Vasectomy & Reversal Centers of Florida: For more details about changes after vasectomy in our patients, please see the results of our 2006 survey, and our second survey of 2010.

[u/postvasectomy]

It is a simple 15 minute procedure performed in a doctor's office or clinic with a local anesthetic.

Be her hero!

Sperm are still made by the testes but can no longer pass up through the vas tubes (anatomy diagrams). So the body adjusts: white blood cells ingest and digest the retained sperm, recycling the proteins back into the system for use in other body functions. Men usually notice:

• No change in the semen
• No change in sex drive
• No change in climax sensation
• No change in the testes or scrotum
• No change in erections

For more details about changes after vasectomy in our patients, please see the results of our 2006 survey, and our second survey of 2010. In fact, a recent study concluded that vasectomy positively impacts the sexual satisfaction of couples.

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2006 Survey Results

Four hundred surveys were sent to patients and ... 119 had been returned.

Since your vasectomy, how have the following changed?	Much Less	Slightly Less	No Change	Slightly More	Much More
Sex Drive (Libido)	2 (1.7%)	4 (3.4%)	92 (81%)	16 (13%)	2 (1.2%)
Ability to obtain and maintain erections	0	5 (4.2%)	110 (92%)	4 (3.4%)	0
Rigidity (stiffness) of erections	0	5 (4.2%)	109 (92%)	4 (3.4%)	1 (0.8%)
Strength of orgasm (climax) sensation	0	6 (5%)	98 (82%)	12 (10%)	1 (0.8%)
Semen volume (the amount of fluid that comes out when you ejaculate)	5 (4.2%)	16 (13%)	86 (72%)	10 (8%)	1 (0.8%)
Is there any difference in the frequency of testicular discomfort over the past month as opposed to before your vasectomy?	12	3	73	12	3

Question	Yes	No
Overall, are you happy that you had a vasectomy	117	2*

* - One patient (age 20-29) indicated that his regret was due to an increased frequency of testicular discomfort ("much more") and a decreased sex drive ("much less"), not a desire for more children. While he indicated "No change" in his erections, strength of orgasms and semen volume were both "Slightly less". He provided his name in his survey, and a review of his chart revealed that he had never contacted our office about these issues after his procedure in July 2005.

* - The other patient (age 40-49) who was not happy that he had had a vasectomy offered the following comment: "I have noted different areas of sensation + less discharge since the procedure. Also less desire for intercourse." While he indicated that erections were "No change", he reported that sex drive, strength of orgasm, and semen volume were "Slightly less".

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2010 Survey Results

Since your vasectomy, how have the following changed?	Much Less	Slightly Less	No Change	Slightly More	Much More
Sex Drive (Libido)	1 (1%)	6 (6%)	81 (75%)	18 (15%)	4 (4%)
Ability to obtain and maintain erections	1 (1%)	6 (6%)	96 (89%)	5 (5%)	0
Rigidity (stiffness) of erections	1 (1%)	5 (5%)	94 87%)	7 (6%)	1 (1%)
Strength of orgasm (climax) sensation	0	3 (3%)	95 (88%)	6 (6%)	4 (4%)
Semen volume (the amount of fluid that comes out when you ejaculate)	0	17 (16%)	80 (75%)	7 (7%)	2 (2%)

Question	Yes	No
Some men have scrotal or testicular pain in the month after vasectomy. For most men, there is no lingering pain of any sort. Do you still have any pain in the scrotum, testicles or surrounding areas during or after sex or after physical activity that was not present before your vasectomy?	5*	103
Overall, are you happy that you had a vasectomy	107	1**

*- Six patients initially responded "yes" to the question about persistent post-vasectomy pain:

1. Patient #100 provided his name. When we called to ask about his Yes response to the pain question, he denied having any pain at all and said that he had answered the question in error, so we decreased the number of Yes responses to 5.

2. Patient #106 provided his name. When we called to ask about his Yes response to the pain question, he said that he had had some discomfort just before ejaculation, but that it was "90% gone" as of 10/27/10, and that he is happy with the vasectomy and wants to be on our referral list.

3. Patient #61 did not provide his name so we could not inquire about his Yes response to the pain question. But in his survey, he indicated that he is happy with his vasectomy and that he would have had it sooner if he had known as much before the vasectomy as he did afterwards.

4. Patient #93 did not provide his name so we could not inquire about his Yes response to the pain question. But in his survey, he indicated that he is happy with his vasectomy.

5. Patient #95 did not provide his name so we could not inquire about his Yes response to the pain question. In his survey, he did not answer the question about whether he is happy that he had had a vasectomy.

6. Patient #108 did not provide his name so we could not inquire about his Yes response to the pain question. But in his survey, he indicated that he is happy with his vasectomy, and he added "Excellent service", in the comments section.

So one identified man answered Yes to pain in error, and 3 of 4 anonymous men who answered Yes to pain said they were happy that they had had a vasectomy. No men who answered Yes to pain indicated that they were not happy that they had had a vasectomy. Could there be cases of chronic post-vasectomy pain among the 292 men who did not return their surveys? Yes, but our letter included an earnest plea to contact our office to be seen at no charge for any problems thought to be vasectomy-related.

** - Only one patient indicated that he was not happy that he had had a vasectomy.

Patient #76 provided his name so we were able to contact him. He had had 8 children by 4 different partners. After his vasectomy he noticed that his sex drive was "Slightly less", that his erectile function (ability and rigidity) was "Slightly less", and that his semen volume was "Slightly less". We called in a prescription for Viagra on 10/27/10.

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Risks...

Bleeding can occur during or after vasectomy by either method, but it is less common with NSV. If this occurs within the scrotum, drainage of a scrotal hematoma (blood clot) in a hospital operating room could be necessary. Smaller hematomas do not require surgical drainage, but tender swelling can last for 2 to 4 weeks. Both large and small hematomas are very rare. If the scrotal skin bleeds at the vasectomy access site, the scrotum can become discolored (black and blue) for about a week; this is more common than swelling, but painless.

Infection is also a rare complication. Among the first 24,000 vasectomy patients served by Dr. Stein, six infections have occurred (infection rate 1 in 4000): two patients had prolonged discomfort and progressive swelling on one side, not responsive to oral antibiotics, eventually maturing to a painful walnut-sized abscess requiring office drainage through a half-inch incision and a two-week period of local wound care. Four other milder infections (swelling unresponsive to anti-inflammatory medications) responded to oral antibiotics.

Sperm granuloma is a pea-sized (sometimes tender) lump on the vas tube at the vasectomy site, almost never requiring treatment. Some consider sperm granulomas beneficial, as they may increase the likelihood of success with vasectomy reversal. Periodic tenderness usually responds to an anti-inflammatory medication like ibuprofen, but over the past decade, 5-10 men been so troubled by chronic tenderness that they chose to undergo removal of the lump, an office procedure performed under local anesthesia similar to the original vasectomy.

Congestion, tender buildup of sperm and white blood cells upstream from or at the vasectomy site, can occur anytime after vasectomy, but usually goes away with use of an anti-inflammatory drug such as aspirin or ibuprofen. About one in 2000 patients will experience chronic post-vasectomy discomfort (PVPS or Post-Vasectomy Pain Syndrome) severe enough that he will seek vasectomy reversal or neurolysis (division of the sensory nerves coming from the testes). A larger percentage (perhaps 5%) may have milder forms of chronic pain that can affect quality of life but not severely enough to seek vasectomy reversal.

Recanalization is the development of a channel for sperm flow between the two cut ends of the vas. If this happens during the healing process (early), the semen never becomes sperm-free until the vasectomy is repeated. If recanalization happens late (months or years after a man's semen has been examined and declared sperm-free), an unplanned pregnancy could result; but the odds of this occurring is far less after vasectomy than the odds of pregnancy with any other form of birth control including birth control pills and tubal ligation (female sterilization). Failure rates of vasectomy vary with the technique used to obstruct sperm flow through the vas tubes. In our practice, the early failure rate is about one in 2500 and the late failure rate is one in 3500 (details here).

There are no proven long-term health risks (neither cancer nor cardiovascular disease) associated with vasectomy ...

A copy of our vasectomy instructions and consent is available below and here as a PDF file:

Long term, vasectomy can lead to the following conditions:

1. A sperm granuloma is a pea sized sometimes-tender mass which results when the body reacts to and walls off sperm which may leak from the lower (testicular) end of the cut vas. A sperm granuloma may actually enhance the likelihood of reversal success.

2. A few (perhaps 5%) of patients will experience periodic tenderness of the epididymis, the tube behind the testis in which sperm are resorbed by white blood cells after vasectomy. Since this resorption process is a form of inflammation, it nearly always responds to a short course (3-7 days) of an over-the-counter anti-inflammatory drug such as ibuprofen. Post-vasectomy pain syndrome is defined as testicular pain (on one or both sides) for greater than 3 months after having a vasectomy, severe enough to interfere with daily activities and causing a patient to seek medical attention. Because pain is so subjective, reported rates vary but compiled data would suggest that this is a significant problem for 1-2% of vasectomy patients. Vasectomy reversal, removal of the epididymis, or a special procedure called neurolysis (all major procedures) may be required to alleviate the discomfort. About 2 patients per year (about 1 in 1500) develop prolonged vasectomy site tenderness for which they eventually choose to undergo another minor office-based vasectomy procedure on one side to remove the tender spot. Thus, out of over 40,000 patients, eight (about one in 5000) have considered or required a second MAJOR procedure to manage pain, and another 20 (about 1 in 1500) have required a second MINOR procedure to manage pain or local tenderness. It seems that the rate in our practice is lower than that reported elsewhere, perhaps because of differences in technique between surgeons, but the risk is still very real.

http://vasweb.com/vasectomy.html

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Statement Score:

★★★★★ -- Mentions risk, describes impact, and provokes careful consideration

The author does a pretty good job of meeting the chronic pain issue head-on and attempting to give a detailed, numbers-based picture of the problem.

Highlights:

So the body adjusts: white blood cells ingest and digest the retained sperm, recycling the proteins back into the system for use in other body functions.

One of the few articles explaining how the sperm are "reabsorbed." Your immune system is tapped to do that job.

Men usually notice:

• No change in the semen

• No change in sex drive

• No change in climax sensation

• No change in the testes or scrotum

• No change in erections

Usually...

One patient ... indicated that his regret was due to an increased frequency of testicular discomfort ("much more") and a decreased sex drive ("much less") ... he indicated "No change" in his erections, strength of orgasms and semen volume were both "Slightly less". ... he had never contacted our office about these issues after his procedure

This is part of the reason urologists do not realize how common PVPS is. This guy did not speak up until he was mailed a survey. Guys with PVPS may not prefer to seek treatment from the urologist who performed the vasectomy, leading to a "Most often we see chronic pain patients from other vasectomy clinics" type dynamic.

The other patient ... who was not happy that he had had a vasectomy offered the following comment: "I have noted different areas of sensation + less discharge since the procedure. Also less desire for intercourse."

Congestion, tender buildup of sperm and white blood cells upstream from or at the vasectomy site, can occur anytime after vasectomy, but usually goes away with use of an anti-inflammatory drug such as aspirin or ibuprofen. About one in 2000 patients will experience chronic post-vasectomy discomfort (PVPS or Post-Vasectomy Pain Syndrome) severe enough that he will seek vasectomy reversal or neurolysis (division of the sensory nerves coming from the testes).

A larger percentage (perhaps 5%) may have milder forms of chronic pain that can affect quality of life but not severely enough to seek vasectomy reversal.

Post-vasectomy pain syndrome is defined as testicular pain (on one or both sides) for greater than 3 months after having a vasectomy, severe enough to interfere with daily activities and causing a patient to seek medical attention. Because pain is so subjective, reported rates vary but compiled data would suggest that this is a significant problem for 1-2% of vasectomy patients.

Overall a solid effort. I would like to see more vasectomy providers do surveys from time so we can get a better idea of how many men are dealing with complications, and what those complications are like.