This is a common question and maybe more common for me than other urologists. Why?
I make one mid-line opening using the no scalpel instrument. This is done at the peno-scrotal junction (upper aspect of the scrotum in the middle.) Through this opening the right side vas deferens is brought to the surface and the vasectomy is performed. This vas then returns to the right. Same thing is done on the left. (Many urologists make two openings, one on each side.)
What can be confusing to the patient is that days or weeks later he notes the mid-opening that is healed, but he feels a small knot on the left or right. What is going on? Something must be wrong.
The knot is where the body has begun the healing process. This varies from left to right, so that one patient may feel something on the right another the left. Because the opening is in the middle the assumption is that the swelling should be in the middle.
Now you know why it is left or right. The middle is where we access the left and right vas deferens but then it returns to its normal location and the healing process then begins.
If it is a small area and minimal discomfort, then this is the normal healing process and no need to call your doctor.
We offer vasectomy conscious sedation, fair all inclusive pricing for self pay patients and accept most all insurances. Call us when you’re ready to consider a vasectomy. We’ve done thousands.
Before the vasectomy patient can be released by the urologist to have unprotected sex, there must be two consecutive semen specimens with no sperm. It takes about 25 ejaculations to achieve this. We customarily give two specimen containers at the time of the vasectomy and recommend dropping off the specimens at approximately six and eight weeks. Dr. McHugh personally examines all of the specimens with a microscope.
After the initial clearance to proceed with unprotected sex, the chances of the the vasectomy “growing back together” is 1/2000.
In the diagram above you can see why. When Dr. McHugh performs a vasectomy a section of the vas is removed (red), both ends are cauterized (green) and then an absorbable suture (yellow) is placed on both ends as well.
The diagram above also answers another very common question about vasectomies: Does it affect the patient’s sex life?
The answer there is no. As you see, the only thing “tied off” is the vas deferens and this is where the sperm travels. Testosterone, which is responsible for the male’s sex drive, is produced in the testicle, but leaves the testicle in the blood stream not the vas deferens.
So there is a vas deferens between where the sperm exits and how the testosterone exits the testicle!
Is Stevie saying, “SNIPPED?”
From The Atlantic
A handful of studies have tried to pinpoint a number of children that maximizes parents’ happiness. One study from the mid-2000s indicated that a second child or a third didn’t make parents happier. “If you want to maximize your subjective well-being, you should stop at one child,” the study’s author told Psychology Today. A more recent study, from Europe, found that two was the magic number; having more children didn’t bring parents more joy.
In the United States, nearly half of adults consider two to be the ideal number of children, according to Gallup polls, with three as the next most popular option, preferred by 26 percent. Two is the favorite across Europe, too.
Ashley Larsen Gibby, a Ph.D. student in sociology and demography at Penn State, notes that these numbers come with some disclaimers. “While a lot of [the] evidence points to two children being optimal, I would be hesitant to make that claim or generalize it past Western populations,” she wrote to me in an email. “Having the ‘normative’ number of children is likely met with more support both socially and institutionally. Therefore, perhaps two is optimal in places where two is considered the norm. However, if the norm changed, I think the answer to your question would change as well.”
About 500,000 vasectomies are performed each year in the U.S. Although the procedure is cheaper, faster, safer, and more reliable than female sterilization (1 pregnancy in 100), only 9% of sexually active men in the United States get vasectomies, while 27% of women get tubal ligations.
“It can be reversed, right?”
Well, yes. However, just because you can reverse a vasectomy, doesn’t mean that you will achieve pregnancy.
I have done several thousand vasectomies and several hundred microscopic vasectomy reversals, so…here are some things to consider “before” you decide to have a vasectomy.
- We tell patients that they should consider a vasectomy permanent and it is…and it isn’t. It can be reversed but it doing so may or may not result in pregnancy.
- A reversal is not covered by insurance and costs range between $3,000- $15,000.
- It is a surgery, there will be an incision on the scrotal area that has to heal and there may or may not be time out of work or cessation of physical activities for a few weeks.
- If it works, i.e. the opening is reconnected and sperm begins to flow again in the ejaculate, there may not be numbers or quality enough to achieve pregnancy.
- It is a patient endeavor as it takes 3-6 months for the testicles to begin producing sperm again normally and if pregnancy occurs it usually does between 6-18 months.
- The longer the period between the vasectomy and the reversal, the lower the chances of success. Click here for success rates based on the vasectomy interval.
- One must visualize how it would feel to have gone through the surgery, the recovery, and the expense only to be on the side of the percentages where pregnancy does not occur.
So…you don’t want to have a vasectomy unless you are pretty darn sure you don’t want to have any more children. An option is to bank sperm before the vasectomy. This costs about $200 a year.
Conclusion: If you think there is any possibility that you might want to have more children do not have vasectomy. Depending on a reversal, even in the best scenario of surgeon and time interval from the vasectomy, is a risky endeavor.
On the flip side: If you have had a vasectomy, the chances of achieving pregnancy is essentially zero. In this setting having a reversal is very reasonable as any chance at pregnancy with a reversal is better than no chance. This is the reasoning most couples have when deciding to pursue a reversal.
A sperm granuloma? It’s good thing for a vasectomy reversal.
Ga Vasectomy Reversal: The above picture shows the vas deferens isolated and one can see the clips and a small area of swelling of the vasectomy site. If there is swelling here, a sperm granuloma, then the potential for success is higher. A sperm granuloma is a “pop-off” valve of sorts and protects the sperm producing process of the testicle.
The presence of a sperm granuloma explains why a patient 10 years out from a vasectomy might have a better chance than a patient 5 years out who doesn’t have one. This is a random occurrence and can’t be predicted who or who will not have a sperm granuloma. They are only beneficial for the vasectomy patient who is to have a reversal.
Vasectomy Reversal Success! Thirty years or so after a vasectomy. A sperm granuloma probably helped.