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Let's take you through some basic male anatomy in order to better understand what a vasectomy is all about. The sperm are made in the testes (testicles). They then travel through the testis and are collected in a structure outside the testis called the epididymis. The epididymis is a thin-walled tube that runs down the center of the back of the testis. As it gets closer to the bottom of the testis, the epididymis becomes thicker and straighter. Eventually, when it reaches the scrotum, it straightens out completely and becomes quite thick and muscular. This muscular tube is called the vas deferens, and it carries the sperm in a very small amount of fluid.
When a physician performs a vasectomy, he is interrupting the flow of sperm by cutting the vas deferens, the tube that carries the sperm. The inside of the tube is sealed and the two ends are blocked off. A few doctors may intentionally damage the epididymis, but this is unnecessary and inadvisable as it increases the chances of inflammation, and makes surgical reversal more difficult .
When a man ejaculates, he pushes out fluid containing mature sperm, but only five percent of the ejaculated fluid actually comes from the testicles. Most of the fluid (semen) comes from organs other than the testicles (the prostate, seminal vesicles, and bulbourethral glands). These organs do not make sperm. This is why men who have had a vasectomy still have normal ejaculation with significant fluid: only the five percent of the fluid made in the testicles, and the sperm, are missing.
HISTORY OF THE NO-SCALPEL NO-NEEDLE VASECTOMY
Since most people would rather avoid surgical cutting, here are the facts. The no-scalpel vasectomy was developed in China, where it is a very common method for birth control. Rather than having to make cuts in the skin to reach the vas deferens, the physician identifies the tubes under the skin and then isolates them with a specialized clamp after the anesthesia has been given. He then uses a special tool to make a tiny puncture and uses the instrument to stretch the opening so the vas deferens can be reached. The vas deferens from each side are pulled through the hole one at a time and cut and blocked. Unlike a conventional vasectomy, there is very little bleeding and scarring and no stitches are required.
No-needle refers to how the anesthesia is given. In a traditional vasectomy, a small needle is used to give a lot of local anesthetic in the area of the vas deferens. This may be somewhat uncomfortable and intimidating to many men.
In a no-needle vasectomy, a relatively new device is used for the anesthetic. This device uses high pressure to push a spray of anesthetic through the skin and into the tissue around the vas. It is virtually painless and delivers even less anesthetic, with no bruising or bleeding.
As we've just mentioned, the anesthesia is delivered in a different way. The no-needle vasectomy uses a jet injector to push anesthetic through the skin and underlying tissues. This numbs the area with maximum patient comfort and eliminates the possibility of bleeding from the needle.
Choosing a Vasectomy
You should understand that a vasectomy is considered a permanent sterilization procedure. While it can often be reversed, the decision to have a vasectomy should not be made assuming that it can be reversed. Reversal is a complicated and time-consuming surgical procedure that requires very specific expertise. If you are sure that your family is complete, your relationship is strong, you want to take responsibility for the prevention of pregnancy, and you and your partner want to be free of the need to use birth control, then a vasectomy may be right for you. It is certainly a much simpler procedure than female sterilization.
When Not to Have a Vasectomy
This is obviously a major decision and a serious one. If you are not comfortable with the idea of permanent sterilization, are rushing into the decision, or are having the vasectomy just to please your partner, a vasectomy should require some additional consideration.
Regretting the Decision
Going into this you should realize that a vasectomy should not be considered temporary birth control, but permanent sterilization. Some couples who fear they might change their minds, bank sperm before a vasectomy just to make sure it is still available for use. This is something that can be done at our laboratory since Dr. Werner, who is an expert in male infertility, has a full andrology laboratory, M.A.Z.E. Labs, on site. Another option is a vasectomy reversal. A vasectomy reversal is a complicated and time-consuming surgical procedure. While it requires specific expertise, there are doctors, like Dr. Werner, who specialize in this procedure although there is no guarantee that it will succeed.
The good news is that since a no-scalpel vasectomy is performed with a single small incision in the skin, the recovery is usually quite easy. Many of our patients tell us the recovery from certain dental procedures has been more difficult. Most men return to work the next day or, if the procedure is performed on a Friday, almost always on Monday. Tenderness and swelling of the surgical site and bruising of the scrotum are usually minimal. Ice should be applied intermittently for the first 24 hours.
Serious complications are rare. Approximately 1 out of 150 patients will develop epididymitis, an inflammation of the epididymis. This will usually disappear on its own in one to two weeks. This is less likely in no-scalpel vasectomies because there is more flexibility in choosing the area to be cut. If the interruption is in the middle of the scrotum, this inflammation is less likely than if the tube is blocked right next to the epididymis (i.e., lower in the scrotum). A similar percentage of patients will develop a hematoma, or deep bruise, which will prolong the recovery. Infection is extremely rare and can usually be treated with oral antibiotics.
Effects on Sex Life
After all these considerations, one big question looms: "Will it affect my sex life?" And the answer is a resounding "no", except that it will alleviate the need for birth control. Many men report that their sex lives are actually improved because they are no longer afraid of an unwanted pregnancy. The testosterone levels, which affect sexual function, are not changed by a vasectomy.
Your doctor will provide you with all of the information you need to prepare. You should wear sweatpants or any baggy pants. In addition, you should arrange to have a ride home.
How will you feel physically after your vasectomy? Well, you should take it easy for a few days, wearing a supportive jockstrap as often as you need in order to feel comfortable. Using ice on the surgical site when you get home will greatly reduce swelling. Refrain from exercise for a few days and otherwise, comfort can be your guideline. If you have any questions, ask your physician.
Time Until Sterile
Once the tubes have been interrupted, no new sperm should be getting into the fluid you ejaculate. However, the reservoir of fluid that has already passed the point where the tube is interrupted and thus has sperm in it is larger than you might think. You will need to clear the system of sperm by ejaculating. It does not matter, in terms of sperm clearance, whether this is through masturbation or with a partner. Because of this you will need to use birth control until you are cleared by your urologist (i.e., until after there are no sperm in the semen when you ejaculate). Six weeks after the vasectomy you will be asked to produce a specimen, which will be evaluated. If there are no sperm, you can begin unprotected intercourse. If there are still some sperm, you will need to repeat the analysis in two to three weeks, after additional ejaculations, to make sure there are no sperm.
FINDING A DOCTOR
We've presented you with a lot of information so far, but there is one simple truth we'd like you to share: the no-scalpel, no-needle vasectomy is, simply put, a better procedure. You should have your vasectomy done this way and find a urologist with significant experience with this technique. Michael A. Werner, M.D., FACS, is a board-certified urologist, with specialty fellowship training in male infertility and sexual dysfunction. A large part of his practice deals with the vas deferens. Because of his expertise with vasectomy reversals, he is experienced with the most effective method for a vasectomy. You will also have the advantage of a board-certified anesthesiologist making sure that you are safe and comfortable.
Your insurance company may reimburse much, if not all of the costs of a vasectomy. We will submit the claim for you and do any preauthorization necessary
STARTING THE PROCESS
You will need to contact your surgeon for a preliminary consultation. If you are working with Dr. Werner, he will discuss the procedure and any concerns you might have. He will also examine you. At that point, you may book your procedure. It will not be done the day of your initial consultation. If, like many of our patients, you are traveling a long distance, we will try hard to minimize your visits to cut down on time away from home (for example, your post-procedure visit and semen analyses could be done by a doctor near you). We'd like the entire process to be as easy on you and your partner as possible.
Contact us for more information about the no no-scalpel, no-needle vasectomy.