Vasectomy: Procedure, Recovery, Semen Test and Reversal

1What is a vasectomy?

A vasectomy (male sterilisation) is a small operation that cuts or seals the two tubes (the vas deferens) that carry sperm from the testicles. After it, the semen a man ejaculates no longer contains sperm. According to the NICHD, the testicles make less sperm over time and the body harmlessly absorbs it. A vasectomy does not lower testosterone, so it does not affect sex drive, erections or ejaculation, and the amount of semen stays about the same. It does not protect against sexually transmitted infections.

🔍Who considers it, and why it should be seen as permanent

The NHS says it may suit men who have children and want no more, or who do not want children, and suggests talking it over with a partner. Points to weigh:

• Permanence: BAUS (the British Association of Urological Surgeons) advises that a vasectomy should be treated as irreversible.
• Timing: BAUS notes that it is not usually suitable during a partner’s pregnancy or in the first six months after a birth.
• Age: according to the NICHD, men who have a vasectomy before age 30 are the group most likely to want a reversal later.
• Personal values: some people also think about cultural or religious aspects. It is reasonable to raise these with your doctor and, if you wish, with someone you trust in your community before you decide.

3How a vasectomy is done

According to the NICHD, both common methods are done under local anaesthetic while the man is awake, usually as a day procedure, and most men go home the same day. BAUS adds that a general anaesthetic may be advised in some cases, for example if the tubes are hard to feel. The methods differ mainly in how the skin is opened:

4Recovery after a vasectomy

The NHS says pain and swelling of the testicles are common for about a week and that erections may feel uncomfortable at first. According to the NHS:

• most men can return to work within 24 hours;
• sexual activity should be avoided for at least 2 to 7 days;
• sport and heavy lifting are usually avoided for 1 to 2 weeks, or as long as the doctor or nurse advises.

Pain relief is decided by your doctor or nurse.

5Assessment beforehand and confirming success afterwards

Before the procedure, the doctor takes a history, examines the scrotum and explains the risks. Afterwards, success is not assumed; it is confirmed with a semen test (semen analysis).

A vasectomy does not work straight away, because sperm remain further along the tubes. According to the NICHD, clearing them takes 15 to 20 ejaculations, or about 3 months, and about 1 in 5 men still have sperm at that point. BAUS gives an average of 20 to 30 ejaculations and advises giving the sample at least 12 weeks after the operation and after at least 20 ejaculations. BAUS explains that:

• if no sperm are seen, the man is cleared;
• if only a few non-moving sperm are seen (fewer than 100,000 per ml on a second sample), a “special clearance” may be given;
• any moving sperm means the vasectomy has not yet worked, and contraception must continue.

⚠️Risks and possible complications

The NHS describes a vasectomy as usually a very safe operation. Possible problems include:

• bruising, swelling or a collection of blood (haematoma);
• infection of the wound or of the testicle and epididymis;
• a sperm granuloma, a usually harmless small lump;
• long-term (chronic) scrotal pain, also called post-vasectomy pain syndrome; BAUS estimates troublesome chronic testicular pain at 1 to 2 in 100 men;
• failure: BAUS puts early failure at about 1 in 250 and late failure (the tubes rejoining after clear tests) at about 1 in 2,000. The NICHD reports that about 15 of every 10,000 couples get pregnant in the year after a vasectomy.

The NHS states that a vasectomy is effective in more than 99% of cases, and BAUS finds no evidence that it causes testicular or prostate cancer. See also our guide to men’s health.

7Vasectomy reversal and sperm retrieval

BAUS describes two main routes if a man later wants children:

• Vasectomy reversal: the cut ends of the tubes are rejoined under magnification (vasovasostomy). If that is not possible, the tube may be joined to the epididymis (epididymovasostomy), which has poorer results. It usually takes one to three hours under general anaesthetic. Sperm usually return within 3 to 6 months, but it can take up to a year.
• Sperm retrieval with assisted conception: sperm are taken directly from the testicle or epididymis with a needle and used in fertility treatment. BAUS states that, on average, assisted conception works in 30% to 40% of cases, depending on factors such as the partner’s age and health.

According to BAUS, results of a reversal fall as time since the vasectomy increases:

The choice is made with a specialist; see also our guide to male infertility.

⏰When to seek urgent medical care

The NHS advises getting urgent medical advice if:

• pain or swelling in the scrotum or testicles suddenly gets worse, or does not start to improve after a few days;
• you have a high temperature;
• blood, pus or fluid leaks from the wound;
• a lump inside the scrotum keeps getting bigger.

BAUS also advises contacting the surgical team if bruising, swelling or pain gets worse day by day.

❓Frequently asked questions

10Sources

1. How to get a vasectomy – NHS
2. Recovery – Vasectomy (male sterilisation) – NHS
3. Complications – Vasectomy (male sterilisation) – NHS
4. Vasectomy – Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
5. Vasectomy – Information about your procedure – British Association of Urological Surgeons (BAUS)
6. Information about your sperm counts (post-vasectomy) – British Association of Urological Surgeons (BAUS)
7. Reversal of vasectomy – Information about your procedure – British Association of Urological Surgeons (BAUS)