Vasectomy

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is vasectomy (male sterilisation).

Vasectomy is a minor operation that stops men being able to get a woman pregnant. The tubes that carry sperm from a man's testicles to the penis are cut blocked or sealed. Vasectomy is usually carried out under local anaesthetic, and takes about 15 minutes.

This prevents sperm from reaching the seminal fluid (semen), which is ejaculated from the penis during sex. There will be no sperm in the semen, so a woman's egg can't be fertilised. The man can still ejaculate.

At a glance: facts about vasectomy

In most cases, vasectomy is more than 99% effective. Out of 2,000 men who are sterilised, 1 will get a woman pregnant during the rest of his lifetime.

Male sterilisation is considered permanent. Once it's done, you don't have to think about contraception again.

You need to use contraception for at least 8 weeks after the operation, because sperm stay in the tubes leading to the penis.

Up to 3 semen tests are done after the operation, to make sure that all the sperm have gone.

Your scrotum (ball sack) may become bruised, swollen or painful. Some men have ongoing pain in their testicles.

As with any surgery, there's a slight risk of infection.

Reversing the operation isn't easy, and is not available on the NHS.

Vasectomy doesn't protect against sexually transmitted infections (STIs). Use a condom to protect yourself and your partner against STIs.

How vasectomy works

Vasectomy works by stopping sperm from getting into a man’s semen. This means that when a man ejaculates, the semen has no sperm and a woman’s egg cannot be fertilised.

How vasectomy is carried out

Vasectomy is a quick and relatively painless surgical procedure. The vas deferens (tubes that carry sperm from a man's testicles to the penis) are cut, blocked or sealed with heat. In most cases, you'll be able to return home the same day.

Most vasectomies are carried out under local anaesthetic. This means that only your scrotum and testicles will be numbed, and you'll be awake for the procedure. You will not feel any pain but it may feel slightly uncomfortable.

Less often, a general anaesthetic may be used. This means that you'll be asleep during the procedure. A general anaesthetic may be used if you are allergic to local anaesthetic or have a history of fainting easily. Most people will only need a local anaesthetic.

Depending on where you live in Scotland, you may get a vasectomy at:

• your local GP practice
• a hospital as a day-patient appointment
• a sexual health clinic

You can also go to a private clinic.

No-scalpel vasectomy

This is a newer technique but is now the commonest method. No-scalpel vasectomy is carried out under local anaesthetic.

The doctor will feel the vas deferens underneath the skin of your scrotum and then hold them in place using a small clamp. A special instrument makes a tiny puncture hole in the skin of the scrotum. This allows the surgeon to access the vas deferens without needing to cut the skin with a scalpel. The vas deferens are then closed either by being tied or sealed with heat.

During a no-scalpel vasectomy, there will be little bleeding and no stitches. The procedure is less painful and less likely to cause complications than a conventional vasectomy.

Conventional vasectomy

During a conventional vasectomy, the skin of your scrotum is numbed with local anaesthetic. The doctor makes 2 small cuts, about 1cm long, on each side of your scrotum.

The incisions allow your surgeon to access the vas deferens. Each tube is cut and a small section removed. The ends of the tubes are then closed, either by tying them or sealing with heat.

The incisions are stitched, usually using dissolvable stitches, which will disappear naturally within about a week.

Before you decide to have a vasectomy

Your doctor will ask about your circumstances and give information and counselling before agreeing to the procedure.

You should only have a vasectomy if you're certain that you do not want to have any, or any more, children. If you have any doubts, consider another method of contraception until you're completely sure.

You shouldn't make the decision about having a vasectomy after a crisis or a big change in your life. For example, if your partner has just had a baby, or has just terminated a pregnancy.

If you have a partner, discuss it with them before deciding to have a vasectomy.

You can have a vasectomy at any age. If you're under 30, particularly if you do not have children, your doctor may be reluctant to perform the procedure. This is because people under 30 have higher rates of regret about having the procedure.

A doctor has the right to refuse to carry out the procedure if they do not believe that it is in your best interests. You have the right to ask for a second opinion.

How do I get the operation?

Speak to your GP or ask at your local sexual health clinic about vasectomies in your area. They can tell you what the local arrangements are.

Recovering after the operation

It’s common to have some mild discomfort, swelling and bruising of your scrotum for a few days after the vasectomy. If you have pain or discomfort, you can take painkillers, such as paracetamol. Contact your GP for advice if you're still experiencing considerable pain after taking painkillers.

It’s common to have blood in your semen in the first few ejaculations after a vasectomy. This isn’t harmful.

Underwear

Wearing close-fitting underwear, such as Y-fronts, during the day and at night will help to support your scrotum. It'll also help ease any discomfort or swelling. Make sure you change your underwear every day.

Hygiene

It's usually safe for you to have a bath or shower after your operation. Check with your doctor what is suitable for you. Make sure you dry your genital area gently and thoroughly.

Returning to work

Most men will be fit to return to work 1 or 2 days after their vasectomy. But you should avoid sport and heavy lifting for at least 1 week after the operation. This is to minimise the risk of developing complications. If any symptoms continue after a few days, speak to your GP.

Having sex

You can have sex again as soon as it's comfortable to do so. It's best to wait for a couple of days. You'll still have sperm in your semen immediately after the operation, as it takes time to clear the remaining sperm in your tubes. It takes an average of 20 to 30 ejaculations to clear the tubes of sperm. You'll need to use another method of contraception until you're told that it's OK to stop.

Once the operation has been carried out successfully and semen tests have shown that there is no sperm present, long-term partners may not need to use other forms of contraception.

A vasectomy does not protect against HIV infection or any other STIs, so you should still use condoms with any new partner.

How will I know if my vasectomy has worked?

After the vasectomy, there will be some sperm left in the upper part of the vas deferens tubes. It can take more than 20 ejaculations to clear these sperm from the tubes so, during this time, there is still a risk of pregnancy.

Until it has been confirmed that your semen is free of sperm, you should continue to use another form of contraception.

At least 8 weeks after the procedure, you'll need to produce a sample of semen, which will be tested for sperm. This will also help to identify the rare cases in which the tubes naturally rejoin themselves. Once tests have confirmed that your semen is free of sperm, the vasectomy is considered successful. You can stop using extra contraception.

A few men continue to have small numbers of sperm in their system, but these sperm do not move. They are known as non-motile sperm. If you're one of these men, your doctor will discuss your options with you. The chances of making your partner pregnant may be low enough to consider the vasectomy successful. Or you may be advised to have further tests or consider other options.

Is reversal possible?

It's possible to have a vasectomy reversed but this is not always successful. You have a better chance if it is done soon after the vasectomy.

Reversal is not available on the NHS and the operation is expensive if done privately. If a reversal is carried out within 10 years of your vasectomy, the success rate is about 55%. This falls to 25% if your reversal is carried out more than 10 years after your vasectomy.

Even if a surgeon manages to join up the vas deferens tubes again, pregnancy may still not be possible. This is why you should be certain before going ahead with the vasectomy. Your doctor can help you to make your decision.

Advantages and disadvantages of vasectomy

Advantages of a vasectomy are:

• the failure rate is only 1 in 2,000 – out of 2,000 men who have a vasectomy, only 1 will get a woman pregnant in the rest of his lifetime
• there are rarely long-term effects on your health
• it does not affect your hormone levels or sex drive
• it will not affect the spontaneity of sex or interfere with sex
• it may be chosen as a simpler, safer and more reliable alternative to female sterilisation

Disadvantages of a vasectomy are:

• it doesn’t protect against STIs
• it’s difficult to reverse, and reversal may not be available on the NHS
• you need to use contraception after the operation until tests show your semen is free of sperm – if your semen contains sperm, you could make your partner pregnant
• complications can occur

Risks of vasectomy

Most men feel sore and tender for a few days after the operation, and will usually experience some bruising and swelling on or around their scrotum.

However, in some cases, a vasectomy can cause more serious problems.

Haematoma

A haematoma is when blood collects and clots in the tissue surrounding a broken blood vessel. Following a vasectomy, you may develop a haematoma inside your scrotum.

Haematomas are mostly small (pea-sized), but can occasionally be large (filling the scrotum). Rarely, they can be very large. This can cause your scrotum to become very swollen and painful. In severe cases, you may need further surgery to treat the blood clot.

Sperm granulomas

When the tubes that carry sperm from your testicles are cut, sperm can sometimes leak from them. In rare cases, sperm can collect in the surrounding tissue, forming hard lumps that are known as sperm granulomas.

Your groin or scrotum may become painful and swollen either immediately or a few months after the procedure. The lumps are not usually painful. They can often be treated using anti-inflammatory medication, which your GP will prescribe. If the granulomas are particularly large or painful, they may have to be surgically removed.

Infection

After a vasectomy, you may be at risk of developing an infection as a result of bacteria entering through the cuts made in your scrotum. After the operation, it's important to keep your genital area clean and dry to keep the risk of infection as low as you can.

Long-term testicle pain

Some men get pain in one or both of their testicles after a vasectomy. It can happen immediately, a few months or a few years after the operation. It may be occasional or quite frequent, and vary from a constant dull ache to episodes of sharp, intense pain. For most men, however, any pain is quite mild and they do not need further help for it.

Long-term testicular pain affects around 1 in 10 men after vasectomy. The pain is usually the result of a pinched nerve or scarring that occurred during the operation. You may be advised to undergo further surgery to repair the damage and to help minimise further pain.

Testicles feeling full

After a vasectomy, some men may develop the sensation that their testicles are 'fuller' than normal. This is usually caused by the epididymis becoming filled with stored sperm. The epididymis is the long, coiled tube that rests on the back of each testicle. It helps to transport and store sperm.

Any such feelings should pass naturally within a few weeks. However, speak to your GP if you are still experiencing fullness after this time.

Fertility

In a very small number of vasectomy cases, the vas deferens reconnects over a period of time. This means that the vasectomy will no longer be an effective form of contraception. However, it is rare for this to happen.

Common questions about vasectomy

Can I have the operation if I am single?

Yes, but if you're under 30 many surgeons are reluctant to do it in case your circumstances change and you regret it later.

Will it affect my sex drive?

No. After a successful vasectomy, your testicles will continue to produce the male hormone (testosterone). Your sex drive, sensation and ability to have an erection won’t be affected. The only difference is that there will be no sperm in your semen. Your body still produces sperm, but they are absorbed without harm.

Is there any risk of vasectomy causing cancer?

Although prostate cancer and testicular cancer can occur in men who have had a vasectomy, research suggests that vasectomy does not increase your risk of cancer.

Can I use IVF to father a child?

If you have a vasectomy, and then decide later that you want a child, there may be the option of doing so by IVF (in vitro fertilisation). To do this, a surgeon would retrieve sperm from your testicles and use this to fertilise your partner’s egg. However IVF:

• may not be available on the NHS
• can be expensive when done privately
• is not always successful

Can I store sperm in a sperm bank, just in case?

You could but, as with IVF, sperm stored in a sperm bank cannot be relied on to bring about a pregnancy. It can also be expensive as it's not available on the NHS. If you're not sure about wanting children in the future, don't have a vasectomy.

Where can you get contraception?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. You can get contraception, and information and advice about contraception, at:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraception and STI testing services
• some young people’s services (phone 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you're safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.