Vasectomy Surgery: Before, During and After

What Is a Vasectomy?

Before and After Vasectomy Surgery
Before and After Vasectomy Surgery. © ADAM

A vasectomy is a surgery to render a man unable to have children, or sterile. It is one of the most commonly performed surgeries in America, with more than half a million men electing to have the procedure each year. While surgery to sterilize women is more popular, the vasectomy surgery is far less invasive and offers a much quicker recovery.

Insurance typically pays for a vasectomy, unless the plan does not pay for birth control of any kind. If the surgery will be paid for out of pocket, plan to pay $750 to $1,500 dollars in most areas. Unlike a tubal ligation, the comparable surgery for women, a vasectomy is performed in a doctor’s office, making it more affordable with a much quicker recovery

What a Vasectomy Does

The vasectomy surgery works by preventing sperm from exiting the body. This is done by severing or blocking the vas deferens, the duct through which sperm travels from the testes and out of the body. Sperm is produced, but it cannot travel outside the body when a man ejaculates.

While the surgery is effective at preventing pregnancy, it does not alter the ability to have/maintain an erection. There is no change in the quality or quantity of semen, nor is there a change in the ability to ejaculate.

What If You Change Your Mind?

This procedure is permanent, so the decision to have the surgery should not be made lightly. You need to be sure that you do not want to have children again, regardless of your marital situation.

It is best to assume that the procedure will mean life-long sterility. While there is a procedure to reverse a vasectomy, the success of that procedure is by no means guaranteed. A vasectomy reversal can also be very expensive as insurance does not typically cover the costs.

A successful vasectomy prevents pregnancy; however, it does not prevent the spread of sexually transmitted disease. Condoms and appropriate precautions should be used to prevent STDs after the surgery.

The Risks and Complications of a Vasectomy

The Vas Deferens During Vasectomy
The Vas Deferens During Vasectomy. © ADAM

A vasectomy surgery has certain risks, in addition to the general risks of surgery.

The Risks of Vasectomy

Bleeding: A small amount of bleeding should be expected, but serious bleeding should be reported to your doctor.

Hematoma: A collection of blood similar to a bruise but more severe, a hematoma after a vasectomy typically results from blood pooling under the skin at the surgical site.

Epidydimitis: A chronic ache or pain in the testicles, best known by the slang term “blue balls," this condition can be resolved with warm compresses in many cases. In severe cases, surgery may be necessary to remove the epydidimis.

Sexual Problems: While there is no physical reason for sexual problems, a small minority of men report problems with their ability to function sexually after surgery. This is typically related to feelings about the surgery rather than the surgery itself.

Spermatic Granuloma: An abscess that forms at the site of a vasectomy, caused by sperm leaking from the vas deferens after surgery.

Fertility/The Need For Repeat Surgery: In rare circumstances, the vasectomy procedure is not effective in preventing sperm from moving out of the testes. This is discovered when the sperm count does not fall after surgery and then the procedure must be repeated to be effective.

Pain: An expected side effect of most surgeries, the pain after a vasectomy is typically mild to moderate in nature and can be handled with over the counter medications or a mild prescription pain reliever. 

The Vasectomy Procedure

The procedure starts with the administration of local anesthesia, to numb the genitals. This allows the patient to remain awake and alert during the procedure, but unable to feel the surgery. In some cases, a new technology, the needleless injection, is used to administer the anesthetic in this sensitive area. Your doctor may or may not have this new system available for use during surgery.

Once the genital area is numbed, the area will be shaved and the skin prepared with a solution that kills bacteria on the surface of the skin. Once the solution dries, the surgery begins with 1 or 2 half-inch long incisions on the underside of the scrotum. The vas deferens, the cord that carries sperm, is then located and either cut and tied off, or cut and cauterized. Research shows that the use of cautery is the most effective, as it prevents the vas deferens from healing back together.

The incision is then closed with sutures, which can be removed at the surgeon’s office in a week to ten days.

No Scalpel Vasectomy (NSV) Procedure

The procedure begins with the administration of local anesthesia, which numbs the genitals but leaves the patient awake and alert. In some cases, a new technology, the needleless injection, is used to administer the anesthetic in this sensitive area. Your doctor may or may not have this new system available for use during surgery.

The skin is then shaved and prepared with a solution to help prevent infection by killing germs on the surface of the skin.

The surgeon makes an opening in the middle of the underside of the scrotum. Instead of using a scalpel, a pair of hemostats or another sharp instrument is used, making a small hole approximately a centimeter wide in the scrotum. Through this hole, the surgeon is able to locate the vas deferens.

Once the vas deferens is located, it is cut and the ends are clamped, clipped or cauterized to close them permanently. Research has shown that a procedure that uses cautery to heat-seal the ends is the best way to prevent pregnancy, as the vas deferens can heal in rare circumstances.  

The surgeon then closes the tiny hole (incision) with either a suture or a steri-strip, an adhesive bandage that holds the hole closed.  

Recovering After a Vasectomy

Recovering After a Vasectomy

While many men fear that a vasectomy will be a very painful procedure and recovery, there is no pain during the procedure itself. After the procedure, bruising and soreness is normal, but that can usually be controlled with mild pain medication and a cold compress as necessary. Most men take a day or two off of work and are able to return to normal activity within a week, very vigorous activity, such as running, may take an extra few days. 

Wearing an athletic supporter or snug underwear during the first few days of recovery can help prevent movement of the scrotum and helps minimize pain. While an ice pack may help ease the swelling, be sure to avoid placing it directly against the skin. Wrap the ice in a towel or a pillowcase before placing it against the skin to prevent “burning” the skin. A bag of frozen peas or corn works very well in this capacity and can be frozen and reused during the recovery period. (Don’t eat the vegetables after using the bag as a cold compress.)

Elevating the scrotum may also help with any soreness. Elevating the area may also help reduce swelling. When sitting or lying down, a washcloth or small towel can be folded and placed under the scrotum to elevate it.  Good incision care is very important at this time.  Over the counter ibuprofen or acetaminophen is a good choice for mild to moderate pain during the first few days after surgery.

The stitches are typically removed in the doctor’s office 7 to 10 days after the procedure. Most men are able to return to active sports and sex at this point; however, birth control is necessary until testing confirms that the surgery was successful and pregnancy is not possible.

Care of Your Incision

Semen Sample/Sperm Count After a Vasectomy

Six to eight weeks after the procedure, a semen sample will be tested for sperm. This is done to make sure the procedure was effective and that no sperm is present. In some cases, it may take longer than 8 weeks for the semen to have no sperm in it, but by 3 months, the semen should be completely free of sperm.

While television shows often show a man being led to a small room and given pornography in order to produce a semen sample for testing, this is not usually the case. In most circumstances, the container for the semen is sent home so the sample can be collected in the privacy of the home. The sample must then be taken to the lab for testing within one hour of collection. It is important to know the hours of the lab or doctor’s office, so it will be open and able to accept the sample for testing immediately.

When collecting a semen sample, it is important that the semen not come in contact with spermacide, a type of birth control that kills sperm. It is often present in condoms and other types of contraceptives.

Once the sample is taken to the lab, it will be studied under a microscope. When the sample is completely free of sperm, the surgery is considered effective and birth control is no longer needed to prevent pregnancy.

After Vasectomy: Testing To Confirm Sterility

In the months after a vasectomy, a semen sample will be needed for testing. Three months after the surgery, the semen should have no sperm in it. If there is any sperm in the sample, the man remains fertile and can father children. Testing will be repeated at a later date to see if sperm remains in the semen. Until the semen is completely free of sperm, another form of birth control should be used to prevent pregnancy.

In rare cases, pregnancy can result after a vasectomy and a semen sample that is negative for sperm. In these cases, pregnancy usually results because the two sides of the vas deferens can actually heal together and reform the path out of the body. This is the least likely to happen when the surgeon uses a procedure that cauterizes the cut ends of the vas deferens, leaving scar tissue that makes it much more difficult to form this type of self-repair. This type of cautery can be done with both the traditional and no scalpel (NSV) approach.

In the vast majority of cases, a vasectomy is one of the most reliable forms of birth control. Pregnancy is far more likely to result from not waiting long enough for the active sperm to leave the body following the procedure than from a failure of the surgery. In other words, assume you are 100% fertile until your semen sample is found to have no sperm.


Facts About Vasectomy Safety. National Institutes of Health.

Vasectomy. National Institutes of Health

Vasectomy. Planned Parenthood of Central North Carolina

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