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Vasectomy

For couples who want to enjoy sexual freedom without the inconveniences and risks that come with contraceptives, as well as those who have decided to no longer or never have children, one of the most effective forms of birth control is a vasectomy.

A vasectomy is a form of male sterilization where the vas deferens (the tubes that carry sperm) are cut and tied, preventing sperm from leaving the testes, thereby eliminating the chances of fertilization and pregnancy. This birth control procedure is established, safe and said to be nearly 100% effective, with the chances of pregnancy cut down to about 1:1000.

How Is a Vasectomy Performed?

In a regular vasectomy, the scrotum is immobilized using mild sedation. Once this is done, the surgeon makes a centimeter-wide incision on the upper part of the scrotum, and cuts and ties the vas deferens. The cut can be closed with only one or two sutures. The entire process takes less than 30 minutes.

An alternative method to the conventional vasectomy is a no-scalpel version where the vas deferens are cut or tied through a small puncture in the scrotum. Because of its small size, the hole will not need stitches after the operation. It is also found to significantly reduce the chance of infection, pain and swelling.

After the operation, the patient may feel some slight discomfort or soreness, but this will diminish completely after a few days.

An important thing to note is that vasectomy doesn't immediately rid the semen of sperm, which resides distal to the vasectomy site, so there's still a need to continue using other birth control methods for up to 3 months after the surgery. Usually, it would take 20 ejaculations before the patient is cleared to have unprotected sex. The attending physician normally conducts follow-up semen analysis to check whether sperm are still present.

Another thing to understand is that vasectomy is effective only in preventing pregnancies, and not sexually transmitted diseases.

Risks of Vasectomy

Vasectomy is a safe and established procedure, especially in experienced hands. However, in rare cases, there may be side effects such as:

  • Blood in semen
  • Bruising
  • Infection
  • Pain
  • Swelling

Contrary to popular belief, a vasectomy will not affect the man's testosterone hormone production, libido, sexual performance and other masculine features. It also does not lead to a higher chance of heart disease, prostate or testicular cancer, or other health issues.

Can It Be Reversed?

Individuals and couples are strongly recommended to think very carefully whether to have a vasectomy or not. This is because the operation itself is generally regarded as a final or permanent birth control method.

However, it is now possible to reverse or undo vasectomies. Reasons for doing so may be personal (change of heart or remarriage) or, in rare cases, medical (post-vasectomy pain treatment).

Vasectomy reversal, albeit a much more complex procedure than vasectomy taking about 3 hours using a microscope, is generally safe and poses few to no complications under the skillful hands of an experienced urology surgeon. The success rate of a vasectomy reversal ranges from 40 to 90 percent. The longer the period between a vasectomy and reversal, the less likelihood for reversal success.

How Is a Vasectomy Reversal Done?

Vasectomy reversal is an outpatient procedure that is performed under general anesthesia. It usually takes about 2 to 3 hours using a microscope, and can be done using two methods:

  • Vasovasostomy – The two ends of the vas deferens that were cut previously during the vasectomy are sewn back together.
  • Vasoepididymostomy – The vas deferens is attached directly to the epididymis (tube that stores and carries sperm from the testes).

During the procedure, the surgeon first creates an incision on the scrotum and takes a fluid sample from the vas deferens. If sperm is present in the fluid, a vasovasostomy is performed. If there is none, or if scar tissue is present in the vas deferens, which can block sperm passage, vasoepididymostomy is done instead. Sometimes both methods are performed, vasovasostomy on one testicle and vasoepididymostomy on the other, depending on which technique works best to regulate smooth sperm flow.

Once the reversal procedure is done, the incision is stitched close and the scrotum is bandaged to stop bleeding. The stitches should dissolve within 10 days. Full recovery can take up to two weeks.

Following the surgery, the patient is advised to refrain from strenuous physical and sexual activities for up to 4 weeks and wear tight underwear to prevent the incision from reopening. Cold compresses and non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce initial swelling and ease pain.

Follow-up appointments after the vasectomy reversal will enable the doctor to check the patient’s semen for sperm. Under normal circumstances, sperm should appear in the semen after a few months or within a year.

Dr Michael Wong is a medical director and senior consultant urologist specializing in the complex medical areas of male and female fertility, and female bladder and pelvic floor issues. He is also known for his success in reversal vasectomies. For more information or appointments, please contact our 24-hour hotline at (+65) 6535 8833 or message us at email@drmichaelwong.com.

Dr Michael Wong

Medical Director & Senior Consultant Urologist
FAMS (Urology), FICS (USA), FRCS (Edinburgh),
M Med (Surgery), MBBS (S’pore)

Dr Michael Wong is a Senior Consultant Urologist who is internationally recognized for his surgical expertise and academic contribution to the field of Urology, in particular the subspecialized field of minimally invasive Endourology.

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