with a history of undescended testis. If the procedure can’t be performed in the office then it should be done in the operating room with a general anesthetic. There is no reason why a vasectomy can not be performed in the operating room with anesthesia even in the setting of an undescended testis. Perhaps a second opinion by an experienced vasectomy surgeon would be useful. Some men who have had undescended testis may have an atrophic testicle that produces little or no sperm. However, this testicle may intermittently produce sperm and there is no guarantee that a man is sterile until both sides of the vas deferens have been treated by the vasectomy procedure.

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I recently (3 days ago) had a Vasectomy done, well I drove over 2 hours and 120 miles to find a doctor to do it the no scalpel method. Well, the first few minutes everything is going along as planned and the doctor says, well left side is done, and I said, well don’t you use just one hole doing it the no scalpel method and he said, well usually, but you scrouom was really thick, so I am having to do it the other way. I said, well ok I guess, so I have 2 incisions, one on each side, but I don’t understand why one is close to the bottom of my scrotom and the other one is up toward the top, one has 2 stitches the other 3. Is this normal? I just expected first one hole, second I thought they would be in the same place on both, but they aren’t. The last thing was, when he started the right one, I had to ask him twice to numb it again because I could feel TONS of pain from him pulling, this wasn’t just pulling pain, but cutting pain. He apologized numerous times for the all discomfort, but too late in my opinion. What are your thoughts?

A vasectomy can be performed through two small openings, one over each vas deferens, or through a single slightly larger incision in the midline. This is primarily based on the doctor’s preference for doing the surgery with similar outcomes. The level of the vasectomy openings is variable and does not necessarily need to be at the same level. The vas deferens extends from the bottom of the scrotum all the way up through the groin and further. The vasectomy can be performed on any part of the vas deferens. It is preferable to perform the vasectomy as high as possible on the vas deferens to prevent back pressure on the epididymis. In special circumstances such as when a patient has a “thick scrotum” a surgeon may adjust the location of the openings to accommodate the patient’s unique anatomy on each side.

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From Colleen:-
My husband and I met and married in our late thirties. As I’m in the health care field and understand the various issues that may arise with advanced maternal age, we decided to end birth control methods few months after marrying, and within 4 months, I became pregnant (we met and married within 11 months and are quite happy). We have now been blessed with a healthy and happy beautiful baby girl whom is now at the wonderfully fun age of 13 months. I had a difficult post partum and really felt I couldn’t take the chance of having the same experience again.

My husband and I both agreed we were very happy with one child. Our daughter was born in February of 2007 and my husband had a vasectomy in October of 2007. Unfortunately, with the daily exhaustion, we’ve only been intimate approximately 6 times and it’s now March 2008. My husband expressed he doesn’t feel comfortable pleasuring himself, so I’m fairly certain he might still have active and healthy sperm. Lately, now that our daughter is a bit older, a little more independent and interactive, I’ve been contemplating whether or not we made the best decision. I’m actually considering the possibility of becoming pregnant and providing the gift of a sibling to our daughter. My husband has yet to return to the urologist for his sperm count since the MD indicated it would take approximately 35 ejaculates before all to be considered “in the clear”. Is it possible at this point to become pregnant and ensure the sperm are healthy and motile?

The likelihood that there are any motile sperm in a man’s ejaculate 6 months after a vasectomy is extremely low if non-existent, even if the required number of ejaculates have not been completed. Sperm have a finite life span and die if they do not accomplish their goal after being released from the testicles. In fact, we see decreasing motility in semen analyses with each increasing day of abstinence in men. I could only assume that there won’t be any motile sperm in a man’s ejaculate after a vasectomy and six months. There may be some non-motile sperm but these sperm do not have the ability to get a woman pregnant naturally. The best course of action is to obtain a semen analysis.

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From Chris:-
It has been about 3 years since I have had the vas-clamp procedure. Every thing is and was good, but my testicle seems to be getting larger like an egg, a bit hard, no pain or anything uncomfortable, just bigger. I did have it checked out about 6 months ago, and the Dr. says its sperm build-up. it was just a smaller cluster back then. Should I worry?

A small “cluster of sperm build up” seems to be describing a sperm granuloma. This should not cause the testicle to enlarge. This will be felt as a separate pea sized lump or greater adjacent to the vasectomy site. An enlarging testicle will not be caused by a vasectomy especially after several years. Any enlarging testicle should be evaluated by a physician to rule out a serious problem such as a testicular cancer. This is the most common solid organ malignancy in men between the ages of 18 and 45 years of age.

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