The procedure is very “user friendly” with, in addition, no special preparation needed. Vasectomies are now the most popular form of contraception in New Zealand, with the failure rate 10 – 100 times less than tubal ligation or long term pill usage.
If you are booking-in for the procedure we would like you to read all the information here.
Delivery of local anaesthetic is via a very fine high speed spray and is painless. The no scalpel means the vasectomy is done with some special small instruments leaving just a tiny hole in the skin.
Despite this easy access we remove a very small piece of vas, and cauterise the top ends. This produces a very low contraceptive failure rates. Technical failure rate is approximately 0.25% (1 in 400) which is on par for this type of procedure. For more on this subject, refer to the RCOG (Royal College of Obstetricians and Gynecologists) website www.rcog.org.uk. From studies mentioned on the RCOG website, contraceptive failure rate for vasectomies is 1 in 2000
Dr Rob Williams performs this almost painless and effective operation from a day clinic (first Wednesday of every month) at 109 Princes Street, North Dunedin, Dunedin, 9016. Throughout Rob’s medical career, he has performed over 10,000 vasectomies and continually updates his methods to keep up with the most effective techniques.
Talk to your GP if you would like to provide samples of semen for “sperm storage”. Should life’s circumstances change in the future, and you would like to father another child, reversal is expensive and doesn’t always work, so sperm storage for a few years can give you some “insurance”. We like to think that men who have a vasectomy realize that this is permanent form of contraception. If you are thinking about the possibility of reversal, then you shouldn’t be getting a vasectomy. Having said that, there are always a small number of men who change their minds in later years and want to become fathers again.
How it works
Men produce 1000 sperm a second. Normally 95% of these go nowhere and get recycled in the testes. The remaining 5% travel up the vas, get stored in the seminal vesicles near the prostate and get fired out through the ejaculatory ducts.
Removing a little (5 to 10 mm) portion of vas and sealing both ends of the tubes just above the testicle cuts off the supply line but from then on it will take one to three months (or even longer) to completely empty the dying residual sperm in the seminal vesicles. The prostate keeps on supplying seminal fluid so all that stays the same. Only 5% of the volume of seminal fluid is made up of sperm, so the volume of the ejaculate remains pretty much the same. It may have a slightly clearer appearance without the sperm being there.
What happens to the sperm once their supply line is blocked? Well just like a factory that is full of produced goods and has no room for any more, production is cut. There is a negative feed-back system which tells the testicles not to produce so much sperm. What sperm are produced, collects in the “warehouse” (the epidydimis) and are broken down and re-absorbed after a few weeks.
Hormones are made in the testes but produce their effects by getting into the blood stream and are, therefore, not affected by vasectomy.
No preparation is needed apart from shaving and taking the medication prior. The main areas to shave would be at the front of the scrotum under the penis and down the sided of the groin and testes. It makes life a little easier for the vasectomist to have a relatively hairless area to work in. If there are a few stray hairs we have clippers in clinic to give a small trim if needed.
There will be some medication given prior to the procedure which we will supply for you when you come for your nurse interview. The lorazepam 1mg is taken the night before, and 1 hour before the procedure, another 2mg of lorazepam along with 1g paracetamol . The lorazepam is used as a pre-operative sedative and muscle relaxant, so you won’t be able to drive to and from the clinic. This is given so we have a loose scrotum to work with. Arrange to have transport for your appointment and you won’t be able to drive till the morning after the proceedure.
The infection is rare and pain is very rarely worse than a dull ache. Many people are surprised at the ease of the “no needle/no scalpel” operation.
A small amount of local anaesthetic with a Madajet (a needleless anesthetic device) is given. A small loop of vas is brought to the surface, a small section is removed, the testicular end is tied down with fine absorbable suture, and the prostatic end is diathermied with a fine hot-wire diathermy. Checking for any bleeding, they are cauterised and the skin is sutured again with absorbable fine suture. This will fall out after two to four weeks.
The complete time involved is about 1 hour and 15 minutes although only about 25 minutes is needed for the operation itself.
You won’t be able to drive yourself home afterwards after taking a sedative like lorazepam. If you choose not to take lorazepam, and you feel ok, you can drive yourself home.
A few hours of complete rest is needed to give the internal raw areas a good chance to seal over. Some restraint over the next two days is advised with minimal activity.
Most men will be able to return to work after two days but if you have a very active job, it may be prudent to have a few more days off or ask for light duties. It’s a bit like a small shaving cut, if it gets knocked around on the first day it will almost certainly bleed – after 2 – 3 days it almost certainly won’t. We advise to avoid heavy lifting, straining, bicycling, contact sports and sexual activity for the first week after a vasectomy. It also helps to wear supportive underwear for a week, so that your scrotum has support against moving about.
Vigorous exercise should be avoided for a week. If there is bleeding or persistent oozing from the wounds, some pressure from an ice- filled, clean cloth or a packet of frozen peas may stop it. Sufficient internal bleeding to warrant hospital care is rare, about 1 in 2000, but if this happens contact us, your Doctor, or go straight to hospital casualty.
Collection of Semen
We require two completely negative sperm tests to confirm the success of the operation. These should be done 2 months and 4 months post-vasectomy. This is to check for “technical failure” where there are still motile (moving) sperm. We aim to get two consecutive completely negative tests.
People often pass through a near negative phase with small numbers of dead sperm (non motile) on the way to the completely negative stage; in some this process is prolonged for months or years. If we have several tests with “Small numbers of non-motile sperm” (i.e. dead) sperm that is as good as a completely negative test. Both carry the same pregnancy rate of around 1:10000 pregnancy rate (lifetime).
Semen should be obtained by masturbation and the whole volume collected into the bottle provided. The specimen must go to the lab within 1 hour of collection, and should not at any stage be put in the fridge. Condom or lubricated specimens are not permitted. In Dunedin, we ask that men take their specimens straight to SCL Collection Centre 18 Filleul Street, Dunedin Central, Dunedin 9016, where the specimen can be analysed directly within the hour of giving the sample.
The labs cannot do semen analysis at the weekends or on public holidays.
If the first test is negative (about 90% are), do another to confirm in 8 weeks time. If there are still small numbers of dead sperm (the lab calls them ‘non-motile’), it sometimes takes several months to get complete clearance. 7% of men still produce small numbers of dead sperm 10 years later but carry no increased pregnancy risk.
The reason for this slowness is that some men have large seminal vesicles and small ejaculatory ducts.
Once sperm tests are clear, then you can stop other contraception.