Vasectomy Counseling Video |
Physician Training |
On-line Vasectomy Registration |
| FAQ's: |
| No Scalpel? |
| No Needle? |
| No Laser? |
| Tiny hemoclips? |
| Pain after vasectomy? |
| Can it fail? |
| Open-ended? |
| Is it reversible? |
| What's a VasClip? |
| Long-term risks? |
| Age restrictions? |
Vasectomy is...
Developed as a means of contraception
in the early 20th century, and
popular (500,000 procedures per year) since the 1950's,
vasectomy is a dependable method of birth control for men
who think they will never want any or any more
children. It is a simple 15 minute procedure performed
in a doctor's office or clinic with a local anesthetic. The objective is
to prevent sperm from entering the semen, 95% of which
is support fluid made by glands called the prostate and seminal vesicles,
located in the pelvis behind and beneath the bladder (anatomy
diagrams). Before Vasectomy...
Sperm are made in the testes. From each testis, sperm move through a long curled-up tube behind the testis (the epididymis) wherein they become mature. From there, they swim up a foot-long tube (the vas) which guides them up to the channel (urethra) through which men urinate and ejaculate. Just before entering the urethra, the left and right vas tubes are enlarged, and it is here, behind the bladder, where many sperm are stored between ejaculations. The easiest place to access the vas tubes is just above the testes where the vas tubes are just beneath the thin scrotal skin, easy to feel and very mobile.Methods...
: An anesthetic solution can be injected with a tiny needle to numb the scrotal skin and the vas tubes, or a pressure spray applicator can be used to numb the skin and vas tubes without using any needles. We use the pressure spray applicator.: During conventional vasectomy, one or two 1/2-inch scrotal incisions are made to gain access to the vas tubes. These incisions are later closed with sutures, which remain in place for about 5 days until they dissolve or are removed. During no-scalpel vasectomy (NSV), special instruments are used to perform the procedure through a single tiny access-opening on the front side of the scrotum. The 1/4-inch slit usually seals within hours, so no stitches are needed. We perform NSV.
: Whichever technique of accessing the vas tubes is used, each vas (left & right) is divided about one inch above each testis, where it is just beneath the thin scrotal skin and very easy to reach. What is done with the ends of the divided vas tubes depends on the preference of the person performing the vasectomy. Some operators remove a piece of vas; others don't. Some tie off one or both vas ends using permanent or absorbable sutures or the small clips used to stop bleeding blood vessels during other types of surgical procedures; others cauterize the ends so that they will seal by scarring. Still others simply place the divided ends out of alignment, by closing the vas sheath between the 2 ends with a suture or tiny clip so the ends won't grow back together. We cauterize the abdominal end and place the divided ends out of alignment, keeping them separated by a small tissue layer secured with a hemoclip.
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After Vasectomy...
The
portions of the vas tubes within the pelvis still contain live sperm until
they are all released. The vast majority of men are sperm-free after 20 ejaculations
and 12 weeks. In a few men, the semen may still contain some sperm for months, so it is important to use other forms of birth control
until it is confirmed by microscopic examination that the semen is sperm-free.
Sperm are still made by the testes but can no longer pass up through the vas tubes (anatomy diagrams). So the body adjusts: white blood cells ingest and digest the retained sperm, recycling the proteins back into the system for use in other body functions.
Most men notice:
- No change in the semen
- No change in sex drive
- No change in climax sensation
- No change in the testes or scrotum
- No change in erections
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Risks...
Bleeding can occur during or after vasectomy by either method, but it is less common with NSV. If this occurs within the scrotum, drainage of a scrotal hematoma (blood clot) in a hospital operating room could be necessary. Smaller hematomas do not require surgical drainage, but tender swelling can last for 2 to 4 weeks. Both large and small hematomas are very rare. If the scrotal skin bleeds at the vasectomy access site, the scrotum can become discolored (black and blue) for about a week; this is more common than swelling, but painless.
Infection is also an extremely rare complication in our practice. Most present as tender swelling and redness of the scrotum and usually respond to a course of antibiotics. AAmong 50,000 vasectomies, 2 men developed painful walnut-sized abscesses requiring office or operating room drainage through a small ncision and a two-week period of local wound care.
Delayed Lightheadedness (fainting) with bodily injury can occur hours after vasectomy even in men who feel great when they leave the office. If a man is driving when this occurs, he could injure himself or others. If he is standing, he could fall and injure himself. We offer all patients a soft drink with caffeine and sugar to decrease the likelihood of this occuring, and we strongly recommend that men come and leave with a driver. Delayed feinting and bodily injury should be considered a risk.
Sperm granuloma is a pea-sized (sometimes tender) lump on the vas tube at the vasectomy site, almost never requiring treatment. Some consider sperm granulomas beneficial, as they may increase the likelihood of success with vasectomy reversal. Periodic tenderness usually responds to an anti-inflammatory medication like ibuprofen, but over the past 30 years and 40,000 vasectomies, 5-10 men been so troubled by chronic tenderness that they chose to undergo removal of the lump, an office procedure performed under local anesthesia similar to the original vasectomy.
Congestion, tender buildup of sperm and white blood cells upstream from or at the vasectomy site, can occur anytime after vasectomy, but usually goes away with use of an anti-inflammatory drug such as aspirin or ibuprofen. About one in 2000 patients will experience chronic post-vasectomy discomfort (PVPS or Post-Vasectomy Pain Syndrome) severe enough that he will seek vasectomy reversal or neurolysis (division of the sensory nerves coming from the testes). A larger percentage (the American Urological Association says 1-2%) may have milder forms of chronic pain that can affect quality of life but generally not severely enough to seek surgical therapy.
Recanalization is the development of a channel for sperm flow between the two cut ends of the vas. If this happens during the healing process (early), the semen never becomes sperm-free until the vasectomy is repeated. If recanalization happens late (months or years after a man's semen has been examined and declared sperm-free), an unplanned pregnancy could result; but the odds of this occurring is far less after vasectomy than the odds of pregnancy with any other form of birth control including birth control pills and tubal ligation (female sterilization). Failure rates of vasectomy vary with the technique used to obstruct sperm flow through the vas tubes. In our practice, the early failure rate is about one in 2500 and the late failure rate is one in 3500 (details here).
There are no proven long-term health risks (neither cancer nor cardiovascular disease) associated with vasectomy, but since questions have been raised, they are addressed in our page of Frequently Asked Questions.
The risks of NOT having a vasectomy are all borne by the partners of men who choose to avoid vasectomy. And they are considerable!
Limitations of Vasectomy...
- Not 100% reversible *
- Must use other forms of birth-control until sperm-free.
- Does not prevent transmission of sexually transmitted infections (STI's).
Advantages of Vasectomy...
- Low one-time expense often covered by insurance companies, and by federal grant money through state programs for low-income men with no insurance (see Florida Providers).
- More dependable than any other form of contraception including female sterilization.
- Eliminates risks associated with birth control pills or shots and the IUD.
- Vasectomy reversals are less costly and more successful than tubal ligation reversals (see Vasectomy Reversal).
- No need for inconvenient and less dependable methods, so there
are...
no more worries!!!!
* - Since reversal attempts often do not lead to pregnancy, vasectomy should be considered an irreversible form of contraception. Statistics show that men who undergo vasectomy in their 20's are more likely to seek vasectomy reversal than men who have vasectomies later in life. In fact, men in their 20's and with fewer than 2 children should read our Special Message for young men. Before choosing vasectomy, couples, especially couples in their 20's with fewer than 3 children, should consider all other forms of reversible contraception including birth control pills, shots, patches, and implants ; the IUD (intrauterine device); and barrier methods such as the condom and diaphragm. A nice review of these options is HERE in VasWeb. Couples using barrier methods should also be aware that, for those occasions when they are just "careless", EC (emergency contraception, or the "morning after pill") is readily available at most women's health services sites such as private primary care and gynecology offices and Planned Parenthood clinics. EC is effective at preventing pregnancy for up to 72 hours (perhaps longer) after the "careless" encounter. Men should not proceed with vasectomy if they feel they are being pressured to do so, if their private lives are temporarily unstable due to marital discord, or if they have not considered all reversible alternatives. For many stable men, circumstances change, and all men, especially younger men, should consider sperm storage as insurance against regret over vasectomy in the event of a major life change. If you have never caused a pregnancy, how do we know that you even need a vasectomy ... or what we should expect if you ever opt for vasectomy reversal? Please see our Special Message for Men Who Have Never Caused a Pregnancy.
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- If your partner has already had a tubal ligation (female sterilization), of if she is pregnant now and may have a tubal ligation during a Ceasarean delivery, please read this Special Message.
- Understand the Alternatives to Vasectomy so that you are confident in your choice.
- Understand the "Instructions Following Vasectomy" below so that you know what to expect.
- Please shave the underside of the penis and the front wall of the scrotum, preferably before the day of the procedure. A bit of alcohol is used to clean the skin before use of the MadaJet® and it can sting slightly right after a fresh shave if the skin is chafed.
- Use no powder or deodorant in the genital area on the day of your procedure.
- Please wear a scrotal support (jock strap) or very tight underwear to the office on the day of your vasectomy.
- Be prepared to sign the operative consent sheet (part of the PDF file in the paragraph above) upon your arrival in the office.
- If possible, arrange to have someone drive you home. A flat tire or fender bender could lead to complications, and some men who leave the office feeling great will experience delayed lightheadedness. If you must drive yourself, drive in the right-hand lane so that you can pull over if you begin to feel lightheaded.
- Plan to do nothing but recline at home (sofa or bed) on the afternoon and evening of the vasectomy.
- Do not take any aspirin-containing medication for five days before the procedure.
- If your insurance company or HMO requires authorization, be sure to bring it or call our office (813-536-1430) a day or two before your vasectomy to see whether we have received it.
- To save time on your procedure day, please watch the Online Counseling Video and complete our Online Registration Form.
- If you are taking TESTOSTERONE for "low T" please list it as one of your medications when you do the Online Registration and read the info HERE.
- Eat before your procedure, a normal breakfast or lunch. Nervous men who do not eat beforehand are more likely to become lightheaded during or after their vasectomies.
- If you have no insurance and are paying $690 ($490 if you are a training case), you will pay a $150 deposit when filling out the online registration and $540 ($340 if you are a training case) immediately before the procedure. If you have insurance though a plan with which are contracted, you will pay a $150 deposit when filling out the online registration and your plan's contracted allowable (less the $150 deposit) immediately before the procedure. We will submit a claim for you. If we are paid by your insurance carrier, that amount or what you paid (whichever is less) will be refunded to you. For men with insurance plans with whom we are not contracted, we will provide an itemized and coded receipt which can be sent to the plan for possible reimbursement.
- Spend a quiet evening at home, reclining in bed or on the sofa. Minimize activity. Some men have no pain at all after vasectomy. Many have mild discomfort that does not require pain pills. Sometimes the discomfort is in the groins or abdomen. That's because the testes originate in the abdomen in embryonic life and drag their nerve supply with them as they migrate into the scrotum. So any issue in the scrotal contents can be perceived as an abdomenal process.
- Avoid aspirin for 2 days after the vasectomy. You may take acetaminophen (Tylenol or generic) if you have any discomfort, as well as Ibuprofen (Motrin, Nuprin, Advil or generic) and naproxen (Aleve) , which are both pain medications and anti-inflammatory drugs. Pain beyond 3 days, especially if accompanied by some swelling of the vasectomy sites above the testes, may signify excessive inflammation, for which ibuprofen and naproxen are better choices than acetaminophen. Some men will have more discomfort or tenderness 3-5 days after the vasectomy than they do for the first few days after their vasectomies. That's because the body goes through a series of steps in responding to the new arrangement, and sometimes the later steps are more noticable than the earlier steps. Usually no reason for concern.
- No need for ice packs, unless you really enjoy having ice on your scrotum.
- On the day after the procedure, you may walk and drive as much as you like, but no sports, yard work, swimming, or heavy lifting over 30 pounds. If your job is sedentary (office work or supervisor), you may return to work.
- You may remove your tight undershorts or scrotal support and take a daily shower starting the morning after the procedure. Replace the tight underwear or scrotal support and wear it whenever you are up and around for the next 2 days, during sports for the next 7 days.
- Two days after the procedure, you may return to more strenuous work and regular activities, including swimming, wearing your scrotal support. When pain is gone and tenderness is minimal, you may return to the gym or to running, but on the first day back, do half of your usual workout: half the weight, half the reps, half the speed, half the distance, etc. If pain does not return, you may do your regular workout the next day. You may also swim in fresh or salt water two days after the vasectomy.
- Sex: When you no longer have any pain or tenderness, you may ejaculate. I have always recommended waiting at least 2 days for sex, but the American Urological Association Vasectomy Guidelines recommend that men wait a week. Sooner ejaculation could prolong discomfort. Blood in the semen within the first few months after the vasectomy occurs in some men, but it is no reason for concern.
- No follow-up visit is required. You will be given our cell phone numbers and if you have undue discomfort or any concerns, you should text your doctor anytime after your vasectomy.
- It is normal to have some discoloration of the skin (black and blue) around the puncture site a day or two after the vasectomy. Some men will develop considerable discoloration of the scrotum about 4 days after the vasectomy. Blood from the deep vasectomy site comes to the surface as a purplish-blue mark, gets darker and spreads out like an oil slick, then gradually dissipates.
- Some men (about one in 20) will develop swelling and discomfort on one side, sometimes on both sides, starting anytime from 3 days to 3 months following vasectomy. This usually represents an exaggerated form of the normal inflammatory response necessary for sperm resorption and recycling. It is effectively managed with a 5-7 day course of ibuprofen 600 mg 3 times per day.
- At least 12 weeks and
20 ejaculations after your vasectomy (time and activity are both
important), mail or bring a semen specimen to our office.
Specimens will not be checked early. If you mail your
specimen earlier than 12 weeks or if you lose the mailer
provided at the time of the procedure, we will send you
another mailer for a fee of $20 payable by credit card over the
phone.
If you are bringing the specimen, it should be in a small container with a lid, such as a pill or vitamin bottle, baby food jar, etc. The sample should be 30 minutes to 4 hours old. If we are not busy, you will have the result in minutes. If we are very busy, we will examine it when we have time and send you an email with the results by 4 PM that day.
If you are mailing the specimen, use the mailer (which contains a preservative) and follow the instructions provided. Negative results (you are all clear) will be emailed to the address we have on file for you. If sperm are still seen, you will be asked by email to call our office, whereupon we will (1) advise you to either bring a second specimen to the office 3-4 weeks after the first sample was analyzed, or (2) send you another mailer kit which you use to send a second specimen 3-4 weeks after the first sample was analyzed. Do NOT assume that your semen is sperm-free (sterile) until you get an email from us that tells you that you may stop other forms of contraception. - Dr. Galante's special post-vasectomy expectations and management are HERE.
- Finally, feel free to write a review HERE.
Fees
| Description | Fee |
| Vasectomy consult and procedure |
$690* |
| Vasectomy reversal consult | $100 |
| Vasectomy reversal procedure |
$6900 |
Payment Options and Financial Aid...
Click for details.Federal Assistance Programs:
Click for details.
Click for details.
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Scheduling
At our Tampa/Lutz office (click for location and directions), we have 50 time slots available for vasectomy most weeks, so we can usually see any candidate within two weeks.
Because there is so much information here in vasweb.com, especially with the online counseling video, we do not require preliminary consultation visits and most men opt for only one visit, during which we complete the consultation and procedure. If you would like to visit the office and meet Dr. Stein, Galante or Samplaski personally before deciding to proceed, we would be delighted to see you twice. (In fact, we prefer to consult with childless men in their 20's either in person or by telephone at least one week before their vasectomies to thoroughly discuss the issues here.) If the consultation and vasectomy are on separate days, either can be done on any weekday.
All scheduling is done by Heather and Sergio at 813-536-1430 between 9 AM & 4 PM M-F. They can also answer many technical and logistical questions.
As you may have seen in the Florida map on our Index Page, we perform vasectomies at a number of locations in peninsular Florida. A complete schedule with links to maps and information about these locations is in our SCHEDULE page.
You must register online before your visit, but when you arrive, you won't have to fill out all those papers like in many doctors' offices. The benefits are numerous and listed in our On-line Registration Page. (Please do not hit SUBMIT more than once. Contact our office if there is any doubt that the registration went through.)
Dr. Stein answers queries to the Contact Us page from home and can usually respond within 24 hours.
Thank you.
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