What happens after a male vasectomy
Vasectomy (male sterilization)
When family planning is complete or there is no desire to have children, some couples opt for sterilization. The procedure can be performed on both men and women. However, male vasectomy is comparatively easier, cheaper, and safer.
In Germany, around 30,000 to 50,000 men decide to have a vasectomy every year. However, many men still shy away from sterilization. Far too often, the procedure is mistakenly equated with castration. Read below about the advantages and disadvantages of a vasectomy and how the treatment works.
When is a vasectomy medically necessary?
It is very rare for a vasectomy to be performed for medical reasons. In individual cases, however, doctors may recommend sterilization, for example in the case of certain genetic diseases. A vasectomy is also an option if sterilization of the partner would be necessary from a medical point of view, but would pose too high a risk for the patient.
Sterilization vs. castration: what's the difference?
Many men fear that they will lose their manhood through sterilization. Sterilization in men (vasectomy) is not to be equated with castration (orchiectomy), in which the testicles are removed. Since the male sex hormone testosterone is formed in the testes, castration has far-reaching consequences for the hormone balance. The feared effects include impotence and a decrease in libido.
In contrast, the testicles remain untouched during sterilization. Only the vas deferens are severed, through which the sperm enter the seminal fluid. The procedure has no effect on the hormonal balance. The semen production also continues as usual. The only difference is that there are no more sperm in the ejaculate. Instead, the sperm cells are broken down by the body
What speaks for / against sterilization in men?
Once family planning has been completed, vasectomy is a permanent and safe form of contraception with few complications.
With a Pearl Index of around 0.1, the contraceptive safety is roughly equivalent to that of the contraceptive pill. In addition, the procedure is less time-consuming than sterilization of the woman, since no general anesthesia is necessary and no surgery in the abdominal cavity is necessary. In addition, the vasectomy has no influence on the hormonal balance in men. Potency and pleasure are not affected by the procedure.
A disadvantage for some men is the emotional stress that comes with infertility. In principle, however, the sterilization can be reversed if the living conditions change, such as a new partnership (refertilization).
Refertilization, however, is significantly more complex and expensive than the vasectomy itself. Refertilization does not always lead to success. The sterilization should therefore be considered permanent.
In rare cases, persistent pain in the testicle area occurs after the vasectomy. The causes of these chronic pain conditions have not yet been clearly clarified. In addition, male sterilization is sometimes associated with an increased risk of prostate cancer. Comprehensive studies have been lacking here, but more recent study findings indicate that the risk is barely increased.
Advantages and disadvantages of a vasectomy:
Advantages of vasectomy:
- with few complications
- less laborious than sterilizing the woman
- no influence on hormonal balance
- Masculinity / potency is retained
- The feeling of pleasure is not impaired
Disadvantages of vasectomy:
- emotional stress possible
- Refertilization possible, but very time-consuming
- Permanent pain / chronic pain in the testicle area possible
- Paralysis / sensory disorders (typically one-sided, e.g. in the hands and feet)
What should be considered before the vasectomy?
The urologist is the first point of contact for men who want to be sterilized. Vasectomy is performed both in hospitals and by resident urologists. The procedure is usually carried out on an outpatient basis under local anesthesia. A hospital stay is therefore not necessary. If the patient so wishes, the vasectomy can also be performed in twilight sleep or under general anesthesia.
In principle, every adult man is suitable for a vasectomy. However, this procedure is a permanent sterilization. For this reason, the vasectomy should be well thought out and only performed once family planning has been completed. As a rule, the patients are men over 30 years of age. If the attending physician has doubts about the suitability of the patient, he may also refuse the procedure.
In order to support the patient in his decision, a detailed consultation takes place first. The patient is fully informed about the possibilities and risks of the procedure. If the man lives in a stable partnership, ideally the partner should also be involved in the decision.
If the patient has decided on a permanent vasectomy, various preliminary examinations are carried out first. The doctor checks the general state of health of the patient and inquires about known pre-existing conditions that could be associated with an increased risk of surgery. In addition to a general physical exam and blood test, an ultrasound of the testicles is also performed, among other things.
Before the vasectomy, the patient should thoroughly clean the genital area and shave the areas to be treated. If the procedure takes place in an inpatient setting, the preparation for the operation is usually done by the nursing staff.
The patient receives further information on preparation for surgery from the attending physician.
How does the vasectomy work?
The vasectomy is a short outpatient procedure and takes about 30 minutes. The treatment is usually carried out under local anesthesia and the patient can then leave the clinic unaccompanied. In individual cases, sterilization under general anesthesia or in twilight sleep is also possible. If you decide to have sedation, you should be escorted home afterwards.
Various surgical techniques are used in vasectomy. A basic distinction is made between the so-called ligature technique and non-scalpel vasectomy.
The ligature technique is the "classic" method. The doctor makes a small incision on the scrotum with the scalpel. The vas deferens are exposed and cut through this incision. The doctor removes a small section of the spermatic duct to prevent it from growing back together. The spermatic cord is then tied off and electrically obliterated.
The process of a non-scalpel vasectomy is basically the same. The only difference is that no skin incision is made. Rather, the doctor works through a tiny puncture of the skin. He carefully spreads the opening open with a clamp, thus gaining access to the vas deferens without any incisions in the skin. After the procedure, the wound is sutured. The patient can immediately meet his usual obligations again, but should take care of the treated areas for the first few days.
When does the vasectomy work?
It is important to know that there is no infertility immediately after sterilization. There may still be sperm in the vas deferens below the severed point. It takes an average of 2 - 3 months or 20 ejaculations until these are completely discharged.
After the vasectomy, at least one sperm analysis is carried out in order to check the semen for the presence of sperm. The analysis is repeated several times as required until no more sperm can be detected. Infertility can only be assumed at this point in time.
What are the consequences and risks of a vasectomy?
The vasectomy is generally a low-risk procedure. As with all surgical interventions, however, complications can arise in individual cases. These include bleeding, wound infections or inflammation of the epididymis (epididymis). However, such complications are very rare.
Possible complications are:
- Feeling of pressure
- Wound infections
- Inflammation of the epididymis
- nodular tissue inclusions of sperm cells (sperm granulomas)
- psychological problems
- chronic pain
Furthermore, bruises or a temporary feeling of pressure may appear in the treated areas. Temporary slight pain is also possible. As a rule, however, such complaints subside quickly. Conscientious aftercare on the part of the patient is important in order to accelerate the healing process.
In rare cases, chronic pain in the scrotum area occurs after sterilization. One then speaks of the so-called post-vasectomy syndrome. It has not yet been clarified whether the pain has physical or psychological causes. However, the symptoms can sometimes be very severe and persist over a longer period of time. In individual cases, a new intervention may be necessary, for example targeted recanalization or removal of the epididymis or spermatic cord nerves.
Furthermore, so-called sperm granulomas can form after the vasectomy or at a later point in time. These are tissue inclusions from sperm. By cutting through the vas deferens, the escape of sperm into the surrounding tissue is facilitated. Small, knot-like changes form.
In addition, spontaneous recanalization occurs in some patients after the vasectomy. This means that the severed spermatic cord grows back together so that sperm can be found again in the seminal fluid. However, such recanalization only occurs very rarely.
Erectile dysfunction or loss of libido is not to be expected after the vasectomy. The procedure has no influence on the hormonal balance. Nevertheless, some men find the sterilization to be psychologically stressful, as their own sterility is a problem for them. In this case, the procedure can have negative effects on sexuality, but these are of a purely psychological nature. It is therefore important for the patient to be aware of the consequences of the treatment and the resulting inability to conceive.
Whether vasectomy promotes the occurrence of prostate cancer remains a matter of dispute. So far there is no clear evidence of this. However, the more recent studies indicate that the risk of cancer increases only minimally with the sterilization.
What is the follow-up care for a vasectomy?
After the vasectomy, the patient should first take some physical care. Mild pain may occur in the first few days, which is usually good to treat with pain medication. Thorough cooling can also prevent swelling and the resulting pain.
For the first week after sterilization, you should avoid sport, sex and intense physical activity. The attending physician also personally advises each patient again on which behavioral measures must be observed in the individual case.
If the pain persists after the operation, it may be a so-called post-vasectomy syndrome. In such a case, you should immediately contact the treating urologist. The doctor will then discuss with you whether drug treatment or possibly another intervention is an option.
After the vasectomy, the patient is initially still fertile. An inability to conceive can only be assumed when the sperm analysis carried out no longer shows any sperm cells. This is usually the case after about 20 ejaculations (2 - 3 months). Until then, you should continue to use contraception. Sterilization also offers no protection against sexually transmitted diseases.
What is the cost of a vasectomy
The total cost of a vasectomy is around EUR 400 - 600. In addition to the consultation, preliminary examination and the procedure itself, this also includes the necessary follow-up controls.
The statutory health insurance companies usually do not cover the costs of a vasectomy. The only exception is medically justified sterilization, for example due to illness. If a medically necessary sterilization cannot be carried out on the woman, the man can also be sterilized. In this case, the sick woman's health insurance company bears the costs.
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