Vasectomy
January 2023 - Our backlog of procedures continues to diminish. We continue to limit this service to patients from our immediate geographic area. If you are outside our catchment, your family physician can refer you to a local urologist. The current wait time between referral for consultation and procedure is in the range of 12-18 months.
All patients are seen in consultation prior to vasectomy. If you decide to go forward with vasectomy, the procedure will be booked on a separate date. There are no associated fees for consultation or the procedure - vasectomy is an insured service under MSP. Referral from your family physician is necessary before consultation.
While we do not have any surcharges associated with vasectomy, we ask that patients coming for vasectomy (or any other service) be considerate of the needs of others. There are many patients who require consultation and surgery for serious, sometimes life threatening, conditions. No shows or cancelling without reasonable notice may result in harm to other patients requiring care.
Description of Procedure
Vasectomy is a reliable method of male contraception. Consider it PERMANENT (reversals are possible but there is no guarantee of success). The goal of the procedure is to prevent sperm in the testes from entering the ejaculate. This is done by obstructing the vas deferens - the tube which carries sperm from the epididymis to the urethra. As mentioned, vasectomy reversal is not always successful and it is expensive (most insurance will not cover the cost which can be $5,000-10,000). An alternative to vasectomy reversal is surgical removal of sperm from the testis combined with IVF. Sperm are still being made even after vasectomy.
Vasectomy is performed as a 10 minute out-patient procedure under needle (local) anesthetic. You do NOT need to fast before the procedure unless instructed to do so by your urologist. Urologists perform many other types of scrotal surgery, including vasectomy reversal, and have access to the resources necessary to manage any and all potential complications. Therefore, urologists are the optimal physicians to perform vasectomy.
There is no known association between vasectomy and hypertension, dementia, coronary artery disease, stroke, prostatic, testicular, or neurological diseases. You will not notice any change in your erections or ejaculatory volume following vasectomy.
Before The Procedure
MAKE SURE YOU SHAVE ALL THE HAIR OFF THE ENTIRE SCROTUM (including at the base of the penis near the scrotum). Do this 2-3 days prior to the procedure.
Shower the morning of the procedure.
Bring tight fitting underpants or an athletic support to put on after.
You DO NOT need to fast prior to vasectomy. You may eat and drink as you normally would.
During The Procedure
The approach used by the Metrovan Group is a Minimally Invasive Vasectomy (MIV). A No Scalpel Vasectomy (NSV) is a variant of a MIV but some practitioners feel that in order for a vasectomy to qualify as a NSV several specific steps need to be followed. The vast majority of vasectomies are performed as some variation of the NSV technique which are categorized as MIVs. In any case, the principle are to avoid use of a scalpel and utilize 2 specific instruments, the ringed vasectomy clamp (to entrap and deliver the vas deferens) and sharp-tipped hemostat (to make the skin opening and assist with delivering the vas deferens).
You may feel some 'pulling' and 'tugging' during the procedure but you should have very little to no pain. The skin and vas deferens are frozen. A small opening about 5 mm in size is made in the scrotal skin (usually only one is made, but sometimes a second opening is necessary). The vas deferens is delivered, divided and the ends tied off or secured with titanium clips (the surgeon may alter the details to fit your circumstances). There are 2 vas deferens (a RIGHT and a LEFT side) so each side is done separately, though usually through the same skin opening.
Immediately After the Procedure
There are 2 major complications that can occur soon after vasectomy - fortunately they are uncommon and affect less than 1 in 50 men:
Infection.
Bleeding (scrotal hematoma) - this is bleeding into the scrotum. The scrotum is loose and can trap blood. This can significantly prolong recovery from days-weeks up to weeks-months (usually 2-3 months for the blood clot to dissolve and reabsorb).
You can reduce your chances of having these problems by 'babying' the scrotum for the first week after surgery:
Avoid vigorous physical activity, including intercourse (this means any exercise or sports).
Use a cold pack.
Use an atheletic support or tight fitting underwear.
You can shower anytime after the procedure. Remove the dressing the day after surgery. Apply polysporin or similar ointment and the opening in the skin will heal faster. It is normal to have a little bit of ooze of blood or clear fluid from the opening - this will usually settle within a week. Mild bruising is normal.
Potential Long-Term Risks
Fortunately, the vast majority of men who have vasectomy do not have any issues. However, a small number do. It is impossible to predict who might have a problem and in some cases the problems can show up years later.
PREGNANCY. This is the big one. Important notes:
USE CONTRACEPTION UNTIL YOU GET THE GO AHEAD FROM THE UROLOGIST. We will give you the requisition, a specimen collection cup, and instructions to check a sperm sample about 2-3 months after the procedure. IT IS YOUR RESPONSIBILITY TO DO THE TEST AND PHONE US TO DISCUSS THE RESULT. Provide a sample about 2 months after your vasectomy; abstain from ejaculating for a minimum of 2 days and no more than 7 days before producing the sample.
Check with your local Life Labs to find out when they will accept a sample, collect the sample at home and bring it in within about an hour of producing it.
Success is defined by less than 100,000 non-motile sperm (ones that have no movement). If there is any doubt, we will ask you to provide another sample.
How likely are 'significant' numbers of motile sperm seen after vasectomy? About 1 in 200 men will have motile sperm in significant numbers at 2-3 months after the vasectomy - some of these men will need to have the procedure repeated.
What is the risk of pregnancy after vasectomy? Vasectomy is not 100% reliable in preventing pregnancy even after vas occlusion is confirmed by a semen analysis. There is a very small but finite risk of pregnancy after vasectomy of approximately 1 in 2,000 for men who have a post vasectomy sample showing rare non-motile sperm.
Chronic pain. Rare, but bothersome enough to have a negative impact on quality of life. About 1 in 50 to 1 in 100 men seek treatment for chronic pain after vasectomy (that is, pain lasting for more than 1 year). There are some studies which identify the rate as being as high as about 5% of men who seek medical care for scrotal pain following vasectomy compared to 2% of men who have not had a vasectomy. A smaller number would consider additional surgical procedures to correct their pain (e.g. with vasectomy reversal or epididymectomy). This is relatively rare (estimated to be about 1 in 500 patients). Surgery is not always successful at correcting the pain. Source: American Urological Association Guidelines (Published 2012, Amended 2015)
It is your responsibility to go for the semen analysis and contact us for the results. Failure to do so could result in unintended pregnancy. You can find the lab nearest you by contacting the lab web page or phoning the lab directly. Links to Lifelabs and BC Biomed can be found here.
If you have questions that are not answered here, please contact us.
What to Expect
It will be normal for you to have some pain and bruising following your procedure (though many men will have no bruising).
Cautions
If you have significant scrotal swelling please contact us as you may be developing a hematoma or infection. Some minor bruising is normal.
Diet
There are no dietary restrictions.
Activity
Avoid vigorous physical activity and intercourse for about a week after your procedure as it can produce post-operative bleeding. You may bathe any time after the procedure.
Medications
You may resume all of your regular medications after your vasectomy. If you are on blood thinners, you urologist will give you specific instructions but, in general, antiplatelets and anticoagulants (e.g. aspirin, plavix and coumadin/warfarin) should be discontinued about 7 days before surgery and can be resumed 7 days after the procedure.