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JAMA Patient Page
June 19, 2018

Vasectomy

JAMA. 2018;319(23):2450. doi:10.1001/jama.2018.6514

A vasectomy is a surgical sterilization procedure for men to prevent future fertility.

For pregnancy to occur after intercourse, sperm from a man fertilizes an egg from a woman. In men, sperm is normally transported from the testicles into the ejaculate by the vas deferens, a thin, muscular tube. During a vasectomy, the vas deferens is cut and blocked. This prevents sperm from mixing with the ejaculate fluid. A vasectomy results in ejaculate that does not carry any sperm and therefore cannot fertilize an egg. Because sperm only make up about 10% to 15% of ejaculate volume, after a vasectomy there are usually no perceptible changes to the ejaculate or seminal fluid.

In the United States, vasectomy is the fourth most commonly used birth control method after condoms, oral contraceptive pills used by women, and tubal ligation (a surgery performed for women to prevent pregnancy). Compared with tubal ligation, a vasectomy is more effective, safer, and less expensive.

Prevasectomy Counseling

A vasectomy should be considered a permanent form of sterilization. Although vasectomy reversal is possible, this procedure is more complicated than a vasectomy. Prior to a vasectomy, it is necessary for a patient to be counseled about all possible risks. These include minor pain and a low risk of bleeding and infection. A vasectomy causes no changes in sexual function, erections, orgasm, or libido and does not increase the risk of developing any additional medical conditions such as dementia or prostate cancer, but it does not prevent sexually transmitted infections.

The Vasectomy Procedure

A vasectomy is most often performed by a urologist. It is usually performed in the doctor’s office using local anesthesia, but it may sometimes be performed in the operating room with sedation. A variety of techniques exist to perform a vasectomy, but regardless of the technique used, the principles of vasectomy remain the same. After medication has been given to numb the scrotum, a small opening is made in the skin and the vas deferens is located. The vas deferens is then brought outside of the scrotum, cut, and occluded (blocked). The occluded vas deferens is then placed back into the scrotum. A dissolvable stitch is sometimes used to close the skin. The procedure generally takes 30 minutes or less.

Postvasectomy Follow-up

Most men return to work a few days after a vasectomy, but it is advisable to avoid heavy lifting, straining, or vigorous exercise for 1 week. Additionally, a 1-week period of abstinence (no ejaculation) is recommended. Following a vasectomy, it is still possible for sperm to be in the ejaculate fluid for weeks to months. Because of this, it is necessary to prove the absence of sperm in the ejaculate prior to having intercourse without a backup form of birth control. This is done by a postvasectomy semen analysis. Until this has been proven, there is a chance of pregnancy. Unprotected intercourse should not be attempted until your doctor has told you that you no longer have sperm in your ejaculate.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: Martinez GM, Chandra A, Amba JC, et al. Fertility, contraception, and fatherhood: data on men and women from cycle 6 (2002) of the 2002 National Survey of Family Growth. Vital Health Stat. 2006;23:1.

Trussell J, Lalla AM, Doan QV, et al. Cost-effectiveness of contraceptives in the United States. Contraception. 2009;79:5.

American Urological Association vasectomy clinical guideline. Published 2012; amended 2015. http://www.auanet.org/guidelines/vasectomy-(2012-amended-2015).

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