Vasectomy is a minor surgical procedure to cut and close off the tubes (vas
deferens) that deliver sperm from the testes; it is usually performed as a
means of contraception. The procedure typically takes about 30 minutes and
usually causes few complications and no change in sexual function. About 500,000
vasectomies are performed annually in the United States. A vasectomy is less
invasive than a tubal ligation (the procedure used to prevent a woman’s eggs
from reaching the uterus) and more easily reversed. An increasing number of
couples choose it as a means of permanent birth control.
Male Reproductive System
To understand a vasectomy, it is helpful to understand the male reproductive
system and how it functions. The testicles, or testes, are the sperm- and
testosterone-producing organs. They are located in a sac at the base of the
penis called the scrotum. Each testicle is connected to a small, coiled
tube called the epididymis, where sperm are stored for as long as 6 weeks
while they mature. The epididymes are connected to the prostate gland by
a pair of tubes called the vas deferens. The vas deferens are part of a
larger bundle of tissue, blood vessels, nerves, and lymphatic channels called
the spermatic cord. During ejaculation, seminal fluid produced by the
prostate gland mixes with sperm from the testes to form semen, which is
ejaculated from the penis.
Surgeons typically require men to do four things before their vasectomy:
- Shave and wash the scrotum (to prevent infection and to allow easier
- Bring a pair of tight-fitting underwear or athletic supporter (to support
the scrotum and minimize swelling)
- Arrange for a ride home (to minimize exertion and movement that
- Avoid anti-inflammatory drugs, such as ibuprofen and aspirin, before
surgery (they thin the blood and can cause excessive bleeding)
A urologist performs a vasectomy on an outpatient basis, frequently in the
office. The procedure takes about 30 minutes. The patient typically remains
clothed from the waist up and lies on his back. The scrotum is numbed with one
or more injections of local anesthetic (lidocaine), the vas deferens is gathered
under the skin of the scrotum, and a small incision (usually 1 centimeter or
less) is made. The vas deferens is then pulled through the incision, cut in two
places, and a 1-centimeter segment is removed. Each end of the vas deferens is
surgically tied off or clipped, and placed back in the scrotum. The incision is
sutured and the procedure is repeated on the other side of the scrotum. Some
urologists cauterize the ends of the vas deferens, but others find that
cauterization complicates reversal and is unnecessary. The incisions are dressed
and most men go home immediately after the procedure.
In the no-scalpel vasectomy, a surgical clamp is used to hold the vas deferens
while a puncture incision (instead of a cut) is made with special forceps. The
forceps are opened to stretch the skin, making a small hole through which the
vas deferens is lifted out, cut, sutured or cauterized, and put back in place.
The puncture incision does not require suturing. Some urologists recommend the
no-scalpel method because they find it is quicker and minimizes postoperative
discomfort and the risk for bleeding and infection.
"Scalpel vs. No-scalpel Vasectomy"
Vasclip® is an alternative to vasectomy that does not involve cutting or
cauterizing the vas deferens. In this procedure, a small plastic device is
clamped around the vas deferens to prevent sperm from entering the semen. The
Vasclip procedure does not require urologists to modify their techniques for
scrotal access and closure.
Because the vas deferens is not cut or cauterized, Vasclip may result in a
shorter recovery time and fewer complications (e.g., swelling, inflammation,
infection) than vasectomy. Statistics on reversal are not yet available. The
procedure should be considered permanent.