Should you get a vasectomy?

Since the United States Supreme Court decision in 2022 to end the federal right to an abortion, allowing instead for individual states to regulate the procedure, contraceptive methods have been more in the spotlight than ever.

One option gaining traction after that decision?

Vasectomies.

But, what exactly is a vasectomy?

“Vasectomies are a permanent form of contraception,” explained James Dupree, M.D., a urologist at Michigan Medicine. 

“It’s mostly chosen once people are finished building their family and don’t see a need or desire for anymore children.”

It’s also very reliable.

“The chance of having a baby post procedure is 0.05%, meaning failure is only 1 out of 2,000, making it more reliable than condoms. It’s more reliable than birth control or IUDs, and its safer than a woman getting her tubes tied.”

Additionally, it's considered very safe and a common procedure doctors do.

“It's done about half a million times a year in the U.S. and performed by over three quarters of practicing urologists, making it very much within the purview of urologists to be able to offer this as a great method of male birth control.”

What to know before getting a vasectomy

How do you know if you’re a candidate for a vasectomy?

“It’s really dependent on the patient and where he is in his reproductive journey,” explained Cathy Nam, M.D., a urologist at Michigan Medicine.

“If the patient is coupled, couples need to have a conversation about whether they’d like any more children in the future. The reason why this is such an important conversation to have is that it’s 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,” said Nam.

Typically, conversations about wanting a vasectomy first happen with your primary care doctor, who then directs you to a urologist.

“Broadly speaking its important to know what techniques your surgeon is using,” said Dupree.

He also suggests looking up the American Urological Association’s patient education materials on this procedure, which can be helpful if you’re interested in pursuing a vasectomy.

You should know there are different physicians who offer vasectomies including urologists, family medicine doctors, or general surgeons.

“At the end of the day, you want to make sure that the physician has had training in vasectomies and that they use a minimally invasive vasectomy method as recommended by the AUA guidelines,” said Nam.

What about insurance coverage?

“Oftentimes a vasectomy is covered by insurance. And I think a good way to look at it is because the equivalent of a vasectomy in a woman is tubal ligation, but that requires general anesthesia and an operating room, making it a lot more expensive,” explained Nam.

“And so from an insurance's perspective, it’s very cost effective for them to cover.”

What to expect when getting a vasectomy

A vasectomy is an in-office procedure and it typically takes about 20 to 30 minutes.

"When a patient arrives, we start by giving them a numbing medication, which is very similar to the numbing medication used in a dentist’s office so that the patient can be nice and comfortable but awake during procedure,” said Nam.

“This way, if you’re feeling any discomfort, there's time and the opportunity to communicate with us and for us to give more numbing medication.”

While there are multiple approaches available, Nam explains that the main objective of a vasectomy is to disrupt the vas, which functions as tubing through which sperm can travel.

Through a vasectomy, the sperm no longer has a pathway to get up through the penis during sexual activity.

What are the risks of a vasectomy?

Overall complication risks are low.

“There’s a small 1-2% chance of bleeding, and it’s normal to have some swelling, bruising, and discomfort in the scrotum for one to two weeks,” said Nam.

Long term pain is rare, only occurring 1-2% of the time. If the pain in impacting your quality of life, there are options of managing it with medications and/or surgery.

It’s also important to know that vasectomies don’t work right away.

“Even though you can resume sexual activity one week after having a vasectomy, you still need to use birth control until you pass your sperm check, which is several months later,” said Nam.

Post procedure

Dupree tells people to avoid heavy lifting, vigorous activity and sexual activity for one week post procedure.

After that they can slowly resume those activities if they’re not causing new or worsening pain says Dupree.

“There's a little bit of wiggle room in terms of how the sperm count 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,” said Nam.

Nam says there’s a lot of myths about how a vasectomy can impact your sexual function.

Patients sometimes worry if it’s going to ruin their sexual function, like their erectile function, or ejaculation. 

And other patients ask, ‘How is this going to affect my testosterone?’

“Because we're only disrupting the plumbing of the sperm not being able to leave the testicle, it doesn’t impact your level of testosterone,” said Nam.

“The truth of the matter is a vasectomy does not work on any of the functions mentioned above, and so it shouldn't 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 won't notice a difference in their overall volume.”

Can you reverse a vasectomy?

Although intended to be permanent, most procedures are reversible if you change your mind.

But the reversal isn't a guarantee, and it can be expensive, and typically not covered by insurance.

“When patients come in to talk to us about a vasectomy, we do counsel them that it's considered permanent, but at the same time, we do offer vasectomy reversals.”

It’s also a much longer surgery that typically requires general anesthesia, notes Nam.

You can listen to more about vasectomies in the Health Lab podcast, or if considering a vasectomy, call 734-936-7030.