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Vasectomy 101
By: Omar Atassi, M.D.
Urology Associates of Wisconsin SC
The Introduction: Vasectomy refers to the interruptions of the passage of sperm through the tubes called the vas deferens. These tubes run from the sperm warehouse next to the testicle to the urethra. In most men, they (one per side) can be felt in the scrotum as firm cords a little bigger than a piece of cooked spaghetti. These tubes are just “duct work.” They have nothing to do with the testosterone production, erectile activity, penile sensation, orgasm, or any other “manly functions.” They are just tubes. The procedure can usually be done in the doctor’s office under local anesthetic, and it takes about 10 minutes, and it’s probably the least we can do, given the work that our wives or significant other did on the front end of the process.
The Decision: Having children is not a decision to be taken lightly since the little rascals don’t come with a no risk free trial. The same goes for bringing your procreative career to an end. Technically, the procedure can be reversed, but it’s far from foolproof and it’ll set you back a bit with no help from insurance, so when you’re ready for your vasectomy-think permanent! Obviously, you are only half the equation in the process so when it’s time to call it quits, make sure the “better half” is squarely on board.
The Consultation: Once you’ve made the decision to have a vasectomy, the next step is consulting with the doctor. My advice on how to pick one? Ask around! You know people who have had this done and chances are they were awake through the whole thing. Ask them how it went and who did theirs. Don’t hesitate to talk to your doctor and your wife’s obstetrician and ask then whom they would recommend.
The next question is, who does it? A family doc or urologist. I’m not hung up on this after all it’s not brain surgery (despite where our wives believe a significant percentage of out thoughts emanate). Again, ask around and when you meet the doctor make sure they’re doing at least a couple every month (the best are doing two a week or more).
The consultation visit itself will take about 15 minutes. The docs will talk to you about the four of five rare, but real, complications that can occur with the procedure and then, usually will perform an exam like you may not have had since your last high school sports physical. They may not ask you to turn you head and cough, but they’ll need to be in the same zip code. This exam is necessary to see how easy it is to feel the tubes that they’ll be after during the procedure and to check for testicular cancer. They won’t tell you this, but they are will also be looking to see if the color drains out of your face and you get the “weak and dizzies” during the exam. My rule is, if you go out during the exam, you bought yourself an anesthetic in a surgery center and aren’t a good candidate for a vasectomy in my office.
I mentioned risks and complications previously. It bears emphasis that complications of vasectomy are very rare, all less than five percent. Post vasectomy testicular inflammation is arguably the most common in around two to four percent and usually only cost you one to two days off work. The more serious complications like hematoma (more commonly known as cantaloupe scrotum), reconnections of the vas deferens, and post vasectomy pain syndrome, are all less that one percent.
The Operation: This is how things typically work. You will be escorted to a procedure room. You will be given a gown or sheet to cover up with and asked to remove your clothes from the waist down. It’s about now that you’ll be struck with urge to bail on this whole idea and run out of the office. You’ll end up staying because you can’t imagine explaining to your wife that you couldn’t tolerate the ten-minute procedure, especially after she probably spent 24 hours or more in labor during childbirth.
At this point, you’ll probably meet the doctor’s assistant who will be responsible for prepping the area of interest. Yes, it is coincidence that this person will in all likelihood be female and likely under the age of 40. Rest assured, this is really a demographic coincidence and not an effort to make your experience more uncomfortable than it needs to be.
After you’re prepped, the doctor will come in and may try a joke to lighten the tension. You’ll laugh politely because (A) you probably are a little tense but (B) more importantly, because you don’t want to offend the person that will be handling the family jewels for the next 10 or 15 minutes. Next come the numbing shots. Depending upon the doctor, you’ll get one of two of these. They’ll feel like bee stings but won’t hurt for as long, resolving after five to ten seconds. That should be the last significant discomfort you feel and within 10 to 15 minutes you will be getting dressed and heading for home with an instruction for the next couple of days.
All kidding aside, during the whole procedure, you should have less than 30 seconds of discomfort. The rest of the time, you should be comfortable enough to read a book, talk about the Packers, embellish on your last deer-hunting story, or just count the ceiling tiles. If it hurts, let the doctor know-there’s usually something that can be done to alleviate your discomfort.
The Recuperation: This is the first time in the process where the patient has some control over the outcome. Rest, ice, and Tylenol are your friends. Two-year-old, Bruce Lee wannabes are not, so find a couch and protect your privates. For the next 48 hours, see if you can watch the entire season of the Sopranos on DVD while rotating bags of frozen peas on the affected area per your doctor’s instructions (follow his instructions carefully since scrotal frostbite is no picnic). You can gradually increase our activity over the next several days, limiting strenuous physical activity for one week after the procedure, and that generally includes the horizontal bop. Call your doctor if you have swelling larger than a peach pit on either side or bruising on the skin bigger than the diameter of a 50 cent piece. You will have some pain but it shouldn’t typically exceed that, which you can control easily with Tylenol or Motrin.
Good Luck!
