Vasectomy (male sterilisation)

There are 2 types of vasectomy:

• a conventional vasectomy using a scalpel (surgical knife)
• a no-scalpel vasectomy

In Devon & Cornwall, most vasectomies are performed by specialist GPs in local surgeries or clinics and employ the no-scalpel technique.

Conventional vasectomy

The doctor first numbs your scrotum with a local anaesthetic. They then make 2 small cuts in the skin on each side of your scrotum to reach the tubes that carry sperm out of your testicles (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 them using heat.

The cuts are stitched, usually using dissolvable stitches that go away on their own within about a week.

No-scalpel vasectomy

The doctor first numbs your scrotum with local anaesthetic. They then make a tiny puncture hole in the skin of your scrotum to reach the tubes. This means they don’t need to cut the skin with a scalpel.

The tubes are then closed in the same way as a conventional vasectomy, either by being tied or sealed.

There’s little bleeding and no stitches with this procedure. It’s thought to be less painful and less likely to cause complications than a conventional vasectomy.

Under exceptional circumstances a vasectomy may be performed in a hospital setting by a urologist but this is increasingly uncommon due to the routine nature of the minor surgery involved.

There are few absolute contraindications to vasectomy however, relative contraindications include the following:

• Anatomical abnormalities, such as the inability to palpate (feel) and mobilize both vas deferens (sperm tubes) or large hydroceles or varicoceles.
• Past trauma and scarring of the scrotum.
• Acute local scrotal skin infections.

In cases of doubt a specialist urological assessment may be necessary.

Possible complications following vasectomy include:

• Haematoma – a collection of blood inside the scrotum.
• Sperm granulomas – hard lumps caused by sperm leaking from the tubes.
• Infection.
• Testicular pain (rare).

The vas deferens is a tube that carries sperm out of each testicle and these tubes can also reconnect, but this is very rare.

If you are considering having a vasectomy, remember that, for the majority of patients, it is quick, safe and effective.

It is important for men to be aware that vasectomy is not successful immediately. So, you will need to continue using your normal method of contraception until you have had a semen sample (about 12 weeks after the procedure) checked to ensure there are no sperm in it. Once you’re informed that the sample is clear, you can stop using contraception.

If you are considering having a vasectomy it is important to think carefully about whether you are certain that you do not want any more children. It is a major life decision that should not be taken lightly and should always be made with your partner (if you have one).

Once you have decided to proceed you should initially contact your GP to discuss the local arrangements for performing vasectomy.

Your GP may suggest a consultation with both you and your partner although it’s not a legal requirement to get your partner’s permission.

Your doctor will want to be satisfied that you (and your partner) have considered all the “what if…” scenarios, such as “what if one of my existing children dies” or “what if my relationship breaks down and I want to start a new relationship with someone else”. These can be difficult/uncomfortable topics to consider but given the permanent nature of surgical sterilisation it is important to make a fully informed decision.

Your doctor will ask about your circumstances including your current relationships, any existing children and any underlying health conditions as well as provide information about the procedure. They may also want to perform a physical examination to ensure there are no underlying anatomical issues that may affect the procedure.

You should only have a vasectomy if you’re certain you don’t want any more children or don’t want children at all.

Once you have had a vasectomy, it’s very difficult to reverse it, so consider all options and use another method of contraception until you’re completely sure.

Factors leading to an increased likelihood of regret following vasectomy:

• Under age 30 years.
• Few or no children.
• Unstable relationship.
• Diminished mental capacity.
• Suspected coercion.
• Insufficient time to consider decision.

Your GP can refuse to carry out the procedure, or refuse to refer you, if they don’t believe it’s in your best interests.

Please note In Cornwall vasectomy is not routinely funded for men under the age of 30 years.

It’s common to have some mild discomfort, swelling and bruising of your scrotum for a few days after the vasectomy. You can take painkillers, such as paracetamol, to help.

See a GP if it’s still painful 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

Wear tight-fitting underwear or athletic support day and night for the first few days to help support your scrotum and 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’s suitable for you. Make sure you dry your genital area gently and thoroughly.

Returning to work

You can usually return to work 1 or 2 days after a vasectomy but should avoid sport and heavy lifting for at least a week after the procedure to prevent complications. See a GP if you still have symptoms after a few days.

Having sex

Avoid sexual activity for at least 7 days after having a vasectomy.

You’ll need to use another method of contraception for at least the first 8 to 12 weeks, as it can take this long to clear the remaining sperm in your tubes.

How long this takes varies from man to man. There’s still a risk of pregnancy during this time.

How will I know if my vasectomy has worked?

About 12 weeks after the procedure, you’ll need to produce a sample of semen, which will be tested for sperm.

Once tests have confirmed that your semen is sperm-free, the vasectomy is considered successful, and you can stop using additional contraception.

Some men may need 2 tests. But until it’s been confirmed that your semen is free of sperm, continue to use another form of contraception.

A few men will continue to have small numbers of sperm in their system, but these sperm don’t move and are less likely to make your partner pregnant. If you’re one of these men, your doctor will discuss your options with you.

These tests also help to identify the rare cases in which the tubes naturally re-join themselves.

Is reversal possible?

It’s possible to have a vasectomy reversed. But this procedure isn’t funded by the NHS and isn’t always successful. If a reversal is carried out within 10 years of vasectomy, the success rate is about 55%. This falls to 25% if reversal is carried out more than 10 years after. Even if a surgeon manages to join up the vas deferens tubes again, pregnancy may still not be possible, so you should be certain before going ahead with the vasectomy.

Could I use IVF to father a child after vasectomy?

If you have a vasectomy and later decide that you want a child, you may be able to use IVF but this procedure would not be routinely funded by the NHS and may be expensive to do privately. A surgeon would have to retrieve sperm from your testicles and use this to fertilise your partner’s egg. This procedure is not always successful.

Pros:

• a vasectomy is more than 99% effective at preventing pregnancy.
• It is a simple, safe, concealed procedure that can be performed outside of the hospital setting in the majority of cases.
• The resulting contraception doesn’t rely on patient compliance.
• long-term effects on your health are rare.
• it doesn’t affect your hormone levels, sex drive or interfere with sex.
• it may be chosen as a simpler and safer alternative to female sterilisation.

Cons:

• vasectomy doesn’t protect against STIs, so you may need to use condoms as well.
• a vasectomy can’t be easily reversed, and reversals are not routinely funded by the NHS.
• you need to keep using contraception after the operation until tests show your semen is free of sperm.
• possible complications include a collection of blood inside the scrotum (haematoma), hard lumps called sperm granulomas (caused by sperm leaking from the tubes), an infection, or long-term testicle pain (you may need further surgery).
• the vas deferens tubes can reconnect, but this is very rare.

• What’s it like to have a vasectomy? – Patient UK
• Your Contraception Guide – NHS UK

Local NHS Providers:

• St Thomas Vasectomy Clinic, Exeter
• Clare House Vasectomy Clinic, Tiverton
• Sentinel Healthcare Vasectomy Service – Plymouth & Cornwall

What you need to know about vasectomy | MSI Reproductive Choices

Making choice possible – MSI Reproductive Choices | Published: 15 Aug 2019

Thinking about a vasectomy? | Amicus Health

Amicus Health – Clare House | Published: 24 Dec 2020

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