The No-Scalpel, No-Needle Vasectomy

In my office, I perform vasectomy as a simple way of contraception. It remains one of the most effective forms of birth control and is now easier to do with minimal discomfort to patients.  The reason is a new method called the no-scalpel, no-needle vasectomy. Let’s learn a little about vasectomy.

 

Worldwide about 50 million men have had a vasectomy – it is a commonly used form of contraception in many parts of the world. Each year, about 500,000 men in the US get a vasectomy, with rates higher among more educated and higher-income men.  Among married couples in this country, only female sterilization and oral contraception are relied upon more often for family planning.


What is vasectomy?

Vasectomy is a simple operation that makes a man sterile, or unable to father a child.  The procedure blocks or cuts the tubes that carry sperm from the testicles.  After vasectomy, sperm cannot be mixed with semen, which is the fluid a man ejaculates during orgasm.  Semen is not made in the testicles, and vasectomy doesn’t affect the semen or how it is ejaculated.  It’s just that after vasectomy, a man’s semen contains no sperm, so he cannot make a woman pregnant.

How is vasectomy done?

There are 2 main techniques for performing vasectomy, but all of them block or cut the 2 tubes, called the vas deferens, that carry sperm cells from the testicles: 

  • Conventional vasectomy.  In this approach, a physician makes 1 or 2 small cuts in the skin of the scrotum, which has been numbed with a local anesthetic. The vas deferen is cut, and a small piece may be removed. Next, the doctor ties or clips the cut ends and sews up the scrotal incision. The procedure is then repeated on the other side.

  • No-scalpel vasectomy.  An improved vasectomy method, devised by a Chinese surgeon, has been widely used in China since 1974. This so-called nonsurgical or no-scalpel vasectomy was introduced into the United States in 1988, and many doctors are now using the technique here. 

We use a refinement of the no-scalpel method that doesn’t involve any needles at all.  An instrument called a MadaJet delivers a stream of anesthetic so fine that it penetrates the skin and numbs a dime-sized patch of scrotal skin.

Then the doctor feels for the vas under the skin of the scrotum and holds it in place with a small clamp. A special instrument is used to make a tiny puncture in the skin and stretch the opening so the vas can be cut and tied. This approach produces very little bleeding, and no stitches are needed to close the punctures, which heal quickly by themselves. The newer method also produces less pain and fewer complications than conventional vasectomy.


Does vasectomy affect orgasm or masculinity?

No. Vasectomy has no effect on a man’s sex drive, testosterone levels, erections, orgasms, or how much semen he ejaculates. Many men who have undergone the procedure, and their partners, find that sex is more spontaneous and enjoyable because they no longer have the inconvenience or concerns about contraceptives such as condoms or a diaphragm. They also don’t have to worry about an accidental pregnancy.


What are the major advantages of vasectomy?

  • A one-time, relatively inexpensive cost that is often covered by insurance or state grant programs
  • More dependable than any other form of birth control
  • Less expensive and poses less of a medical risk than female sterilization
  • Easier to reverse than female sterilization
  • Eliminates risks to female partner of oral contraceptives or IUDs
  • Freedom from hassle and worry of contraception

Are there any disadvantages to vasectomy?
One of the main advantages of vasectomy—that it is relatively permanent—can also be a disadvantage if a man later decides he wants to father children. Reversing a vasectomy is possible, but it is a difficult and expensive operation with no guarantee of success.


It is possible to store semen in a sperm bank to preserve the possibility of producing a pregnancy at some future date. However, doing this is costly, and the sperm in stored semen do not always remain healthy and able to cause pregnancy. For all of these reasons, doctors advise that vasectomy be undertaken only by men who are prepared to accept the fact that they will no longer be able to father a child. The decision should be considered along with other contraceptive options. Men who are married or in a serious relationship should also discuss the issue with their partners.


Although it is extremely effective for preventing pregnancy, vasectomy does not offer protection against AIDS or other sexually transmitted diseases. Consequently, it is important that vasectomized men continue to use condoms, preferably latex, which offer considerable protection against the spread of disease, in any sexual encounter that carries the risk of contracting or transmitting infection.


Are there any risks to the procedure?

Any medical procedure, no matter how minor, carries some degree of risk. No-scalpel vasectomy is no different, though the risks are quite low and are lower than conventional vasectomy. Here are the complications that are possible (though very unlikely) to occur:

  • Bleeding or bruising (typically minor)
  • Infection
  • Vasectomy failure (very rare, but it is possible for sperm to cross the void between the two blocked ends of the vas deferens)
  • Sperm granuloma (a hard, pea-sized lump that results from sperm leaking from the cut end of the vas deferens—these are not harmful and typically disappear with time)
  • Congestion (a sense of fullness or pressure in the scrotum, which typically resolves itself with time)

How do I prepare for a no-scalpel vasectomy?
Even though the no-scalpel method is very quick and simple, there are some things you need to do before the procedure:

  • Don’t take any aspirin-containing medication for five days before the procedure
  • Carefully shave the underside of the penis and at least the front wall of the scrotum a day or two before the procedure (this may be easier during a bath)
  • Don’t use any powder or deodorant in the genital area on the day of your procedure
  • Eat a normal breakfast or lunch before your procedure
  • If possible, arrange to have someone drive you home (driving itself is not a problem, but if you had to fix a flat tire or if you were in an accident, you might have complications)
  • Plan to do nothing but recline at home on the evening of the vasectomy

Does vasectomy affect orgasm or masculinity?
No. Vasectomy has no effect on a man’s sex drive, testosterone levels, erections, orgasms, or how much semen he ejaculates.  Many men who have undergone the procedure, and their partners, find that sex is more spontaneous and enjoyable because they no longer have the inconvenience or concerns about contraceptives such as condoms or a diaphragm.  They also don’t have to worry about an accidental pregnancy.


What can I expect after a no-scalpel, no-needle vasectomy?

You can resume light activity the day after a vasectomy, and full activity two days after the vasectomy. The vast majority of men have little or no post-procedure pain. Only about 1 in 1000 men will have enough discomfort to request a prescription pain medication.

How soon can I have sex?

You can have sex two days after your vasectomy, but you must continue to use some type of contraception until a semen test confirms that you are sterile! It generally takes about 8 weeks and 20 ejaculations to completely clear out the sperm that remain in the reproductive system after the vas deferens have been cut, but a few men will not be sperm-free for 5 or 6 months.

 

Added to Sex and Relationships, Men's Health on Thu 11/12/2009