Section Resources

Vasectomy

We understand that you desire sterilization by vasectomy. This operation prevents the sperm from leaving your body and thereby renders you incapable of fathering a child. In order to more completely understand what is done during such an operation, you must have knowledge of the male genital structure and function.

Sperms are manufactured by the testicles, which also produce male hormones, especially testosterone. Each testicle has a tubular system (epididymis and vasdeferens) through which sperm travel to and eventually reach the penis/urethra.

The sterilization operation mentioned above - vasectomy- is done by making two small cuts in the skin at the top of the scrotum (testicle sac), exposing the vasa, which carry the sperm. A small piece of the tube is removed and the open ends are cauterized and often clipped off. The skin openings are then stitched closed. Anesthesia will be managed by injection of a "local" drug (Xylocaine) into the area where the operation is done.

If desired, an additional intravenous injection of a sedative (Versed) may be given before the vasectomy. Patients who are very nervous or have felt queasy, faint or nauseated during other medical exams or procedures, should strongly consider Versed. Versed will not be billed to your insurance and a $40 charge will be due and payable at the time of your procedure. If you are being sedated, you are required to bring a driver with you, the day of the procedure; otherwise, a driver is still a good idea, but not mandatory. The vasectomy procedure usually takes 15 minutes to perform.

After a vasectomy, the amount of semen ejaculated will not be noticeably different. The semen will not contain sperm, although some sperms are still produced in the testes. Sperms produced will "die" at the "roadblock" created by the vasectomy; and will then dissolve.

For several months following the vasectomy, there may still be sperm in your ejaculate, and you may be able to father a child. For one week after the procedure, you should not ejaculate or have intercourse. After the 1st and until the 8th week after the vasectomy, use some other form of reliable contraception (e.g., condoms, diaphragm, or birth control pills. A semen analysis, to be brought to your insurance-directed laboratory (not to our office), will be arranged for eight weeks post-vasectomy. Ejaculated three to four times weekly between the end of the first and the eighth week post-vasectomy. Call us one week after the semen analysis is done to check that your sperm count is zero. Do not rely on the vasectomy until you are told you have a zero "count"! Sometimes, more than one sperm count will be recommended.

The operation, as outlined above, is done as a permanent form of sterilization. There is an operation designed to restore fertility by sewing the cut ends of each tube (vas diferens) back together: the success rate is about two out of three. This being the case, you should not have a vasectomy unless you are absolutely certain that you never again wish to father a child. On very rare occasions, vasectomies done by capable surgeons have failed, and sperm continue to be passed out through the penis during sexual intercourse. This may happen even after sperms have been absent from the semen for a prolonged time, even years. For this reason, the expected goal of the surgery, sterilization, cannot be guaranteed. The "failure" rate is felt to be about 1/2000.

An occasional patient will have difficulty with intercourse following the vasectomy. In some such cases, these patients are emotionally unstable; have strong religious objections to the operation; have been having sexual difficulties prior to the operations; or have been coerced into having the operation. If you fall into any of these categories, you certainly should not have a vasectomy. Even though a vasectomy should have no affect on your ability to have sexual intercourse, this cannot be guaranteed.

Vasectomy is a safe operation. As with any surgical procedure, mild complications including infections, bleeding, swelling and chronic pain may occur. You should know, however, that on very rare occasions, more serious surgical complications have been reported including major bleeding, infection with abscess, and loss of testicular hormonal function/shrinkage of one or both testes. Minor complications are 1/50 to 1/100. Major complications are closer to 1/500.

Wear the gauze dressing until noon the next day, and then you may shower. After 24 hours, the gauze pads are optional. The athletic supporter should be worn for a week. Any stenuous physical activities, such as lifting more than 20 pounds, should be avoided for one week. An occasional pain tablet may be required for post-operative discomfort. Use the prescribed pain tablet; if pain is mild, tylenol alone may suffice.

An office visit is not required post-operatively. The skin sutures will not have to be removed. Our office, however, should be notified of any problem such as unexpectedly severe pain, excessive swelling or discoloration, fever or redness of the skin, or significant drainage of non-clear pus. After hours or on weekends, your local emergency room can assess any serious issues. As mentioned above, a semen specimen will need to be brought into the local laboratory after eight weeks.

Our fee for this procedure is $780.00. This covers the pre-operative interview, local anesthesia, surgery and postoperative care if needed. It does NOT cover sedation (Versed), if requested. Because this is an elective surgery, we do require payment in full at the time of the surgery. HMO patients, who have referral/authorization, are responsible only for their office visit and procedure co-payments and Versed cost, if used. PPO patients need to verify that this procedure is covered benefit; co-payments will be collected the day of your procedure (if applicable). You are also responsible for laboratory fees (billed to you by the laboratory) if post-vasectomy semen analysis is NOT a covered laboratory charge, through your insurance.

How Dr Freedman Does A Vasectomy

Dr. Freedman has done vasectomies for over 20 years. His technique has evolved over the last 10 years into one which works well and has few risks. Each surgeon/urologist needs to develop a style of operating which seems "right" for him or her.

His method is a combination of steps used in the conventional vasectomy and the no scalpel vasectomy. Two very small incisions are made, one on each side at the top of the scrotal sac. The no scalpel instruments are utilized for finding and dividing the vas, but he still uses cutting to get through the skin (as apposed to using the no scalpel sharp clamp)

A small piece of vas is actually removed from both sides. The inner canal of the vas is cauterized and tiny metallic skin clips (which cause not pain by themselves) secure the vas segments.

The subcutaneous and skin are re-approximated with an absorbable stitch.

Although many urologists try to sell their patients on a no scalpel vasectomy, realize this is marketing - just as you see in all areas of consumerism. There is not proven/scientific evidence that a no scalpel vasectomy is more effective, less painful, or less risky than a traditional vasectomy or a hybrid technique as used by Dr Freedman.

Buyer beware - choose a good doctor to do your vasectomy or any other surgery; and let the doctor choose his best technique.


Vasectomy Reversal

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