Methods such as tubal ligation and vasectomy are definitive contraceptive forms. They are different methods with completely different procedures and distinct recovery times. Tubal ligation is nothing more than the removal or tying of the fallopian tubes1. The vasectomy surgery, on the other hand, consists of cutting the connection between the sperm-producing channels and their exit2. Men over 30 years old who have 2, 3, or more children can undergo this procedure without any problems. Although simple, the surgery requires the couple’s authorization, so, if legally married, the man and his partner must sign a contractual term provided by the urologist responsible for the surgery. The vasectomy surgery is performed on a canal called the epididymis, which is located on the posterior part of the testicles. This canal carries the sperm produced in the testicles to the vas deferens, which in turn carries it to the urethra for exit through the penis during intercourse. The man continues to produce seminal fluid, but it no longer contains sperm after vasectomy surgery.
Vasectomy Surgery Procedure
The vasectomy surgery procedure is relatively simple and is an outpatient practice in almost all cases. After fasting, the man goes to the facility to undergo vasectomy surgery where he receives a local anesthetic and, in some cases, mild sedation, similar to what is used in endoscopy or similar procedures. The incision is made in the scrotal sac, usually one on each side, and it is about 1 cm in size. Through these openings, the doctor finds the epididymis and makes a cut with stitches at both ends where the disconnection occurred. In another step, the doctor also cuts and separates the vas deferens. In this stage of the vasectomy surgery, the man may feel brief discomfort, but nothing significant. This last step concludes the vasectomy surgery process, and the man is then ready to go home. Recovery is easier than the procedure itself; sexual abstinence is advised during the postoperative period, along with ice packs to reduce the pain from the cuts, and anti-inflammatory medication to avoid complications during recovery. There are reports of occasional discomfort during the first weeks after vasectomy, but recovery is usually very quick and within 1 or 2 days, normal activities can already be resumed. Some men return to work as early as the day after the procedure.
Myths and Truths About Vasectomy Surgery
Some fears still surround many men when it comes to vasectomy surgery, but most of the factors that may prevent this practical sterilization method from happening are myths or merely excuses motivated by the patient’s fear.
Will vasectomy surgery cause me to have erection difficulties?
No, let’s just say vasectomy is 100% safe against impotence. Vasectomy surgery is performed by specialists who are trained specifically for this purpose. We can also say that the cut channels have nothing to do with the blood vessels that supply the penis for a complete erection.
Is it still possible to be fertile after vasectomy surgery?
Yes, in some rare cases, the channels may regenerate or naturally reconnect, or sperm leakage may occur. Another more common factor is that the couple resumes unprotected sexual relations too soon after surgery; generally, the time required for total absence of sperm is 90 days after the procedure. Some sperm may still remain in the upper vas deferens and pregnancy can occur. After 60 days of vasectomy surgery, the man should undergo a semen analysis to verify the success of the surgery.
Can men who have any testicular problem undergo vasectomy?
Yes, but the doctor should evaluate each case individually before recommending the procedure, so consult with a urologist before making any decision. Problems such as varicocele, for example, do not prevent a vasectomy. Scenes of a vasectomy surgery are relatively easy to watch, but if you are easily impressed, refrain from pressing play.
Is vasectomy surgery reversible?
Yes, but it is not 100% guaranteed3. There are cases in which even vasectomy reversal surgery may not be successful due to problems that can affect the male organ where sperm is produced. Some examples include the production of antibodies against sperm. Another problem is the difficulty in recanalizing the pathways, so seeking a good specialist is ideal if you regret your vasectomy. Some cases are more delicate, and if reversal is not possible, in vitro fertilization should be considered. For this purpose, there are procedures that obtain sperm directly from the source, making it possible for the couple to have a baby. Couples who have decided not to have any more children should consider vasectomy as it is much simpler than a tubal ligation. While vasectomy is simple to perform, tubal ligation is much more invasive. Both vasectomy and tubal ligation can sometimes be reversed, but as both are invasive procedures, the decision should be made by the couple and carefully thought out, considering the risk of regret. Sitting down and discussing whether this is the right course of action is very important to avoid future regrets.
Can Vasectomy Fail?
When it comes to avoiding having children, responsibility typically falls on the woman to avoid pregnancy, but in reality, the man is also a protagonist in the process – conception. In addition to contraceptive methods like male and female condoms and tubal ligation, there is vasectomy. However, not all men are willing to undergo this procedure, whether out of fear, concern about becoming impotent, unwillingness to have such a procedure (cultural issues), or even fear that it might not work, that the vasectomy might fail… It is known that vasectomy is a significant option for couples who do not want any more children, especially because the procedure for men is much simpler than for women. For a woman to undergo permanent sterilization, such as tubal ligation, her body goes through much more, requiring many more layers to be cut and much longer postoperative rest. After all, there are 5 layers cut, even in laparoscopy, meaning 3 more cuts than in vasectomy. Not to mention that the anesthesia is stronger than for men. In summary, 9 out of 10 doctors recommend vasectomy as the permanent sterilization method due to its simplicity. In general, vasectomy surgery takes about 20 minutes, with rest recommended on the first day and normal life resuming soon after. The incision is very small, anesthesia is local, and it can be performed in a clinic or medical office. It is important to note that the surgery takes some time to take full effect, so after a few months or ejaculations, an exam is needed to verify the success of the procedure. However, the big unanswered question is: can vasectomy fail? Can a man impregnate a woman even after vasectomy? Yes, vasectomy can fail, but these are extreme cases due to the way the procedure was done. The older method of simply cutting the vas deferens, which carries sperm produced in the testicles to the semen, is more prone to failure since the ends may reconnect and fertility can return. The most current (and also most used) technique—cutting and tying the ends—is much more effective. The chances of this method failing are very small, but there is still a small margin of error (0.5 to 1.0% chance of failure).
How to Know If It Worked?
After vasectomy, the man should have some ejaculations (about 30) to eliminate all the sperm from the vas deferens. In the meantime, the couple should be careful and use condoms or contraceptives. After the time provided by the doctor or after 30 ejaculations following the surgery, the man should have a semen analysis to check if the procedure was successful.
Interview with Urologist Diego Delgado
Urologist Diego Delgado gave an interview about vasectomy and vasectomy reversal. Doubts that may concern those who want to have a child after the procedure can be clarified with both the written material and the video kindly provided by the doctor.
What exactly is vasectomy?
Dr Diego Delgado: Vasectomy is a surgery performed on men with the objective of preventing pregnancy! It is a simple procedure carried out in the clinic. It takes about 30 minutes and is practically painless.
Who can have a vasectomy?
Dr Diego Delgado: According to Brazilian law, vasectomy is permitted for all men over 25 years old and for men under 25 who have at least two children.
How difficult is it to reverse a vasectomy to be able to have children again?
Dr Diego Delgado: Vasectomy reversal is a surgery that does not have 100% guaranteed success, which is why we recommend vasectomy only for men who truly do not want more children. Another factor that makes vasectomy reversal challenging is the cost, as this surgery is ten times more expensive than vasectomy.
How is vasectomy reversal performed and what is the success rate for this procedure?
Dr Diego Delgado: Vasectomy reversal is done in a specialized surgical center with a microscope; the procedure takes a few hours and recovery requires more care than after a vasectomy. It’s important for the patient to understand that vasectomy reversal is a completely different surgery from vasectomy with a longer surgical time.
Is there any factor that makes reversal more difficult?
Dr Diego Delgado: The way in which the vasectomy was performed may make reversal easier or harder. When having your vasectomy done, it is important to make sure the surgeon also performs reversals since this way he’ll perform the vasectomy more appropriately. The period between vasectomy and reversal should be less than 15 years. The shorter this period, the greater the chance of success.
Which doctor should the couple see if they want to have a child after vasectomy?
Dr Diego Delgado: The couple should first consult a urologist who will determine if there is a need for a female fertility evaluation with a gynecologist.
Where can you have a vasectomy reversal for free or find a trustworthy professional in your area?
Dr Diego Delgado: There is the option of some federal public hospitals for this surgery, but the waiting lists are very long. If the couple would like more information about the surgery, they can contact CBU – Brazilian Center of Urology at 11 2338-3600 or 11 94479-6009.
What advice do you give to those thinking about vasectomy and reversal?
Dr Diego Delgado: Vasectomy reversal is not just a simple surgery, and the time for semen analysis to be positive (to have sperm in the ejaculate again) can take up to a year. Once the decision is made to have another child, the couple should look for a registered doctor from the Brazilian Society of Urology – SBU to have an initial evaluation, from which they will be individually advised. Contact Dr Diego Delgado: Dr Diego Delgado’s Website / Office Phone: (11) 2338-3600