(Published September 2009)

Male Sterilization: Vasectomy

Description. Vasectomy has been used for decades for male sterilization. It is safe, highly effective, and has very few side effects. The procedure is done on an outpatient basis with about 10 minutes for prep and administration of local anesthesia and another 10 minutes for the procedure.

Use. No-scalpel vasectomy (NSV) is the standard of care. A small opening (a few millimeters) is made in the skin of the scrotal sac to deliver the vas deferens. The vas are then ligated or cauterized. There is no need for sutures. Sexual activity may be resumed as soon male sterilization vasectomy as the patient feels comfortable. However, a backup contraceptive method should be used for the first 15–20 ejaculations (or about 12 weeks) after the procedure because sperm remain in the vas beyond the point of occlusion.

Effectiveness. This method is extremely effective. The failure rate of vasectomy is very low (0.10%–0.15%).

Risks and Side Effects. Reactions to local anesthesia are possible but rare. Some short-term tenderness and bruising may occur. Overall, NSV is associated with little pain and a low risk of infection.⁷

Advantages

Long-term method
Discreet
Low risk of side effects
After up-front cost, no ongoing cost to maintain method
No effect on hormonal milieu
Highly effective
Quick recovery

Disadvantages

Requires surgical procedure
Requires trust between partners
Lack of protection against STIs

Counseling Messages. Vasectomy should be considered a permanent method of male sterilization. Reversal procedures exist but are technically complex, expensive, and have a variable success rate. Stress the importance of a return visit to check for sperm, and the use of backup contraception until then. Counsel women whose partners have had a vasectomy to protect themselves against STIs.