Family doctor

Overview:

• Vasectomy is appropriate for stable couples who have completed their family
• Modern vasectomy is performed with minimal discomfort
• Vasectomy prevents sperm being released in the ejaculate by dividing the vas deferens
• The operation does not affect the production of male hormones
• Some men may want to store sperm before the operation
• Vasectomy makes no difference to the appearance of the ejaculate or sensation
• Sperm will completely clear after about 20-25 ejaculates following the operation
• A zero sperm count must be confirmed before stopping contraception

Information on vasectomy:

For couples in a stable relationship who have completed their family vasectomy takes away the concern of unplanned pregnancy. Using the modern "no scalpel" technique the vasectomy is performed with minimal discomfort.

Vasectomy is the surgical division of the vas deferens to bring about sterilisation. The vas deferens are the tubes that transport and store sperm from the testis to the prostate gland, sperm then comes out of the penis on ejaculation. The sperm account for only a small portion of the ejaculatory fluid.

Vasectomy doesn't affect the production of male hormones.

It is worth considering the age of your children (particularly the youngest) before deciding to go ahead with a vasectomy, as it should be considered irreversible. Make sure both you and your partner have no reservations about having a permanent form of contraception.

It may be worth considering sperm storage if you are not 100 percent sure.

Before the operation, make sure you have allowed two days to recuperate afterwards (longer if you have a strenuous manual job), and that you can arrange for someone to take you home after the operation.

Do no hesitate to have a pre-operative consultation, if you have any doubts or concerns.

The operation:

Sedation is given before the procedure starts then an injection of local anaesthesia is given into a small area on the front of the scrotum. After this, the procedure is painless.

Using a dissecting forceps the numb skin of the scrotum is entered in the midline, directly under the penis. Via this opening the vas deferens on the left side is exposed and a 1-2cm segment is removed and sent to the laboratory to confirm that it is a normal vas deferens. The ends are folded and tied back with sutures. The same procedure is repeated on the right side through the same opening.

The incision is closed with dissolving sutures under the skin. There will be a dressing over the wound which is to be removed in the shower the next day. Please wait until the next day to shower. Avoid as much activity as possible for the first 24-48 hours.

If you carefully follow the post-op instructions: rest, wear two pairs of supportive underwear, take regular pain relief, there should not be any problems. Most of the discomfort should subside over the first two to four days.

Note: There are still sperm remaining in the tubules. They will clear after about 20 to 25 ejaculates. It is important to do the sperm counts after the operation to check that there are no sperm remaining.

You will not notice any difference when you ejaculate in either sensation or appearance of the ejaculate. There is about a 1-2 in 1000 chance that the vas deferens will rejoin on one side or the other. This normally happens in the healing phase and is picked up on the sperm counts. In this case the sperm count would increase rather than decrease.

Please note that the thought of the operation is always worse than the procedure itself.

Pre-op vasectomy information:

Arrange for someone to drive you home after the operation, about one hour after the start time. This is because sedation is given.

You need to completely shave all the scrotum across to the sides of the groin and the underside of the penis. Alternatively you can use hair removal cream (test the cream on a small patch first because some people are sensitive to it). It is not necessary to shave the pubic hair above the penis. The incision is on the midline of the scrotum, under the penis.

Bring two pairs of supportive underpants to wear after the operation.

You may eat and drink as normal.

Post-op vasectomy information:

Rest for at least 24 hours. Do not shower for 24 hours. Remove dressing during first shower. Wear two pairs of supportive underpants (or a pair of speedos) until pain free.

Take the pain relief as directed until the pain has settled.

Take all the antibiotics to prevent infection.

You can start sexual activity when you feel able (usually about one week) but wait until you are completely pain free.

Note: you must use alternative contraception until there is a zero sperm count.

Do the first sperm count after 20 - 25 ejaculates. Take the sample to the laboratory. Contact the surgery five days later for the results.

If the count is zero you can stop contraception if you wish, though you must send a second sample to the lab four months after the operation, which is the end of the healing phase, for final confirmation. You cannot be absolutely safe until the test four months after the operation is zero.

If the first count is not zero, continue contraception and do another count after 10 more ejaculates. You should have a zero count four months post-op to be considered safe.

Getting help

Your GP or family planning clinic will be able to refer you to someone experienced in doing the operation.

For information on sperm storage contact Fertility Associates, Auckland. Ph 520 0499