A vasectomy procedure involves the cutting and separating of the ends of the vas deferens, the tubes that move sperm from the testicles to the penis. After the procedure, ejaculate will contain no sperm. Sperm is the component that leads to pregnancy. After a vasectomy the sperm will be recycled by your body through your epididymis instead of making its way into your ejaculate (cum).
Vasectomy procedure options available with me include a no scalpel vasectomy, open-ended vasectomy or a closed-ended vasectomy where both ends are closed with dissolvable suture.
During your pre-vasectomy consultation, I will explain the various options available and allow you to make an informed decision and ensure you are clear that the procedure we do is right for you.
Regardless all my vasectomies are done with a minimally invasive technique. Over the past 25 years, I have performed over 5000 vasectomies and less than 50% of my patients require pain medication after their vasectomy and less than 1% have problems with their scrotal wounds.
The debate on the best method is an ongoing one and according to national guidelines either approach is acceptable.
The closed-ended vasectomy is where both ends of the tubes are closed with dissolving sutures.
An open-ended vasectomy only closes the upper part of the tube, leaving the end connected to the testicle completely open. This allows the sperm to be released into the scrotum.
From my review of the literature, it appears that open vasectomies are associated with a slightly higher failure rate as a contraception but also a slightly lower chronic pain rate. The difference in failure rate may be due to the fact that while a closed vasectomy shuts both doors (entrance and exit) to sperm passage and open vasectomy leaves one door open.
The reason closed vasectomy causes more pain is probably because this technique is more likely to lead to a pressure build up behind the blockage, which can cause some epididymitis or congestion near the testis. Open vasectomies are not without issues and with this method there is an increased risk of scrotal granulomas as spilled sperm rev up the immune system which sees them as foreign.
Reassuringly, the congestive epididymitis (tenderness caused by pressure building up) with the closed method usually resolves spontaneously or with some simple medication.
A no scalpel vasectomy requires a single small tear in the skin, and no stitches. This is done with a specially designed set of forceps where the scrotal skin is torn apart.
I am happy to discuss the pros and cons and options for vasectomy further with you at your pre-vasectomy consultation.