Vasectomy

A vasectomy is an effective, safe and permanent form of contraception. It is a surgical operation in which the tubes that carry sperm are cut or blocked. These tubes are called the vas deferens or the “vas” – as in vas-ectomy.

Sperm is produced in the testes. It then moves to a tightly coiled tube at the back of the testis called the epididymis, where it matures for another 10 days . This is like a training ground for sperm – the epididymis is where they learn to swim, become “motile”, and undergo morphological changes that would allow them to attach to and penetrate an egg. During orgasm, sperm is mixed with fluids to create semen. Muscular contractions forces the semen out of the epididymis, through the vas deferens and into the penis from which it then ejaculates. The vas deferens can be cut so that sperm can't make the journey from the epididymis to the penis.

A vasectomy is a simple surgery that usually takes less than 30 minutes, where at least one side of each vas deferens is occluded (sealed or tied).

Traditional Vasectomy

In a traditional vasectomy, one or two incisions are made to the scrotum – either one central incision of around 1 – 2” in length, or smaller incisions on each side. The vas deferens are exposed through the incisions, and the tube is cut. Sometimes sections of the vas deferens are removed. Both cut ends of the tube are tied or stapled to seal them, and the skin of the scrotum is then closed with sutures.

This procedure usually takes ~10 minutes, and 3 days to a week to recover. Complications that may occur during recovery include bleeding, infections and pain. Long-term risks include back-flow pressure that may cause rupture of the epididymis. [1] [2]

Open Ended Vasectomy

In an open-ended vasectomy, only one end of the cut vas tubes is blocked. As with the traditional vasectomy, incisions are made to access the vas deferens. The tubes are then cut but only one end is sealed - the end closest to the penis is closed. The testicular end (or end closest to the epididymis) of the cut vas is left open and held in place with fine sutures to the tissue of the scrotal sac. This allows seminal fluid to flow under the tissue of the scrotal skin where it will be naturally reabsorbed by the body. This method redirects sperm flow to be absorbed under the skin rather than building up and causing back-flow pressure in the tubules. This helps to reduce the risk of long-term complications like blow out (rupture of the epididymis).

Open-ended vasectomy patients reportedly heal faster than traditional vasectomy patients with very little pain and tenderness, though complications of bleeding, infection and pain of the incision site remain a risk [3].

Open-ended vasectomies take ~30 minutes. [1]

No Scalpel Vasectomy

A no scalpel vasectomy is similar to a traditional vasectomy in that both ends of the cut vas tubes are sealed off (as opposed to an open-ended vasectomy when only one end is sealed, allowing seminal fluid to flow naturally and be reabsorbed by the scrotal tissue). Instead of the traditional method of the scrotum being opened by incision, the vas is instead grasped through the scrotal skin. Another instrument is then used to make a very small perforation in the skin over the vas and the tube is pulled through this tiny incision. The vas is cleaned, nerves are removed and the tube is cut, cauterised, and separated. Sometimes a small section of the vas is removed or a small piece of connective tissue is placed between the cut ends to prevent the two side of the vas from growing back together. The vas is then returned to the scrotum and a bandaid is placed over the incision. There is no need for stitches.

The no scalpel vasectomy has a complication rate of less than 1%. Recovery is generally very quick and here is no bleeding or scarring of the scrotum as in the traditional vasectomy [2] [3].

Other Procedure Differences

No Needle Procedure

A no needle vasectomy refers only to the method of delivery of anaesthesia. Normally, a local pain killer is delivered via injection around the vas and the scrotal skin. In a no-needle procedure, the local anaesthetic is delivered via a high pressure injector that pushes the medication through the skin and into the vas. If you have issues with needles, ask your surgeon if they offer “no needle” options for anaesthetic.

 Laser Vasectomy

A laser vasectomy doesn't different very greatly from a traditional vasectomy, except that a laser is used to make the incision to the scrotum and/or to cut the vas tubes. An incision is still required to access the vas deferens.

Post Vasectomy Pain Syndrome

Post vasectomy pain syndrome is a chronic condition of >3 months of scrotal pain caused by a variety of possible complications of vasectomy. It affects 1 - 2% of vasectomy patients and causes pain that can be mild to so severe that it is debilitating [4]. Here's what can go wrong in these very rare cases:

Back Pressure & Blowout. In most cases, there is greater pressure on the testicular side of the vas deferens. This causes back pressure to push against the other structures of the testes – the epididymis, efferent ducts and seminiferous tubes are often affected, causing pain and increased thickness in the area. The vas back-pressure can cause a “blowout” or rupture to the epididymis [5].

Sperm Granulomas. In some cases, sperm leaks from the cut vas deferens and forms lesions called sperm granulomas in the scrotum. These are only occasionally painful. In some cases they can actually help to relieve pain if placed in the right position to relieve back pressure [1]. Open-ended vasectomy procedures are meant to reduce risk of sperm granulomas by directing sperm into the scrotum skin layers, but in some cases this backfires and causes painful granulomas anyway. [5]

Trapped Nerves. Nerves can become trapped between any scar tissue that develops after the vas tubes are cut or the scrotum is cut. Trapped nerves send pain signals and the pain can become more severe during sex and ejaculation as muscle contractions lift the testes.  [4] [5]

Vasectomy Reversal

Reversing a vasectomy is possible in some cases, but fertility may not be fully restored in all cases, it can be a very expensive procedure and comes with more risk of complications and side effects.

It may be easier to reverse an open-ended vasectomy than a traditional or no-scalpel vasectomy.

Recovery – What To Expect

The surgeon who performs the procedure will give you personalised advice on how to best care for yourself after a vasectomy. Generally, recovering from traditional and open-ended vasectomy procedures includes 2 – 3 days of bed (or couch) rest with your feet elevated, and no showering for 48 hours to allow the incision to heal and fight infection. No-scalpel vasectomy is easier to recover from but you should still take it easy.

• Minor pain generally occurs after the local anaesthetic wears off a couple of hours after the procedure. This can feel like lower abdominal cramps and discomfort in the scrotum. Ask your surgeon what pain killers to take if the pain is severe – some pain killers like aspirin and ibuprofen can increase risk of incision bleeding.
• Swelling and bruising are common at the site of incision for traditional and open-ended vasectomies.
• Infection is reported in only 3.4% of vasectomy patients, and is much lower for no-scalpel patients. Most infections are localised and easily treated, so keep an eye out for any discolouration, extreme swelling or pain of your scrotum [3].
• Libido and sex drive will generally return to normal  improve once pain and swelling have resolved. It's advised to wait at least 1 week before having sex after a vasectomy.
• Erections and orgasms should remain unchanged. There may be a general ache in the testicles during arousal but for most people this passes within 1 – 3 months after vasectomy. Delaying ejaculation for at least a week after your vasectomy can reduce the risk of developing sperm granulomas [2] [3].
• Mood fluctuation can occur following a vasectomy. You may experience symptoms of sadness, stress, and irritability. Some patients may experience depression. The best way to reduce risk of these mood changes is to learn as much as you can about the procedure beforehand [3].

NOTE: You will not be sterile directly after a vasectomy and should use other forms of birth control until your sperm count reaches zero. Ejaculate will contain any sperm that remain in the vas deferens. After 20 ejaculations or 3 months, your doctor will check your sperm count. If there is still sperm present, you will be asked to submit samples until your sperm count reaches zero and the doctor can declare you sterile.

Natural Remedies for Vasectomy Aftercare

Kick Back & Recline

Rest is absolutely essential for vasectomy aftercare. The body has been through a big shock, and you may also be feeling the effects emotionally. Reclining in the best position to maintain – not just sitting, but leaning back with your legs up higher than your hips. This is the best position to take pressure off the testicles.

Apply an ice pack regularly if your surgeon has recommended it to reduce swelling and ease pain.

Arnica

Arnica is a herb and its homeopathic preparation is said to reduce bruising and enhance recovery from tissue injury. The efficacy of homeopathy is a contentious issue, but recent studies are showing that homeopathic preparations of Arnica montana can stimulate gene expression to promote tissue healing and repair [6]. There are no adverse effects to taking arnica homeopathic remedies, so it might be worth a shot.

Oral formulations come as small pilules or pellets. Tip 5 pilules directly into the mouth and hold them under the tongue until dissolved, three times a day for at least the first three days. Do not eat or drink anything strong smelling or brush your teeth for 30 minutes before & after taking homeopathic remedies.
Arnica cream or Traumeel can be applied to the area around the site of the incision or no-scalpel perforation and may reduce pain, inflammation, and boost healing processes [6].

Zinc

Zinc is a key mineral for healing and immune function. It is required for the building of proteins to suture wounds together, and for the proliferation of immune cells to stave off infection.  It is also said to have an affinity for the testes as zinc is highly concentrated in the testes. A dose of 60mg – 90mg of zinc for three weeks may help to reduce risk of infection, enhance healing, and boost the immune system [7].

References

1. Labrecque, M., et al. (2004) Vasectomy surgical techniques: a systematic review. BMC Med., 2, 21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC428590/
2. Cook, L. A., et al. (2014) Scalpel versus no-scalpel incision for vasectomy. Cochrane Database, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004112.pub4/full
3. Lowe, G. (2016) Optimizing outcomes in vasectomy: how to ensure sterility and prevent complications.
4. Tan, W. P. & Levine, L. A. (2016) An overview of the management of post-vasectomy pain syndrome. Asian J Androl., 18:3, 3232 – 337. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854072/
5. Sinha, V. & Ramasamy, R. (2017) Post-vasectomy pain syndrome: diagnosis, management and treatment options. Transl Androl Urol., 6:1, S44 – S 47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503923/
6. Marzotto, M., et al. (2016) Arnica montana Stimulates Extracellular Matrix Gene Expression in a Macrophage Cell Line Differentiated to Wound-Healing Phenotype. PLoS ONE, 11:11. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166340
7. Kogan, S., et al. (2017) Zinc and Wound Healing: A Review of Zinc Physiology and Clinical Applications. Wounds, 29:4, 102 – 106. http://www.woundsresearch.com/article/zinc-and-wound-healing-review-zinc-physiology-and-clinical-applications