A vasectomy is a surgical procedure to make a man sterile. After the operation, sperm can no longer mix with semen. This is the fluid that’s ejaculated from the penis.
A vasectomy has traditionally required a scalpel to make two small incisions in the scrotum. However, since the 1980s, a no-scalpel vasectomy has become a popular option for many men in the United States.
The no-scalpel method results in less bleeding and a faster recovery while being just as effective as a conventional vasectomy.
Every year, about 500,000 men in the United States have a vasectomy. They do so as a means of birth control. About 5 percent of married men of reproductive age have vasectomies to avoid fathering any children or avoid fathering any more children if they already have kids of their own.
The main difference between no-scalpel and conventional vasectomies is how the surgeon accesses the vas deferens. The vas deferens are ducts that carry sperm from the testicles to the urethra, where it mixes with semen.
With conventional surgery, an incision is made on each side of the scrotum to reach the vas deferens. With a no-scalpel vasectomy, the vas deferens are held with a clamp from outside the scrotum and a needle is used to make a small hole in the scrotum for access to the ducts.
A 2014 review notes the benefits of a no-scalpel vasectomy include almost 5 times fewer infections, hematomas (blood clots that cause swelling under the skin), and other problems.
It can also be done more quickly than a conventional vasectomy and requires no sutures to close up incisions. A no-scalpel vasectomy also means less pain and bleeding.
In the 48 hours before having a no-scalpel vasectomy, avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve). Having these medications in your system before any surgery can increase your chances of bleeding complications.
Also consult with your doctor about any other medications or supplements you normally take. There may be others you should avoid before the operation.
A vasectomy is an outpatient procedure. This means you can go home the same day as the surgery.
Wear comfortable clothing to the doctor’s office, and take an athletic supporter (jockstrap) to wear home. You may be advised to trim the hair on and around your scrotum. This may also be done at your doctor’s office just before the procedure.
Check with your doctor’s office about anything you may need to do to prepare. Your doctor should give you a list of instructions in the days leading up to the vasectomy.
In the operating room, you’ll wear a hospital gown and nothing else. Your doctor will give you a local anesthetic. It’ll be inserted in the scrotum or groin to numb the area so you won’t feel any pain or discomfort. You may also be given some medication to help you relax before the vasectomy.
For the actual procedure, your doctor will feel for the vas deferens under the skin. Once located, the ducts will be held in place just under the skin with a special clamp from outside the scrotum.
A needlelike tool is used to poke one small hole in the scrotum. The vas deferens are pulled through the holes and cut. They’re then sealed with stiches, clips, a mild electrical pulse, or by tying their ends off. Your doctor will then place the vas deferens back into their normal position.
After the operation, your doctor will prescribe you some painkillers. Usually, it’s acetaminophen (Tylenol). Your doctor will also provide instructions on how to take care of the scrotum during recovery.
The holes will heal on their own, without stitches. However, there’ll be a gauze dressing on the holes that’ll need to be changed at home.
A small amount of oozing or bleeding is normal. This should stop within the first 24 hours.
Afterward, you won’t need any gauze pads, but you’ll want to keep the area clean. Taking a shower is safe after a day or so, but be careful drying the scrotum. Use a towel to pat the area gently, rather than rub it.
Ice packs or bags of frozen vegetables can help reduce swelling and pain for the first 36 hours or so after the vasectomy. Be sure to wrap the ice pack or frozen vegetables in a towel before applying to the skin.
Avoid intercourse and ejaculation for about a week after the procedure. Also refrain from heavy weightlifting, running, or other strenuous activities for at least a week. You may return to work and normal activities within 48 hours.
Some discomfort is normal during the first few days after the procedure. Complications are rare. If they do occur, they can include:
- redness, swelling, or oozing from the scrotum (signs of infection)
- trouble urinating
- pain that can’t be controlled with your prescription medications
Another post-vasectomy complication can be a buildup of sperm that forms a lump in your testicles. This is called a sperm granuloma. Taking an NSAID may help ease some of the discomfort and reduce inflammation around the lump.
Granulomas usually disappear on their own, though an injection of a steroid may be needed to speed up the process.
Likewise, hematomas tend to dissolve without any treatment. But if you experience pain or swelling in the weeks following your procedure, schedule a follow-up appointment soon with your doctor.
One other important consideration is the possibility of remaining fertile during the first several weeks after a vasectomy. Your semen can contain sperm for up to six months after the procedure, so use other forms of birth control until you’re assured your semen is clear of sperm.
Your doctor may advise you to ejaculate several times in the first couple of months after a vasectomy and then bring in a semen sample for analysis.
A vasectomy of any type can cost up to $1,000 or so without insurance, according to Planned Parenthood. Some insurance companies, as well as Medicaid and other government-sponsored programs, may cover the cost entirely.
Check with your insurance company or with your local public health office to learn more about options to pay for the procedure.
Reversing a vasectomy to restore fertility is possible for many men who have undergone the procedure.
A vasectomy reversal involves the reattachment of the severed vas deferens. It’s often requested by men who had one or more children with one partner and later on want to start a new family. Sometimes a couple changes their minds about having children and seek a reversal.
A vasectomy reversal isn’t always guaranteed to restore fertility. It’s often most effective within 10 years of the vasectomy.
A no-scalpel vasectomy can be an effective and safe form of long-term birth control. When performed by surgeons with experience, the failure rate can be as low as 0.1 percent.
Because it’s meant to be permanent and because a vasectomy reversal isn’t a guarantee, you and your partner should strongly consider the implications of the operation before having it done.
Sexual function is usually unaffected by a vasectomy. Intercourse and masturbation should feel the same. When you ejaculate, however, you’ll release semen only. Your testicles will continue to produce sperm, but those cells will die and be absorbed into your body like any other cells that die and get replaced.
If you have questions or concerns about a no-scalpel vasectomy, talk with your urologist. The more information you have, the easier it’ll be to make such an important decision.