I have performed a lot of vasectomies. This is because I ran an NHS vasectomy clinic in the UK, where we received nearly 60 new referrals each month for two and a half years. Every Wednesday, I would leave the hospital setting and head to a small family medicine clinic in the center of Norwich, Oak Street Medical Practice, to meet 11 men coming in for their vasectomy procedures.
Here is what I have learned from performing nearly 1,000 vasectomies, listening to patients’ pre-operative concerns, and gathering their post-operative feedback.
The most obvious reason prompting men to have a vasectomy is that they do not want any more children. But for most of them, the decision goes a little deeper than that.
Many acknowledge the fact that their partner already bore much of the responsibility that comes with family planning. In the early years of a relationship, contraception typically falls on the woman, where the oral contraceptive pill or other hormonal methods are commonly used, and these may not be well tolerated by everyone. Then comes pregnancy and childbirth, both of which can profoundly affect a woman physically and emotionally. In certain cases, additional pregnancies may carry increased health risks for a woman.
For many men, choosing to undergo a vasectomy is a way of taking on that responsibility themselves, seeing it as a fair and practical solution once their family is complete.
The second most common reason is the unexpected arrival of a third, fourth, or even fifth child. An unplanned pregnancy often reinforces the importance of having in place a more reliable and long-term contraceptive solution.
Men have always been protective of their testicles, so it may seem unusual that some would proactively choose to undergo surgery in such a sensitive area.
The first thing to understand is that a vasectomy doesn’t involve operating on the testicles themselves. Many men are not entirely familiar with the anatomy involved and therefore may mistakenly assume that the procedure is performed on the testicles.
I often explain it this way: the testicles represent the factory, while the vas deferens are the transport routes carrying sperm from the factory to their destination. During a vasectomy, we simply block those routes. The factory itself is not affected in any way and continues to function normally.
Therefore, we can say that the procedure only affects the pathway that sperm travel through, rather than the testicles producing them.
Most of the vasectomies I have performed were carried out under local anesthesia and typically took no more than 20 minutes. The most common comments I hear afterwards are: “That wasn’t as bad as I expected,” “I barely felt anything,” and even, “I’d rather do that again than visit the dentist.”
To minimize pain levels after the procedure, I advise on the following:
A small number of men may experience a condition known as post-vasectomy pain syndrome, which is characterized by chronic discomfort lasting more than three months after the procedure. Reassuringly, a recent study from the UK involving 102,549 vasectomies found that the condition was reported in only 0.17% of cases.
This finding aligns with my own clinical experience. As the clinician in charge of managing chronic scrotal pain in my region of the UK, I only saw relatively few cases of post-vasectomy pain syndrome, considering the large number of vasectomies performed.
I do think surgical technique plays an important part. A no-scalpel technique can minimize trauma by avoiding any damage caused to surrounding tissue. Some vasectomy surgeons choose to cauterize (burn) long segments of the vas deferens. This can cause significant inflammation, so I personally use minimal cautery when performing a vasectomy.
For men considering a vasectomy, a common concern is whether the procedure will affect normal bodily or sexual function. The reassuring answer is no.
The testicles have two main functions: The production of sperm and testosterone. A vasectomy does not interfere with any of these functions and the testicles continue to produce sperm and testosterone as before. This also explains why a vasectomy reversal can often restore the presence of sperm in the ejaculate.
I often explain to patients that the testicles act as the factory while the vas deferens represent the transport routes. The testicles will continue producing the sperm as normal even though the vasectomy has blocked the routes.
Another common concern is whether a vasectomy will reduce the volume of ejaculate. In reality, only about 5% of ejaculate volume comes from the testicles. Most of it is produced by the seminal vesicles (60-70%) and the prostate gland (20-30%), both of which are not affected by vasectomy. As a result, most men notice little to no change in the volume of ejaculate.
An important aspect is that erections remain unchanged, levels of testosterone are maintained, and sexual satisfaction is generally unaffected. In fact, some studies have even reported improvements in sexual satisfaction following vasectomy.
Inquiring about the possibility of reversal during the consultation is a yellow flag, though not necessarily a red one. Men considering a vasectomy should approach the procedure with the understanding that it is intended to be a permanent form of contraception. While reversal is possible, its success cannot be guaranteed. Therefore, if there is a possibility that a man may wish to have children in the future, a vasectomy may not be the most suitable choice.
It’s important to recognize that life can take unexpected turns, and the desire to have more children may occasionally arise. As highlighted earlier, the testes continue to produce sperm after a vasectomy, which means that having more children may still be possible through two options: vasectomy reversal or sperm retrieval with assisted reproduction (IVF/ICSI).
The best option depends on the time since the vasectomy and the age of female partner. Generally speaking, a short vasectomy interval and younger female partner, leads to better chances of pregnancy following vasectomy reversal.
Vasectomy is a low-risk, quick, effective and long-term form of contraception. It is an excellent option when you have completed your family. Most men are genuinely surprised at how little discomfort there is during or after the procedure. There is no notable change in sexual function. Reversal is possible but shouldn’t be a consideration when deciding to have a vasectomy.
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