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Vasectomy: What is it and what you need to know
Dr. Kevin Ostrowski explains what a vasectomy is, who would consider a vasectomy, the success rate, recovery, and if there are any risks.
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Learn more about Kevin Ostrowski, MD
Kevin Ostrowski, MD
Kevin Ostrowski, MD is a Physician at EvergreenHealth Urology & Urogynecology Care.Learn more about Kevin Ostrowski, MD
Transcription:
Melanie Cole (Host): Welcome to Check-up Chat with EvergreenHealth. I’m Melanie Cole and today we’re discussing vasectomy. Joining me is Dr. Kevin Ostrowski. He’s a Physician at EvergreenHealth Urology and Urogynecology Care. Dr. Ostrowski, thank you so much for joining us today. Start by telling us what is a vasectomy and who usually thinks about this very important decision?
Kevin Ostrowski, MD (Guest): We consider a vasectomy a permanent form of birth control. So, it’s for people who are looking either to not having anymore children or not have any children at all. And really, any male who is in that scenario is a candidate to at least have that discussion.
Host: So, what dose that discussion look like? Do you discuss age? What’s the first step for a man that’s even considering this?
Dr. Ostrowski: Yeah, I think the first step is really to get a little bit more information and obviously there’s a lot of information on Google and those sorts of things but really, it’s a discussion with your physician about kind of the pros and cons to a permanent form of birth control. It allows a male to take their birth control decisions and a couple into their own account and they can make decisions about what they want as far as their family to look like in the future without having to worry about other forms of birth control which have impacts either to the female health or the use of condoms and things like that that aren’t as guaranteed as a vasectomy.
Host: Do the partners usually attend this first discussion? As you’re coming into this discussion, is there usually a spouse or a partner involved in this decision?
Dr. Ostrowski: You know, I would always recommend that a spouse be involved in the decision making process or a partner to be involved in the decision making process as it is a permanent decision and does have impacts. It doesn’t mean that it couldn’t be reversed but it means that it is either expensive and isn’t guaranteed for you to be able to get pregnant in the future. And so, whenever you are making a permanent decision like that, I would definitely recommend at a minimum discussing it with your partner or spouse and if the partner or spouse want to come in and have the discussion, I’m always happy to have them in the room kind of discussing it.
Host: Is there an age limit?
Dr. Ostrowski: There’s no age limit but we do have more detailed discussions with younger patients. If you are 16 or 18 or 20, it doesn’t mean that you couldn’t get a vasectomy but those discussions about kind of the permanency of it would be very important because people obviously change their minds and can change their minds in the future and there are other options for patients in that scenario. But there isn’t really a true age limit.
Host: Doctor what is the actual procedure day like? It may seem intimidating to men who are going through it. Please reassure them of the ease of this procedure and what you can do for them.
Dr. Ostrowski: I think that it’s a sensitive area of the body and guys are obviously concerned and worried about it and so, I totally understand that. But from an overall procedural standpoint, it is an outpatient procedure that takes about 20 minutes or so to do. We basically numb everything up which means we numb the skin and then we numb the vas which is the tube that carries sperm from the testicle out. That’s the part that’s painful basically. Once that’s numb, there’s some pressure and movement, but there really isn’t any pain. Once we do that, we then transect the vas and then use cautery which is like burning some of the tissue to make sure that those two ends of that tube can’t come back together. And then some providers put in a piece of tissue between those two ends to try to prevent those two tubes from coming back together. We have to do it on both sides. So, you’ll feel kind of that numbing shot on both the right and left side because you have got vas coming from each testicle. We can normally do that through one small little incision that ends up being about a quarter to half an inch in the scrotum.
Host: How effective is a vasectomy?
Dr. Ostrowski: A vasectomy is about as good as it gets from a fertility or preventing fertility standpoint. What I mean by that is that there’s about a one in 2000 to one in 10,000 chance of those two tubes coming back together. Immediately after the procedure, you still are fertile and not fully sterile yet. What that means is for the first few months after your vasectomy, you need to use some other form of birth control but at two to three months typically, we’ll get a semen analysis to prove that there is no sperm or a very small amounts of nonmoving sperm and then you are considered sterile. That from a numbers standpoint is about as good as it gets from a sterilization procedure and at that point, you can stop using other forms of birth control. And that’s what guys and their partners really like about it is that kind of once they are through that waiting period afterwards, then there’s no other forms of birth control needed.
Host: Dr. Ostrowski, I think that another concern that men and their partners may have, are there any risks or complications? Can this cause erectile dysfunction? Can there be anything that would really be concerning from this procedure?
Dr. Ostrowski: Yeah Melanie, I think those are really great questions and that is definitely one of the things that I hear about from patients is what are the risks, is there going to be some issues from an erection standpoint or what is sex going to be like after this and what is that going to look like? And most patients and their partners say that actually their sex life gets better. There is no issues with erectile dysfunction and there’s been no association shown with vasectomy and any kind of health conditions. They looked at it for prostate cancer and all sorts of other things but really, never found any association between vasectomy and anything from a permanent standpoint. From a short term kind of risk standpoint, there are a few things to kind of think about. Those risks are really low, by that I mean we’re talking much less than one percent. There’s a small chance of getting an infection. That chance is so low that the vast majority of people do not use any antibiotics. We just use completely sterile instruments and a sterile technique. And then there’s a small chance of getting some bruising or swelling. Obviously, it is going to be a little bit sore down there after the procedure, but the vast majority of men are going to kind of get back to their usual activity after just a few days. If we did it on a Thursday or Friday, I may tell those guys to take it easy kind of over the weekend and then go back to their usual activity kind of early on a Monday or Tuesday of the next week. There is something called post-vasectomy pain syndrome which is incredibly rare and that is more permanent or chronic pain down in the testicles. We find that in men who have their vasectomy done really close to the testicle and we think that it’s due to some pressure or buildup because you’re still making sperm, it’s just the ability for that sperm to get out into that tube and then your body resorbs it naturally. So that tube length needs to be long enough for that to happen. So, we do vasectomies as far away from the testicle as possible and we make sure that guys are really comfortable during the vasectomy meaning after that numbing shot you shouldn’t really be feeling anything. The numbing shot is not comfortable but it’s not too bad. Once everything is all said and done, really most guys say it wasn’t nearly as bad as they thought it was going to be.
Host: You’ve explained it all so very well Dr. Ostrowski. Is this a permanent procedure? What if a man decides they want to try and have children after having a vasectomy or they want to reverse it?
Dr. Ostrowski: A vasectomy is considered a permanent form of birth control. What I mean by that, is that it’s not guaranteed that you could get pregnant afterwards. There are two options for men to get pregnant after they’ve had a vasectomy if kind of life changes and those two options are a vasectomy reversal which is basically where we go in and we kind of undo what happened. And what we do basically, is identify those tubes where the vasectomy happened and then reconnect those two tubes back together. And the success rate for that is fairly good but it isn’t guaranteed. The other option is in vitro fertilization and that is a procedure where the man’s partner would have a procedure where she is stimulated with some hormones, eggs are taken with a procedure outside the body and we take some sperm from the testicle and combine it outside the body, grow embryos outside the body and then transfer those back in. Those are kind of the two options, but we do consider it permanent because it isn’t guaranteed that you can get pregnant after a vasectomy although those are two very good options for patients who kind of change their mind.
Host: Wrap it up for us then Dr. Ostrowski. This is such an interesting topic. So, please just let the men listening know what you’d like them to know when you have these discussions every day with men that have this decision, they’d like to make what do you say? Give us your best advice.
Dr. Ostrowski: I think that realize that there’s about a half a million men who decide to undergo a vasectomy each year. It’s an incredibly safe procedure that is an outpatient procedure, that is quick, relatively painless kind of when everything is all said and done and has the ability to permanently cause sterilization which basically means you can’t have any more kids. I think it requires a discussion with your partner and a really good understanding kind of for the procedure but from my standpoint given kind of all the different options from a sterilization perspective, this is by far the safest and easiest one to do and it is kind of really the only one from a male perspective that we have currently. I think that for people who are interested in this, there are a lot of really great options to learn some more information and really that a lot of those risks and things that they are worried about while I understand completely and I thought about those; those risks end up being incredibly uncommon and the procedure itself goes very smoothly in the vast, vast majority of men.
Host: Thank you so much Dr. Ostrowski for joining us today. Such a fascinating topic. Thank you for sharing your expertise. To learn more about these services at EvergreenHealth Urology and Urogynecology Care please visit www.evergreenhealth.com/urologists to get connected with one of our providers. And that concludes this episode of Check-up Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. I’m Melanie Cole.
Melanie Cole (Host): Welcome to Check-up Chat with EvergreenHealth. I’m Melanie Cole and today we’re discussing vasectomy. Joining me is Dr. Kevin Ostrowski. He’s a Physician at EvergreenHealth Urology and Urogynecology Care. Dr. Ostrowski, thank you so much for joining us today. Start by telling us what is a vasectomy and who usually thinks about this very important decision?
Kevin Ostrowski, MD (Guest): We consider a vasectomy a permanent form of birth control. So, it’s for people who are looking either to not having anymore children or not have any children at all. And really, any male who is in that scenario is a candidate to at least have that discussion.
Host: So, what dose that discussion look like? Do you discuss age? What’s the first step for a man that’s even considering this?
Dr. Ostrowski: Yeah, I think the first step is really to get a little bit more information and obviously there’s a lot of information on Google and those sorts of things but really, it’s a discussion with your physician about kind of the pros and cons to a permanent form of birth control. It allows a male to take their birth control decisions and a couple into their own account and they can make decisions about what they want as far as their family to look like in the future without having to worry about other forms of birth control which have impacts either to the female health or the use of condoms and things like that that aren’t as guaranteed as a vasectomy.
Host: Do the partners usually attend this first discussion? As you’re coming into this discussion, is there usually a spouse or a partner involved in this decision?
Dr. Ostrowski: You know, I would always recommend that a spouse be involved in the decision making process or a partner to be involved in the decision making process as it is a permanent decision and does have impacts. It doesn’t mean that it couldn’t be reversed but it means that it is either expensive and isn’t guaranteed for you to be able to get pregnant in the future. And so, whenever you are making a permanent decision like that, I would definitely recommend at a minimum discussing it with your partner or spouse and if the partner or spouse want to come in and have the discussion, I’m always happy to have them in the room kind of discussing it.
Host: Is there an age limit?
Dr. Ostrowski: There’s no age limit but we do have more detailed discussions with younger patients. If you are 16 or 18 or 20, it doesn’t mean that you couldn’t get a vasectomy but those discussions about kind of the permanency of it would be very important because people obviously change their minds and can change their minds in the future and there are other options for patients in that scenario. But there isn’t really a true age limit.
Host: Doctor what is the actual procedure day like? It may seem intimidating to men who are going through it. Please reassure them of the ease of this procedure and what you can do for them.
Dr. Ostrowski: I think that it’s a sensitive area of the body and guys are obviously concerned and worried about it and so, I totally understand that. But from an overall procedural standpoint, it is an outpatient procedure that takes about 20 minutes or so to do. We basically numb everything up which means we numb the skin and then we numb the vas which is the tube that carries sperm from the testicle out. That’s the part that’s painful basically. Once that’s numb, there’s some pressure and movement, but there really isn’t any pain. Once we do that, we then transect the vas and then use cautery which is like burning some of the tissue to make sure that those two ends of that tube can’t come back together. And then some providers put in a piece of tissue between those two ends to try to prevent those two tubes from coming back together. We have to do it on both sides. So, you’ll feel kind of that numbing shot on both the right and left side because you have got vas coming from each testicle. We can normally do that through one small little incision that ends up being about a quarter to half an inch in the scrotum.
Host: How effective is a vasectomy?
Dr. Ostrowski: A vasectomy is about as good as it gets from a fertility or preventing fertility standpoint. What I mean by that is that there’s about a one in 2000 to one in 10,000 chance of those two tubes coming back together. Immediately after the procedure, you still are fertile and not fully sterile yet. What that means is for the first few months after your vasectomy, you need to use some other form of birth control but at two to three months typically, we’ll get a semen analysis to prove that there is no sperm or a very small amounts of nonmoving sperm and then you are considered sterile. That from a numbers standpoint is about as good as it gets from a sterilization procedure and at that point, you can stop using other forms of birth control. And that’s what guys and their partners really like about it is that kind of once they are through that waiting period afterwards, then there’s no other forms of birth control needed.
Host: Dr. Ostrowski, I think that another concern that men and their partners may have, are there any risks or complications? Can this cause erectile dysfunction? Can there be anything that would really be concerning from this procedure?
Dr. Ostrowski: Yeah Melanie, I think those are really great questions and that is definitely one of the things that I hear about from patients is what are the risks, is there going to be some issues from an erection standpoint or what is sex going to be like after this and what is that going to look like? And most patients and their partners say that actually their sex life gets better. There is no issues with erectile dysfunction and there’s been no association shown with vasectomy and any kind of health conditions. They looked at it for prostate cancer and all sorts of other things but really, never found any association between vasectomy and anything from a permanent standpoint. From a short term kind of risk standpoint, there are a few things to kind of think about. Those risks are really low, by that I mean we’re talking much less than one percent. There’s a small chance of getting an infection. That chance is so low that the vast majority of people do not use any antibiotics. We just use completely sterile instruments and a sterile technique. And then there’s a small chance of getting some bruising or swelling. Obviously, it is going to be a little bit sore down there after the procedure, but the vast majority of men are going to kind of get back to their usual activity after just a few days. If we did it on a Thursday or Friday, I may tell those guys to take it easy kind of over the weekend and then go back to their usual activity kind of early on a Monday or Tuesday of the next week. There is something called post-vasectomy pain syndrome which is incredibly rare and that is more permanent or chronic pain down in the testicles. We find that in men who have their vasectomy done really close to the testicle and we think that it’s due to some pressure or buildup because you’re still making sperm, it’s just the ability for that sperm to get out into that tube and then your body resorbs it naturally. So that tube length needs to be long enough for that to happen. So, we do vasectomies as far away from the testicle as possible and we make sure that guys are really comfortable during the vasectomy meaning after that numbing shot you shouldn’t really be feeling anything. The numbing shot is not comfortable but it’s not too bad. Once everything is all said and done, really most guys say it wasn’t nearly as bad as they thought it was going to be.
Host: You’ve explained it all so very well Dr. Ostrowski. Is this a permanent procedure? What if a man decides they want to try and have children after having a vasectomy or they want to reverse it?
Dr. Ostrowski: A vasectomy is considered a permanent form of birth control. What I mean by that, is that it’s not guaranteed that you could get pregnant afterwards. There are two options for men to get pregnant after they’ve had a vasectomy if kind of life changes and those two options are a vasectomy reversal which is basically where we go in and we kind of undo what happened. And what we do basically, is identify those tubes where the vasectomy happened and then reconnect those two tubes back together. And the success rate for that is fairly good but it isn’t guaranteed. The other option is in vitro fertilization and that is a procedure where the man’s partner would have a procedure where she is stimulated with some hormones, eggs are taken with a procedure outside the body and we take some sperm from the testicle and combine it outside the body, grow embryos outside the body and then transfer those back in. Those are kind of the two options, but we do consider it permanent because it isn’t guaranteed that you can get pregnant after a vasectomy although those are two very good options for patients who kind of change their mind.
Host: Wrap it up for us then Dr. Ostrowski. This is such an interesting topic. So, please just let the men listening know what you’d like them to know when you have these discussions every day with men that have this decision, they’d like to make what do you say? Give us your best advice.
Dr. Ostrowski: I think that realize that there’s about a half a million men who decide to undergo a vasectomy each year. It’s an incredibly safe procedure that is an outpatient procedure, that is quick, relatively painless kind of when everything is all said and done and has the ability to permanently cause sterilization which basically means you can’t have any more kids. I think it requires a discussion with your partner and a really good understanding kind of for the procedure but from my standpoint given kind of all the different options from a sterilization perspective, this is by far the safest and easiest one to do and it is kind of really the only one from a male perspective that we have currently. I think that for people who are interested in this, there are a lot of really great options to learn some more information and really that a lot of those risks and things that they are worried about while I understand completely and I thought about those; those risks end up being incredibly uncommon and the procedure itself goes very smoothly in the vast, vast majority of men.
Host: Thank you so much Dr. Ostrowski for joining us today. Such a fascinating topic. Thank you for sharing your expertise. To learn more about these services at EvergreenHealth Urology and Urogynecology Care please visit www.evergreenhealth.com/urologists to get connected with one of our providers. And that concludes this episode of Check-up Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. I’m Melanie Cole.