Vasectomy FAQ

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Today on Health Lab we're bringing you something a little bit different - an expert FAQ with a U-M Health urologist answering common questions about vasectomies.

Transcript 

Podcast Host:

Welcome to Health Lab, your destination for news and stories about the future of healthcare. Each week on Health Lab, you’re used to us bringing you the latest advances in health research, public health information and more. Today on Health Lab, we’re bringing you something a little bit different - an FAQ with a University of Michigan Health urologist answering the most common questions people have about vasectomies. Let’s jump in.

Interview Host:

Welcome to the University of Michigan Health Lab. Today we are with Michigan Medicine urologist Dr. Cathy Nam to help us talk more about vasectomies. Can you tell us what is a vasectomy?

Dr. Cathy Nam:

Yes. A vasectomy is an in-office procedure and it typically takes about 20 to 30 minutes. And when a patient arrives, we start with giving them numbing medication, which is very similar to the numbing medication that's used in the dentist office so that the patient can be nice and comfortable and the patient is awake for the procedure. And so if he is feeling any discomfort, there's the time and the opportunity for them to communicate with us and for us to be able to give more numbing medication. And there are multiple ways of disrupting the plumbing from the testicle to the outside world at the level of the vas to be able to achieve a vasectomy. At the end of the case, we close with either a dissolvable suture or just with cautery so that the patient does not have to come back and get those removed after the procedure.

Interview Host:

Who usually is a primary candidate for a vasectomy?

Dr. Cathy Nam:

So in terms of deciding who's the primary candidate for vasectomy, it's really dependent on the patient and their partner. It's about where they are in their reproductive journey. So they need to have had a conversation either by themselves if they're unpartnered or with their partner about whether they would like any more children in the future. The reason why this is such an important conversation to have either with yourself or with your partner, is that it is considered permanent, and so because of the permanent nature of it, they need to be sure that they don't want any more children in the future.

Interview Host:

You said that it's permanent, but can it also be reversed?

Dr. Cathy Nam:

When patients come in to talk to us about vasectomy, we do counsel them that it is considered permanent, but at the same time, we do offer vasectomy reversal as one of the options to reverse their vasectomy or for them to be able to achieve a pregnancy in the future. So one option would be a vasectomy reversal, which is a surgery that restores the plumbing, or the vas in, continuity with the testicle where the sperm is being made. But the reason why we counsel them on the permanence of this procedure is because oftentimes with the counseling vasectomy reversal may not be covered by insurance.

It is a much bigger surgery where they have to oftentimes undergo general anesthesia and a much longer procedure compared to vasectomy, which is about 20, 30 minutes. And there's also no guarantee in that they will be able to achieve a pregnancy with the reversal. The other option that we have for achieving a biological pregnancy after vasectomy for our patients is testicular sperm extraction, whether that be done with a needle like in the form of aspiration or surgically. But for that one, they have to use assistive reproductive technology or IVF, and so because of those aspects, we often counsel our patients that vasectomy is considered permanent, and that's per our professional guidelines as well.

Interview Host:

You mentioned about having a conversation with either yourself or your partner. Who likely, in your experience, is usually the ones that are either making the ultimate decision for a vasectomy or driving that conversation?

Dr. Cathy Nam:

I think oftentimes in patients who are coupled, it's shared decision making amongst the couple. I think oftentimes the textbook patient that we would see in the office are ones who have been able to achieve pregnancies in the past. Their family building is done. I think oftentimes when it's coming from the male partner, they've seen their wives or their female partners go through the pregnancy, the delivery, and the aftermath of that. And so they feel pride and responsibility in being able to take part in the permanent form of birth control to help the couple. Sometimes it's coming from the wives or their female partners where after they've gone through the family building practice, they are asking their husbands to do their part in terms of the permanent solution of birth control.

Interview Host:

When it comes to the vasectomy itself, the procedure, and you talked about it being about 20 to 30 minutes, are there myths that people coming in have regarding what's going to happen, how long it's going to take, what the recovery is going to be like? What are some of those myths that we could bust?

Dr. Cathy Nam:

I think there's a lot of myths about how it can impact their sexual function or their hormone parameters, and so one of the key or most often asked questions is, "How is it going to affect my testosterone?" And because we're only disrupting the plumbing of the sperm not being able to leave the testicle, it does not impact your level of testosterone. So a lot of the patients who come in to ask that question, I'm able to reassure them. Some other questions that have been asked is if it's going to impact their sexual function, whether it's in the form of their ejaculate volume, or their ability to climax or their erectile function, and the truth of the matter is vasectomy does not work on any of the functions mentioned above, and so it should not impact that. I think the ejaculatory volume is an interesting one because what people often don't realize is that the majority of the volume is actually not sperm, but it's the rest of the fluid that comes from elsewhere. And so oftentimes men with a history of vasectomy will not notice a difference in their overall volume.

Interview Host:

If someone was considering a vasectomy, what would those next steps look like and what would a typical patient journey be?

Dr. Cathy Nam:

Yeah, so oftentimes the patients want a referral for a vasectomy. Typically, these conversations first happen with their primary care doctor or their family practice. After they come in to see one of the urologists or the APPs, they are provided with information on vasectomy, some preoperative counseling and postoperative expectations. And after that's been done, they can go ahead and make an appointment with us to get a vasectomy done.

Interview Host:

So you mentioned earlier about insurance. Does insurances cover a vasectomy?

Dr. Cathy Nam:

Yeah, oftentimes vasectomy is covered by insurance. And I think a good way to look at it is because the equivalent of vasectomy in a woman is tubal ligation, but a tubal ligation requires general anesthesia and the operating room, and so it's a lot more expensive. And so from insurance's perspective, because vasectomy is about a quarter of the cost of tubal ligation, it is very cost effective for them to cover. So the majority of the time we don't have issues with getting insurance coverage for vasectomy.

Interview Host:

As a patient coming in, you said it's 20 to 30 minutes, what can my expectation be for that procedure from time I arrive to the time I leave and then what is that recuperation period like?

Dr. Cathy Nam:

Yeah. So typically when they first show up in the office, the procedure itself, like I said, takes about 20 to 30 minutes, but we build in a little bit more time so that we can go through the consent process where we highlight some of the key understandings and takeaways of vasectomy. One of the things that I have not yet talked about, but it's important for our patients to know, is that the vasectomy does not work right away. So for patients who are undergoing vasectomy, before we give them the go ahead, after looking at the post vasectomy semen analysis, they have to use another form of birth control during that time.

So we go through some of the highlights in terms of what's important for the patients to understand and the post-operative course. So we typically tell our patients to come stay with us for about an hour. In terms of what's expected after the vasectomy for the patient's recovery, we say the first week or so there can be some swelling, some bruising. That's to be expected. We ask them to refrain from heavy lifting or strenuous exercise or sexual activity to allow time for them to heal. But after that, we say, "Listen to your body." We don't set any strict rules in terms of how much they can or cannot lift, and if their body's able to tolerate it, they can go ahead and do it.

Interview Host:

And then what is the timing from the procedure to the follow-up to see if it was effective?

Dr. Cathy Nam:

Yeah, so there's a little bit of wiggle room in terms of how that is checked depending on the practice. But here at Michigan Medicine, we check at about a 12-week mark to make sure that we have a sense of whether it worked or not.

Interview Host:

Is there anything that we've not covered that you want to make sure that is covered around vasectomy and what people should know should they be making these family planning decisions?

Dr. Cathy Nam:

I think it's important to know that vasectomy is very commonly done. It's done about half a million times a year in the US. It's performed by over three quarters of practicing urologists. So it is very much within the purview of urologists to be able to offer this as a great method of male birth control. I think the other thing to be mindful of is when it compares to other forms of birth control, including female contraception, it is a standout option for families. And so I think going back to some of the key factors for our male patients to be aware of is that we counsel patients on the permanent nature of it. You should be done with your family planning stages in order to pursue a vasectomy, but once they have a great understanding of the pros and cons of vasectomy, I think it's a great option for many of our patients.

Interview Host:

Great. Thank you.

Dr. Cathy Nam:

Thanks.

Podcast Host:

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