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What You Need to Know About Vasectomies
Reproductive plans may lead you to consider vasectomy or vasectomy reversal. Dr. Luriel Smith-Harrison, Assistant Professor in the Division of Surgical Urology, discusses what you need to know about vasectomies.
Featuring:
Learn more about Dr. Smith-Harrison
Luriel (Riel) Smith-Harrison, MD
Dr. Smith-Harrison’s research interests involve variations in access and utilization of Men’s Health resources, and male infertility.Learn more about Dr. Smith-Harrison
Transcription:
Scott Webb (Host): Vasectomies are a great option for men and couples who want to manage their families. I may have seen too many TV shows that haven’t taken the subject seriously enough. But it feels like vasectomies are perhaps misunderstood. My guest today is Dr. Riel Smith-Harrison, an Assistant Professor in the Division of Surgical Urology at VCU Health. So, let’s talk to Dr. Smith-Harrison about vasectomies and reversing them.
This is Healthy with VCU Health. I’m Scott Webb. Doctor, thanks for being on today.
I don’t know if misunderstood is the right word but what’s involved with a vasectomy?
Luriel (Riel) Smith-Harrison, MD (Guest): I’m not sure if it’s about the vasectomy being misunderstood, but more not knowing the details of the procedure. In short, a vasectomy is an outpatient procedure that guys have the option of using to take control of their reproductive needs and any desires to not have kids in the future. It’s a 15-minute procedure. It’s all outpatient where basically we put the vas (or the two little tubes that take sperm from the testicle to the outside world) in discontinuity. We basically block them. We now use what we call a ‘no-scalpel procedure’ so the discomfort and pain is significantly less than the olden days, we will call it the 70s, when they were opening things up. It’s a relatively quick recovery and after that, guys kind of have dealt with contraceptive management on their terms.
Host: That’s great Doctor, thanks for explaining things. How about the recovery time? How quickly can people get back to their daily lives?
Dr. Smith-Harrison: So, obviously, it’s going to be a little bit different if you are working on power lines verse if you sit at a desk. But in general, what I tell guys is obviously that first day, you are going to take it really, really easy and we say no heavy lifting for about a week. That’s basically nothing more than ten pounds or a jug of milk. And then no heavy, heavy exercise like going to the gym, etc., for about two weeks. And that’s just to really limit the likelihood of one of the postoperative risks, which is a hematoma or a blood clot in the scrotum. Obviously, nobody wants that.
Host: That’s not too bad. It’s just a couple of weeks at the most, right? How long before a vasectomy becomes a viable form of contraception? Because I’m assuming that’s really the only reason someone does this right?
Dr. Smith-Harrison: After the vasectomy, it doesn’t work immediately. You still have swimmers in the tubes and we have to flush them out. What we do is we bring you back at two to three months for a semen analysis to make sure you are in the clear, which most guys are, and once we get that result back, you are good to go.
Host: Doctor, do you find that your patients are just really relieved after the surgery?
Dr. Smith-Harrison: Oh yeah, absolutely. A lot of the time, it’s not just the gentleman who is being affected but also his partner is worried about this. So, it’s just them having better control of how they want to manage their lives in the future, previous children, future children…their family in general.
Host: So, doctor what kind of counseling is available to men and couples as they begin to think about managing their families?
Dr. Smith-Harrison: Most of the time it’s just the male coming in. We sit down and do an exam. I go through the whole procedure in detail and leave it up to them. There is obviously no pressure on my end to do the vasectomy. A lot of guys come in six, eight months later saying hey, I’m finally ready. And a lot of times, the partner is there as well because they have questions. But yeah, it’s usually just a good honest conversation to make sure that’s exactly what they want to do.
Host: And I’m sure like with any surgery, insurance is a factor. Are vasectomies covered by insurance?
Dr. Smith-Harrison: I wish insurance was standard. It’s rare that they are not covered in some capacity at all. Some insurances have pre-prescribed protocols dictating where it can be done, when it can be done etc. For most patients, we can find a way to get it done.
Host: Okay so at least some coverage. We assume that a vasectomy is kind of irreversible, but I don’t think that’s the case anymore, correct?
Dr. Smith-Harrison: Correct. About 20% of guys, for whatever reason, come back at least asking about what the options are for having a biological child after a vasectomy. While you have a vasectomy, your testes are still working. The factory is still on. It’s just blocked. So, as I said, about 20% of guys come back asking what their options are and the main one for most guys is basically a vasectomy reversal.
Host: And I’m assuming then, that the same thing applies for the initial surgery, the original vasectomy with reversals, same sort of prep time, recovery time, down time if you will?
Dr. Smith-Harrison: So, the reversal tends to be little more involved. Instead of it being a 15-minute procedure, it’s more like a two to four-hour microsurgery. It’s a lot easier to block something than to open it up. So, we are basically trying to take a hollow piece of spaghetti and sew it back together with suture that is finer than your hair. It’s a little more involved.
Host: That does sound a little more involved. And are there more risks involved with a reversal?
Dr. Smith-Harrison: Not really more. The risks tend to be about the same. The reversal does have a true incision, so it is more uncomfortable but again, not terrible.
Host: That’s all great information. What else can we tell people about the surgery, the reversal and specifically the work being done at VCU Health by you and others?
Dr. Smith-Harrison: Yes. So, in terms of a vasectomy, it’s an easy way for a guy (and his partner as well) to really take control of family management. In terms of reversals, I think there’s this misconception that success rates are really low. If we can do vas to vas, if you look at data, the success rate of getting sperm back in the ejaculate is about 95% - so actually pretty good. There are some instances where it’s a little bit more complicated of a surgery where that drops down to about 65-70% but still, a reconstructive surgery has pretty good odds for a good result.
Host: Yeah, I would say so. I mean even at the worst case, 65%, that’s still pretty good. Well Doctor, thanks so much for your time and your insight today. Really fascinating topic. Thank you.
To hear more about how you can take control of your health, listen to other episodes of Health With VCU Health at www.vcuhealth.org/podcasts. This is Healthy with VCU Health. I’m Scott Webb. Thanks for listening.
Scott Webb (Host): Vasectomies are a great option for men and couples who want to manage their families. I may have seen too many TV shows that haven’t taken the subject seriously enough. But it feels like vasectomies are perhaps misunderstood. My guest today is Dr. Riel Smith-Harrison, an Assistant Professor in the Division of Surgical Urology at VCU Health. So, let’s talk to Dr. Smith-Harrison about vasectomies and reversing them.
This is Healthy with VCU Health. I’m Scott Webb. Doctor, thanks for being on today.
I don’t know if misunderstood is the right word but what’s involved with a vasectomy?
Luriel (Riel) Smith-Harrison, MD (Guest): I’m not sure if it’s about the vasectomy being misunderstood, but more not knowing the details of the procedure. In short, a vasectomy is an outpatient procedure that guys have the option of using to take control of their reproductive needs and any desires to not have kids in the future. It’s a 15-minute procedure. It’s all outpatient where basically we put the vas (or the two little tubes that take sperm from the testicle to the outside world) in discontinuity. We basically block them. We now use what we call a ‘no-scalpel procedure’ so the discomfort and pain is significantly less than the olden days, we will call it the 70s, when they were opening things up. It’s a relatively quick recovery and after that, guys kind of have dealt with contraceptive management on their terms.
Host: That’s great Doctor, thanks for explaining things. How about the recovery time? How quickly can people get back to their daily lives?
Dr. Smith-Harrison: So, obviously, it’s going to be a little bit different if you are working on power lines verse if you sit at a desk. But in general, what I tell guys is obviously that first day, you are going to take it really, really easy and we say no heavy lifting for about a week. That’s basically nothing more than ten pounds or a jug of milk. And then no heavy, heavy exercise like going to the gym, etc., for about two weeks. And that’s just to really limit the likelihood of one of the postoperative risks, which is a hematoma or a blood clot in the scrotum. Obviously, nobody wants that.
Host: That’s not too bad. It’s just a couple of weeks at the most, right? How long before a vasectomy becomes a viable form of contraception? Because I’m assuming that’s really the only reason someone does this right?
Dr. Smith-Harrison: After the vasectomy, it doesn’t work immediately. You still have swimmers in the tubes and we have to flush them out. What we do is we bring you back at two to three months for a semen analysis to make sure you are in the clear, which most guys are, and once we get that result back, you are good to go.
Host: Doctor, do you find that your patients are just really relieved after the surgery?
Dr. Smith-Harrison: Oh yeah, absolutely. A lot of the time, it’s not just the gentleman who is being affected but also his partner is worried about this. So, it’s just them having better control of how they want to manage their lives in the future, previous children, future children…their family in general.
Host: So, doctor what kind of counseling is available to men and couples as they begin to think about managing their families?
Dr. Smith-Harrison: Most of the time it’s just the male coming in. We sit down and do an exam. I go through the whole procedure in detail and leave it up to them. There is obviously no pressure on my end to do the vasectomy. A lot of guys come in six, eight months later saying hey, I’m finally ready. And a lot of times, the partner is there as well because they have questions. But yeah, it’s usually just a good honest conversation to make sure that’s exactly what they want to do.
Host: And I’m sure like with any surgery, insurance is a factor. Are vasectomies covered by insurance?
Dr. Smith-Harrison: I wish insurance was standard. It’s rare that they are not covered in some capacity at all. Some insurances have pre-prescribed protocols dictating where it can be done, when it can be done etc. For most patients, we can find a way to get it done.
Host: Okay so at least some coverage. We assume that a vasectomy is kind of irreversible, but I don’t think that’s the case anymore, correct?
Dr. Smith-Harrison: Correct. About 20% of guys, for whatever reason, come back at least asking about what the options are for having a biological child after a vasectomy. While you have a vasectomy, your testes are still working. The factory is still on. It’s just blocked. So, as I said, about 20% of guys come back asking what their options are and the main one for most guys is basically a vasectomy reversal.
Host: And I’m assuming then, that the same thing applies for the initial surgery, the original vasectomy with reversals, same sort of prep time, recovery time, down time if you will?
Dr. Smith-Harrison: So, the reversal tends to be little more involved. Instead of it being a 15-minute procedure, it’s more like a two to four-hour microsurgery. It’s a lot easier to block something than to open it up. So, we are basically trying to take a hollow piece of spaghetti and sew it back together with suture that is finer than your hair. It’s a little more involved.
Host: That does sound a little more involved. And are there more risks involved with a reversal?
Dr. Smith-Harrison: Not really more. The risks tend to be about the same. The reversal does have a true incision, so it is more uncomfortable but again, not terrible.
Host: That’s all great information. What else can we tell people about the surgery, the reversal and specifically the work being done at VCU Health by you and others?
Dr. Smith-Harrison: Yes. So, in terms of a vasectomy, it’s an easy way for a guy (and his partner as well) to really take control of family management. In terms of reversals, I think there’s this misconception that success rates are really low. If we can do vas to vas, if you look at data, the success rate of getting sperm back in the ejaculate is about 95% - so actually pretty good. There are some instances where it’s a little bit more complicated of a surgery where that drops down to about 65-70% but still, a reconstructive surgery has pretty good odds for a good result.
Host: Yeah, I would say so. I mean even at the worst case, 65%, that’s still pretty good. Well Doctor, thanks so much for your time and your insight today. Really fascinating topic. Thank you.
To hear more about how you can take control of your health, listen to other episodes of Health With VCU Health at www.vcuhealth.org/podcasts. This is Healthy with VCU Health. I’m Scott Webb. Thanks for listening.