Having a vasectomy is a step that should be carefully considered because it’s a permanent form of birth control. (It’s true that vasectomies can be reversed, but doing so requires a second, more involved procedure.) The following Q&A goes over many of the questions many men have as they’re contemplating having a vasectomy.

What happens during a vasectomy?

A vasectomy is a simple surgical procedure done to prevent pregnancy. It involves cutting two tiny tubes called the vasa deferentia. (One tube is called a vas deferens or vas.)

Typically, sperm cells travel through the vasa deferentia before they’re mixed with semen and ejaculated out of the body. By cutting these tubes, the sperm cells’ path is blocked. Instead of being ejaculated, the cells are absorbed by the man’s body.

What is a conventional vasectomy?

During a conventional vasectomy, the surgeon accesses the vasa deferentia through one or two small incisions in the scrotum, the sac that holds the testicles. After the vasectomy is done, the scrotal incisions are closed with dissolvable stitches.

What is a no-scalpel vasectomy?

With a no-scalpel vasectomy, the puncture heals on its own, and no stitches are necessary.

With a no-scalpel vasectomy, the surgeon accesses the vasa deferentia through a tiny puncture made in the scrotum. The puncture heals on its own, and no stitches are necessary.

How effective is a vasectomy?

After it takes effect, a vasectomy is about 99.95% effective in preventing pregnancy. This success rate makes it the second most effective form of birth control available. (The first is abstinence—not having sex at all.)

Where are vasectomy procedures done? How long do they take?

Most vasectomy procedures can be done in a urologist’s office. Occasionally, they may be done at a surgical center or hospital. They take about a half hour, and men can go home the same day.

Is a vasectomy covered by health insurance? How much does it cost?

Vasectomies are often covered by health insurance in the United States. A man should check with his insurance company for details on his specific coverage and his out-of-pocket costs. Costs can vary depending on location and the type of surgery needed.

Does it hurt to have a vasectomy?

Men are given local anesthesia (the area is numbed), so there shouldn’t be any pain. There might be some minimal discomfort after the anesthesia wears off. This can usually be managed with ice packs (placed over clothing) or acetaminophen (Tylenol). Aspirin or ibuprofen are not recommended, as they raise the risk of bleeding or bruising.

Can there be complications after a vasectomy?

All surgical procedures have some risk, but complications after a vasectomy are rare. In fact, the American Urological Association notes that complication rates are around 1% to 2%. Complications can include the following:

• Sperm granuloma. When a vas deferens is cut, stray sperm cells can leak out. The immune system responds, which can lead to inflammation and, eventually, a small mass called a sperm granuloma. The mass is benign (not cancerous). A sperm granuloma can cause some temporary discomfort, but it usually goes away on its own. Pain medications may help. If it is especially bothersome, it may need to be surgically removed.

• Infections. Some men develop an infection after their vasectomy. The infection is usually treated with antibiotics.

• Hematoma. A hematoma occurs when blood collects in the scrotum after surgery. It often goes away on its own, but men should call their doctor if their scrotum gets bigger or becomes painful.

• Post-vasectomy pain syndrome. About 1% to 2% of men have chronic pain after vasectomy due to fluid buildup in the scrotum. Pain medications and warm baths may help. In more severe cases, surgery—or a vasectomy reversal procedure—may be needed.

Research shows that men who have vasectomies are not at higher risk for cancer or ED.

Does a vasectomy raise a man’s risk for cancer or erectile dysfunction (ED)?

No. Research shows that men who have vasectomies are not at higher risk for cancer or ED.

What is the vasectomy recovery period like?

Most men take it easy for a day or two after their vasectomy. There may be some pain and swelling, but these symptoms can be managed with pain medication and cold packs.

Men who work desk jobs usually go back to work the next day. Heavy lifting is restricted for about a week, so men with more physically demanding jobs may need to adjust their routine.

Men should avoid ejaculation—through partnered sex or masturbation—for about a week.

Is a vasectomy effective immediately?

No. It takes time for sperm cells to “clear” each vas deferens after a vasectomy. For this reason, couples need to continue using another form of birth control for a few more months or about 20 ejaculations.

After that period, men can see their urologist for a semen analysis. The doctor will check a semen sample for sperm cells. If some remain, couples should continue using birth control for a bit longer. If the semen is clear of sperm, other birth control methods should no longer be needed.

The best way to know whether sperm cells have cleared is to have a semen analysis with a urologist.

What happens to sperm cells after a vasectomy?

Instead of being ejaculated, sperm cells are absorbed by the body. This process is harmless.

What is sex like after a vasectomy?

Sex drive and orgasms feel the same as they did before the procedure. Semen volume should also be about the same, as sperm makes up a small percentage. Partners don’t feel a difference either.

Some men find sex to be more exciting after a vasectomy because they can be more spontaneous. The anxiety of unwanted pregnancy is reduced.

Does a vasectomy protect against sexually transmitted infections?

No. While vasectomies are extremely effective in preventing pregnancy, they do not protect against sexually transmitted infections (STIs) like HIV, HPV, and gonorrhea. Couples should still practice safe sex by using condoms and/or dental dams. Regular testing for STIs may also reduce the risk of transmission.

Can a vasectomy be reversed?

Yes. In general, vasectomy is considered a permanent decision, and men should think carefully before having one. But there are times when a man decides he would like to father children after all. That’s when a vasectomy reversal may be considered.

A vasectomy reversal procedure reconnects the ends of the vasa deferentia, giving sperm cells a clear path out of the body. (In some cases, the end of a vas may need to be connected to the epididymis, a coiled tube that links a testis with a vas deferens. The epididymis stores sperm cells.)

Vasectomy reversals are more involved than vasectomies, and they don’t always lead to pregnancy. Success can depend on how much time has passed between the vasectomy itself and the reversal. The longer the time frame, the less likely a pregnancy will happen.

It also takes time—sometimes a few months to a year—before sperm cells reappear in the semen.

Other factors, including a man’s overall health and the health and age of his partner, play a role in getting pregnant, too.

Besides vasectomy reversal, are there other ways to become a biological father after having a vasectomy?

Yes. It might be possible to retrieve sperm cells from the testes. These cells can then be used for in vitro fertilization (IVF).

Some men have their sperm frozen and stored by a sperm bank before their vasectomy, just in case they change their mind about fatherhood later.

Resources

American Urological Association

Sharlip, I.D., et al.
“Vasectomy (2015)”
(Published 2012; Amended 2015)
https://www.auanet.org/guidelines-and-quality/guidelines/vasectomy-guideline

“Vasectomy”
(Last updated: December 2020)
https://www.urologyhealth.org/urology-a-z/v/vasectomy

Mayo Clinic

“Vasectomy”
(August 21, 2021)
https://www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580

UpToDate

Viera, Anthony J., MD, MPH
“Patient education: Vasectomy (Beyond the Basics)”
(Topic last updated: February 16, 2021)
https://www.uptodate.com/contents/vasectomy-beyond-the-basics

Male Birth Control: Present and Possible Future

Perhaps you and your partner are finished having children. Or you just know you don’t want children in the future and want to make sure no unplanned pregnancies happen. If this is the case, you might be looking for permanent methods of birth control.

Is a vasectomy the answer? For many men the answer is “yes.” Since vasectomy became common in the 1970’s it has provided men and families a safe, effective, minimally-invasive form of birth control with a fast recovery period. A vasectomy involves cutting two tubes called the vas deferens – the pathways that sperm travel through. The cut ends are then tied or sealed together with heat, blocking the path of sperm. (Note: A vasectomy doesn’t take effect immediately, as some sperm cells remain in the vas deferens and will need clear out. You and your partner will still need to use contraception until there are no more sperm cells in the pipeline.)

Vasectomies are usually considered permanent. A vasectomy reversal is an option if a man changes his mind, but the procedure can be expensive, and reversals are not effective 100% of the time. This may give some men reason to consider alternatives to vasectomy. Nowadays viable sperm can also be surgically retrieved for use with IVF (in vitro fertilization) procedures, even years after a vasectomy.

Vasectomy Alternatives

Are there alternatives? Yes.

Condoms

Male condoms can be an effective form of birth control – 98% effective, in fact – as long as you use them the right way. Condoms can reduce the risk of sexually transmitted infections (STIs), too – again, when used correctly. Many men unknowingly use condoms incorrectly, often because they learned how to use a condom informally or casually when they were younger and perhaps sexually inexperienced. (If you’re not sure you’re using condoms correctly, we can provide you with accurate educational material.)

Options for Women

Your partner has temporary contraceptive options, too. Female condoms, hormonal contraceptives, birth control pills, intrauterine devices (IUDs), and diaphragms are all possibilities for temporary birth control. Her gynecologist can help her choose which methods are best for her.

Women may also consider tubal ligation (sometimes called “getting your tubes tied”), a surgical procedure that cuts and seals the fallopian tubes, preventing sperm cells from reaching an egg. This method is permanent, however. It’s also more complex than a vasectomy, and it may have more complications, a longer recovery period, and a higher cost.

What about withdrawal?

Some men wonder whether withdrawal (coitus interruptus or “pulling out” before ejaculation) is a viable contraceptive method. This approach is not considered reliable, as sperm cells can be present in pre-ejaculate (precum) and find their way into the vagina before the man withdraws his penis. The method also requires determination and perfect timing on the part of the man, which can be hard to control in the midst of intercourse. (One more point to consider – withdrawal alone provides no protection against STIs.)

Male Birth Control Under Investigation

In the meantime, scientists are looking into other temporary, reversible male contraceptive options.

• Birth control pills. Scientists are studying hormonal oral contraceptives for men. While these pills have generally passed safety tests in humans, more research is needed to determine how effective they are.
• Hormonal gel. Scientists are also investigating a hormonal contraceptive gel that can be applied to the skin once a day.
• Reversible Inhibition of Sperm Under Guidance (RISUG). Like vasectomy, RISUG blocks the path of sperm cells. But instead of undergoing surgery, men receive an injection of a special gel that attaches to the walls of the vas deferens, forming a barrier that sperm cells can’t swim past. Clinical trials have shown RISUG to be effective, and the effects could last up to 10 years. It can also be reversed by injecting another substance that breaks down the gel and flushes it out.
• “Clean Sheets Pill.” How about a pill that allows men to feel the pleasure of orgasm without actually ejaculating? That’s the aim of the “clean sheets pill,” which men can take a few hours before sex. Much more research is needed, however, and some experts question whether men will be open to semen-free ejaculation.

Talk with Your Partner(s)

We encourage you and your partner to discuss your birth control options thoroughly. This is a decision you should make together, considering your feelings about family planning and your comfort with different contraceptive methods. If you’re single and/or having sex with multiple partners, we urge you to have the vital contraception/STI conversations with everyone you have sex with, including oral sex and anal sex.

Resources

Basic and Clinical Andrology
Khilwani, Barkha, et al.
“RISUG® as a male contraceptive: journey from bench to bedside”
(Published online: February 13, 2020)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017607/ 


BBC.com
Campo-Engelstein, Lisa
“Are we ready for men to take the pill?”
(October 22, 2019)
https://www.bbc.com/news/health-49879667

Birth Control Pharmacist
Gonzalez, Steven
“Updates In Male Contraceptive Agents”
(June 22, 2020)
https://birthcontrolpharmacist.com/2020/06/22/updates-in-male-contraceptive-agents/

Endocrine Society
“Dimethandrolone undecanoate shows promise as a male birth control pill”
(March 18, 2018)
https://www.endocrine.org/news-and-advocacy/news-room/2018/dimethandrolone-undecanoate-shows-promise-as-a-male-birth-control-pill

“Second potential male birth control pill passes human safety tests”
(March 25, 2019)
https://www.endocrine.org/news-and-advocacy/news-room/2019/endo-2019–second-potential-male-birth-control-pill-passes-human-safety-tests

LiveScience
Rettner, Rachael
“World’s First Injectable Male Birth Control May Soon Arrive in India”
(November 20, 2019)
https://www.livescience.com/male-birth-control-risug.html

Mayo Clinic
“Withdrawal method (coitus interruptus)”
(April 8, 2020)
https://www.mayoclinic.org/tests-procedures/withdrawal-method/about/pac-20395283

MedlinePlus.gov
“Tubal Ligation”
(Page last updated: August 10, 2020)
https://medlineplus.gov/tuballigation.html

National Health Service (UK)
“Condoms: Your Contraception Guide”
(Page last reviewed: September 19, 2017)
https://www.nhs.uk/conditions/contraception/male-condoms/

Urology Care Foundation
“Quick Snip: Should You Get a Vasectomy?”
(Fall 2014)
https://www.urologyhealth.org/patient-magazine/magazine-archives/2014/fall-2014/quick-snip-should-you-get-a-vasectomy

Vasectomy.com
Radcliffe, Shawn
“Birth Control for Men: ‘Clean Sheets’ Pill”
(November 28, 2018)
https://www.vasectomy.com/article/vasectomy/alternatives/birth-control-for-men-clean-sheets-pill

Verywellhealth.com
Stacey, Dawn, PhD, LMHC
“Male Birth Control Options”
(April 29, 2020)
https://www.verywellhealth.com/male-birth-control-injections-3970355

A vasectomy is a minor surgical procedure performed to block sperm from leaving the body. It’s a highly effective and common birth control option. Experts estimate that one in five men over age 35 in the United States has had a vasectomy. It’s a simple procedure, and it doesn’t take long for most men to recover. As minimally invasive urologic procedures go, vasectomies are inexpensive, even as an out-of-pocket charge, and especially if you have health insurance that covers it.

You will, of course, want to consider your decision to have a vasectomy carefully. It’s possible – and not uncommon – to reverse a vasectomy, but a reversal procedure is generally more invasive and more expensive than a simple vasectomy. The success rate of a reversal depends on many factors. That said, there are ways to retrieve sperm cells from the testes for in vitro fertilization, so if a vasectomy reversal is not successful, there may still be options for starting a family.

If you aren’t sure a vasectomy is right for you, there are a number of other contraception options to consider.

Vasectomy: How Does It Work?

To review the essentials of male reproductive anatomy, sperm cells are made by your two testes (testicles). Attached to each testis is a coiled area called the epididymis. Once the sperm cells are created, they move to the epididymis where they mature. They’re stored in the epididymis for up to 6 weeks until they’re ejaculated.

When sexual stimulation starts, sperm cells move from the epididymis to the vas deferens (sometimes just called the “vas”), a tube that connects the epididymis to the urethra. Sperm cells can be stored in the vas as well. In fact, it’s common for some sperm cells to overflow into the vas before ejaculation. Sperm cells that aren’t ejaculated can stay behind in the vas, too.

Along the way, seminal fluid and sperm cells mix to form semen, which is expelled through the urethra out the tip of your penis when you ejaculate.

During a vasectomy, the vas is cut, so the sperm cells can’t make it to the urethra. (You have two vas deferentia – one vas for each testicle. In a vasectomy, both tubes are cut.)

After a vasectomy, your testes will continue to make sperm, but your body will simply absorb them. You’ll still ejaculate semen, but the fluid won’t contain sperm (once sperm has cleared from your system, which takes roughly three months). Your orgasms won’t feel any different. There is a minimal loss in semen volume.

Vasectomy Advantages

It takes time for a vasectomy to fully take effect. But once it does, the success rate for pregnancy prevention is around 99.95%. Sex can be more spontaneous, and for some, sex is more pleasurable without the worry of an unplanned pregnancy.

Vasectomy Disadvantages

As already mentioned, a vasectomy isn’t effective immediately. You’ll need to use another form of birth control until your semen is clear of sperm.

Also, while a vasectomy is estimated to be 99.95% effective, there is still a less than 1% chance that pregnancy may occur. And it does happen. Only abstinence is 100% effective for any type of birth control.

Safe sex is still critical after a vasectomy, too. Vasectomy does not provide any protection against sexually-transmitted infections (STIs). You’ll still need to use condoms or dental dams every time you have sex unless you know your partners do not have STIs.

What to Expect

Before your vasectomy

We’ll schedule an informational visit to explain the procedure. This is a good time to ask questions. Consider writing down your questions beforehand. Your partner is welcome to join you and ask questions too.

In the week or so before your vasectomy, it’s important not to take any nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen. These medications can thin your blood and put you at higher risk for bleeding. If you’re not sure about a specific drug, just give our office a call.

As with most minor medical procedures, you should also have someone drive you to and from your vasectomy appointment.

The vasectomy itself

Vasectomy is actually a straightforward procedure, and it usually takes about a half hour. Vasectomies are typically performed in our office. A local anesthetic is used. If you’re feeling especially anxious, you may choose to be sedated. In some cases, general anesthesia may be used.

After your scrotum is shaved and washed, the local anesthesia will numb the vas deferens area. Your surgeon will locate the vas deferens, which will be accessed in one of two ways:

• Conventional vasectomy. With this type of procedure, your surgeon will access your vas deferens through 1 or 2 small incisions in your scrotum.
• No-scalpel vasectomy. The vas deferens will be accessed through a small puncture in your scrotum. The puncture is made with forceps that stretch the skin.

At this point, a small section of your vas deferens will be cut and, in some cases, removed. Next, your surgeon will clip, tie, or cauterize (seal with heat) the ends of the remaining vas segments. This blocks the sperm’s travel path. You might feel a pulling sensation.

The procedure is then repeated for your other vas.

If you’re having a conventional vasectomy, the incisions will be closed with sutures. If it’s a no-scalpel procedure, you shouldn’t need sutures.

You should be able to go home shortly after the procedure is finished. As noted earlier, plan to have someone bring you home.

Potential complications

According to the American Urological Association (AUA), about 1% to 2% of men undergoing vasectomy experience surgical complications, such as hematoma (where blood collects outside a blood vessel).

Recovery

When you get home

We’ll give you detailed instructions to follow while you recuperate.

The most important element of a successful recovery is rest. Be prepared to limit your activities for five days to a week, especially lifting heavy things. Wearing a jockstrap might make you more comfortable. Don’t bathe or swim for up to two days.

You might be able to return to work in a few days, depending on how you’re feeling. But you might have to modify some of your work activities for a short time. That will be part of our follow up discussion.

Placing an ice pack on the affected area (over your clothing) can help reduce pain and swelling. You might also try taking some Tylenol (acetaminophen), but we recommend that you avoid aspirin or ibuprofen, as these drugs can raise the risk of bleeding or bruising. We can prescribe a stronger medication if you need it.

What to watch for

Most men go through vasectomy without any serious complications. But you should be on the lookout for bleeding, swelling, fever, redness, and signs of infection. Give us a call if you experience these symptoms.

Some men develop a mass called a sperm granuloma after vasectomy. This forms as part of your immune system’s response to stray sperm cells coming from the cut vas deferens. It’s usually nothing to worry about and should go away on its own, but it can be uncomfortable. In severe cases, it may need to be surgically removed.

Post-vasectomy pain syndrome

Some men develop significant chronic pain in their testicles or scrotum after a vasectomy, although this is not common. Usually, this pain can be treated with medications and warm baths. If it becomes severe, we might have you see a pain specialist. Surgery or vasectomy reversal might be considered at some point.

What about sex?

After your vasectomy, you’ll also need to avoid ejaculation for about a week. And for the next 16 to 18 weeks, you’ll still need to use birth control.

Why? Remember, each vas deferens is connected to the epididymis, a storage area for sperm cells. And sperm cells can be stored in the vas as well. When the vas is cut, there can still be residual sperm cells lingering, and these cells can still mix with semen when you ejaculate. So, until these remaining sperm cells clear, you will still be able to get a partner pregnant.

We’ll be monitoring the situation, though. During your follow-up appointments, we’ll do a semen analysis to check how much sperm is left in your semen. Once we’ve determined all the sperm have cleared, your vasectomy should be effective.

For most men, it takes about three months – or 20 ejaculations – for sperm to clear. But every man is different, and it might take more or less time. It’s important to keep all of your follow up appointments.

Aside from the need to use birth control until your semen clears, you shouldn’t see any major changes in your sex life. You’ll still ejaculate semen like you did before, but once cleared, the semen won’t contain any sperm. (Sperm makes up about 5% of semen, so the volume you ejaculate shouldn’t change significantly.) You’ll still feel the same pleasure from orgasm. Your partner won’t be able to tell you’ve had a vasectomy.

Your body will still produce sperm cells, but they’ll simply be absorbed by the body.

Vasectomy reversal

Oftentimes life circumstances change. You might at some point consider a vasectomy reversal (vasovasostomy).

As noted earlier, the reversal procedure is more complex than the vasectomy itself. It may also be more expensive, and it’s not always covered by insurance.

The success rate of a reversal depends on several factors and can vary widely. The more years that have passed between your vasectomy and your reversal procedure, in particular, is a determinant of whether a vasectomy reversal will be successful.

But an unsuccessful vasectomy reversal doesn’t mean there aren’t viable sperm cells available. For some men, sperm cells can be surgically retrieved from the testes.

It used to be commonly believed that over time, sperm antibodies damaged all the sperm in a man’s body. We now know how to find and identify healthy sperm, even in men who had vasectomies many years ago. The retrieved sperm can be used for IVF (in vitro fertilization) procedures.

Also, some men decide to freeze their sperm before a vasectomy, just in case they change their minds later.

Resources

American Urological Association
“Vasectomy: AUA Guideline”
(Approved by AUA Board of Directors in May 2012. Amended in 2015)

Johns Hopkins Medicine
“Overview of the Male Anatomy”
https://www.hopkinsmedicine.org/health/wellness-and-prevention/overview-of-the-male-anatomy

Medical News Today
Villines, Zawn
“What to know about sperm production”
(July 31, 2019)
https://www.medicalnewstoday.com/articles/325906

MedlinePlus
“Sperm release pathway”
(Reviewed: January 15, 2020)
https://medlineplus.gov/ency/anatomyvideos/000121.htm

UpToDate.com
Viera, Anthony J., MD, MPH
“Patient education: Vasectomy (Beyond the Basics)”
(Topic last updated: June 12, 2019)
https://www.uptodate.com/contents/vasectomy-beyond-the-basics

Urology Care Foundation
“What is a vasectomy?”
https://www.urologyhealth.org/urologic-conditions/vasectomy

“What is sperm retrieval?”
https://www.urologyhealth.org/urologic-conditions/sperm-retrieval

Verywellhealth.com
Boskey, Elizabeth, PhD
“The Anatomy of the Epididymis”
(Reviewed: September 1, 2020)
https://www.verywellhealth.com/epididymis-anatomy-4774615

Hayes, Kristin, RN
“The Anatomy of the Vas Deferens”
(Reviewed: July 9, 2020)
https://www.verywellhealth.com/vas-deferens-4846228