Ask the Doctor

from Mike:-

Can I have sex hours before the procedure? If so, how many hours before I should have intercourse?

There are no restrictions for abstinence prior to a vasectomy. A man can have intercourse immediately prior to the vasectomy procedure. Restrictions for intercourse or ejaculation should be followed after the procedure. Early ejaculation/intercourse after the vasectomy procedure can lead to post-operative problems.

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From Nick:-

As I am one of first generation to have had a vasectomy and am now 62. Are there any indications that show any cause for lack of erections? At the time when I had mine there were no studies to show what would happen in later life. I am a non drinker and non smoker (although did in earlier years) and not on any form of medication accept half a disprin a day (just for precautions for strokes). Have used cailis but not to any advantage (minor erection ). Any thoughs on the subject?

There are no studies to date implicating vasectomy with erectile dysfunction (E.D.). Erectile dysfunction is a common condition and becomes more prevalent in men as they become older. Smoking, atherosclerosis, diabetes mellitus and certain medications are the most common causes of E.D. and most of these conditions will continue to increase a man’s risk of E.D. long after the problem has resolved. In fact, many of these conditions never completely resolve, but may stabilize or not continue to progress. Many men are affected by E.D. and the prevalence of this condition in our society is approximately 1 in 5 men.

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From Tray:-
My girlfriend complains that I give her thrush after every time we have sex. I had a vasectomy 7 years ago. As soon as I was able to have sex again she would say the fluid would make her sting and she would have to wash almost immediately for relief. This went on for a few months afterwards and eventually over time subsided. But she is of the firm belief that because of the vasectomy it causes her to have thrush. She has had thrush over the counter treatments and via GP. Can this be proven? Is it possible? What can be done?

The vasectomy procedure does not add any fluid to the ejaculate, but instead eliminates the sperm component that makes up 5% of the fluid by volume that is ejaculated. Sperm, in and of itself, has never been shown to have any anti-infective properties. The vast majority (95%) of fluid in a man’s ejaculate comes from the prostate and seminal vesicles. This fluid has been shown to have anti-infective properties and is not affected by a vasectomy procedure. However, the prostate can become infected (prostatitis) and this is more common as men get older. Prostatitis can lead to changes in the consistency, color and smell of semen. Prostatitis can lead to irritative symptoms in the man and, theoretically, can cause irritation for the female partner if the ejaculate is infected. The relationship between thrush and vasectomy, or oral intercourse for that matter, has never been shown to exist. Evaluation by an urologist with evaluation for and treatment of prostatitis can resolve these problems.

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From Rob:-
I had my vasectomy done in April 2010, the procedure went very well. I took my first ‘sample’ back to the doctor after 25 ejaculations in mid May. This sample came back negative. I took my second ‘sample’ back to the doctor after 37 ejaculations in mid June. This sample also came back negative. My question is this: since both samples were negative, does this mean that I was sterile between the 25th and 37th ejaculations (mid May to mid June)?

There is no guarantee that the samples between the first and second post vasectomy sample demonstrating no sperm are devoid of sperm but we can only assume that they were. I have seen men with semen samples showing no sperm on the first analysis, sperm on the second analysis, and subsequent azoospermia on the following 2 samples. All of these semen analyses demonstrated only a few non-motile sperm on the second analysis which most experts would agree is not capable of causing a pregnancy. Previous studies have shown that all men in one study demonstrated azoospermia after 24 ejaculates. Other surgeons have advocated only a single semen analysis 3 months after the vasectomy.

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From Marty:-
In an earlier post you said that “The reason most vasectomy reversal patients are asked to refrain from sexual intercourse or ejaculation for a period of time after the vasectomy reversal is because it is important for the tubes to seal and heal prior to having forceful contractions of the vas deferens as is common during ejaculation. The only thing holding everything together after surgery are some fine microsurgical sutures that can tear if force is applied to them. Additionally, a water tight seal at the anastomotic site prevents sperm from leaking out which can cause obstruction of the vas deferens. There is no right answer for the duration of abstinence that is required after a vasectomy reversal and can vary anywhere from two to six weeks. Oftentimes this period of time is determined by the surgeon’s experience with performing the surgery. Whether or not something could have been damaged by prematurely having intercourse is really difficult to say. The first semen analysis will demonstrate if any potential things could have been damaged.”

My question is this. *if* the microsurgical sutures were to break (for any reason) – what happens with the “loose ends” of the vas deferens in the scrotum? Would the loose ends simply “hang there” or would semen/sperm begin to fill the scrotum over time?

Disruption of the sutures prior to healing would cause leakage of sperm outside of the vas deferens. A partial disruption would cause sperm to leak out of the vas deferens and this would ultimately be sealed off by the body similar to when an open-ended vasectomy is performed. Oftentimes, a sperm granuloma forms which can vary in size from a pea sized lump to anything larger. The process is self limited and we don’t see huge sperm granulomas filling the entire scrotum even in the extreme case of open-ended vasectomy. Complete disruption of the anastomotic sutures would result in a similar situation, but probably to a greater degree. The ends of the vas deferens are not “free-floating” and would not be dangling in the scrotum. Usually, the ends of the vas deferens are surrounded by some degree of scar tissue and are fixed in the scrotum after a vasectomy reversal.

Dr. Karpman’s website

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From Amy:-
Thank you in advance for answering this question. My husband recently had a vasectomy reversal and the procedure went well. He is currently recovering. He has a 4yr. old daughter who is ~50lbs. She frequently wants him to pick her up and carry her around. How long should he wait in order to safely pick her up without running the risk of injury and damaging the reversal?

The recommendations for post-operative restrictions on activity vary from surgeon to surgeon and are dependent on how the operation was done and the surgeons own experience. I usually tell my patients to restrain from any strenuous or physical activity including picking up objects or persons over 10 pounds for 2 weeks after their operation. This recommendation might be conservative or liberal based on other surgeons experience.

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From Edie:-
I have a friends with benefits situation, I am a 47 yr. woman and my BF is 35. We have been together 2 1/2 months and he INSISTS on using condoms even though he had a vasectomy at 23 and I have missed 2 periods since Sep 09. He said when he had the vasectomy done the Dr. told him since he had the clamp procedure done there was a slight possibilty that he could get someone pregnant. I told him they have to say that for legal reasons and he is worring way too much. My ex of 17 yrs had a vasectomy after the first year of marriage and so did another boyfriend I had at 19. I told him if I was going to get pregnant it would have been with these 2 guys as we used no protection. He doesn’t even let me play with his penis on my vulva for fear I will get pregnant! Who is right?

The real question in this situation is “Has the man had his sperm count checked after the vasectomy or recently?” Vasectomies have been know to fail on rare occasions. The Vasclip procedure was a procedure done for vasectomy in the past and is no longer available. A recent study done on the Vasclip has shown that 25% of men will still have little channels through which sperm can travel even after the procedure. Recently, a new company caleed Pro-Vas is trying to market a similar type of occlussive device for perfoming vasectomies. The company does NOT have any clinical data to support their claim that the procedure is any more effective than the Vasclip and only received FDA approval because of its similarity to the VasClip procedure. I would caution men about this procedure until there is clinical data available to review that shows this device to be effective as a sterilization procedure.

The statistical probability of getting a 47 year old woman pregnant is extremely low, but not zero so we can never tell a man or woman that they do not need to use protection while having sexual intercourse. The best recommendation to any man who is concerned about his fertility potential after a vasectomy is to get his semen analyzed with a pelleted sample to determine his ability to get someone pregnant. This test is not expensive, is available at any laboratory and results are known within 24 hours.

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From Susannah:-
My husband is 36 and had a Vasectomy, via regular micro surgery, not laser surgery, 6 years ago while married to his ex-wife. He has four children and I do not think fertility has ever been a problem for him. I am 37 and have two children and I also have had no trouble in the past conceiving or carrying to term. My questions are: My husband tends to scar and gets keloids from surface cuts, not horrible thicked, raised, dark scarring, but enough to notice. Is Vasectomy reversal an option for us? Would it be better to go with laser surgery this time vs. tradition surgery? He also says that since his procedure, his ejactulations seem to ooze out like a lava flow rather than spurt out (sorry for the graphic details). Is this a factor to consider? Does this indicate that more internal scarring has occurred than normally expected? Will this contribute to vasectomy reversal failure?

The type of vasectomy performed rarely limits our options at the time of vasectomy reversal. The only limitation to vasectomy reversal surgery is when large segments of the vas deferens are removed at the time of vasectomy by aggressive vasectomy surgeons. Laser vasectomy is still performed by only a few surgeons around the country. There is no proven benefit for using a laser during the vasectomy procedure and some surgeons use it as a marketing gimmick to attract men to get their vasectomy done at their center.

Keloids and hypertrophic scars do occur in some men and are more commonly seen in men with darker skin. I am not aware of any relationship between keloid type scarring of the skin and worse outcomes during vasectomy reversal. Men who form keloids and hypertrophic scars do need to be aware of the fact that their skin incision might show some scarring greater than a man that doesn’t form these types of scars. I would probably recommend that men who are prone to scarring be given a course of strong anti-inflammatory medications in the early post-operative period.

Dr. Karpman’s website

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From Brian:-
I am really angry about the way my stitches look post vasectomy. Is it normal for them to look like this? Although it is somewhere that can’t be seen, it still bothers me. Is this something that could have been prevented? The photo was taken 6 days post op.

The attached photograph appears to be that of a relatively normal healing process for a vasectomy procedure. The size of the incision is a little generous, but otherwise looks normal for 6 days after surgery. The nice thing about operating on the scrotum is that it is a very forgiving area of skin and most scars will not be apparent after a period of time.

Dr. Karpman’s website

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From Doug:-

Hello. I think the website is an excellent source of information, but had 2 quick questions.

I also had a question on the titanium clips. It seems odd that they place them on the vas, then just let everything slide back in. isn’t there a risk that those clips might bump up against a teste or something?

The purpose of wearing masks during any surgical procedure is as much for the protection of the surgeon from bodily fluids as it is for the patient. That said, I don’t know of any studies that have shown that when surgeons wear a mask during the vasectomy procedure that the risk of infection is lower than if they didn’t wear a mask. The infection rate during vasectomy procedures is incredibly low to begin with (1%) and, therefore, most surgeons wear a mask based on their own preferences.

Tight fitting underwear or a scrotal support are encouraged for use immediately after the vasectomy procedure for patient comfort and to minimize any hematoma formation. Minimizing the movement of the testes and scrotum after the procedure decreases patient discomfort. Compression of the scrotum and surgical site can help reduce swelling and/or hematoma formation after the procedure. The scrotum has a large potential space and any slight ooze can accumulate into a lot of fluid if left unopposed. A golden rule in medicine is that all bleeding stops with direct pressure to the bleeding site.

The vasectomy procedure is performed on the vas deferens in the spermatic cord located above the testicle. Theoretically, anything can happen, but practically we do not get any complaints from patients that they feel the clips rubbing or touching other structures in the scrotum. Patients have reported that they can palpated the clips through the scrotal wall if they poke around down there. Titanium clips have been used extensively by vasectomy surgeons for many years because of their effectiveness, reliability and lack of side effects.

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