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Important information about the vasectomy: male sterilization

During male sterilization (vasectomy), the two vas deferens in the scrotum are severed and the loose ends are then sealed. This means that sperm can no longer get into the semen.

The engagement during vasectomy

The vasectomy is usually performed on an outpatient basis and under local anesthesia or general anesthesia in a urological practice. The operation takes about half an hour in total.

Various surgical procedures are available for severing the two vas deferens in the scrotum. In a "scalpelless" vasectomy, the skin of the scrotum and the sheaths of the spermatic cord are only incised and spread apart to gain access to the vas deferens. This procedure is associated with comparatively few surgery-related complications such as bruising (hematoma). Wound infections are also comparatively rare.

The two vas deferens are pulled out a little through the resulting small hole and then severed. The loose ends of the vas deferens are then closed by tying, heat, chemical substances or titanium clips and placed in various layers of tissue in the scrotum so that they do not grow together again. As a rule, no skin sutures are necessary, so that in the end two small plasters on the skin of the scrotum are sufficient.

Other techniques involve making incisions to access the vas deferens. In addition, the vas deferens are not only severed, but also shortened by about one centimeter each.

In terms of contraceptive security, none of the methods has turned out to be better. Regardless of the surgical technique used, a few days of physical rest and sexual abstinence are usually sufficient after the procedure to recover. You should avoid sports and physical training for two weeks if possible. Sometimes it is also recommended to wear a testicle protector (jockstrap) during this time.

The procedure does not affect the production of hormones and sperm in the testicles. Since the vas deferens are severed, the sperm can no longer get into the semen (ejaculate) and are broken down by the body. The degradation process happens unnoticed and painlessly. A vasectomy is not to be confused with a castration, in which the testicles are surgically removed or their function is hormonally prevented.

Follow-up inspection

In order to check whether there are still fertile sperm in the ejaculate, the semen should possibly be examined several times after the procedure. It can take several months before you are definitely infertile, since there are still many sperm in the upper sections of the vas deferens even after the vasectomy. It usually takes 15 to 20 ejaculations before there are no more sperm to be found. Only when there are no more sperm can you stop using other contraceptives. The follow-up of the semen is also important to check whether the severed vas deferens may have grown back together.

Security

Vasectomy is the most reliable contraceptive method for men. The failure rate with perfect application is 0.1 percent, with typical application 0.15 percent.

In the first few months after the vasectomy, the severed vas deferens may grow back together by themselves (recanalization). Reports on how often this occurs vary from 50 to 530 out of 10,000 cases. It is therefore important that the success of the procedure is ensured by one or two follow-up checks. Additional contraception is required until the follow-up check is successful.

In very rare cases (estimates range from 3 to 120 out of 10,000) recanalization and possibly pregnancy can occur years after the procedure.

Advantages

The advantage of a professionally performed vasectomy is its high level of safety as a contraceptive method. The vasectomy has no direct influence on the feeling of pleasure, the stiffening of the penis (erection), the orgasm and the ejaculation (ejaculation). The amount of semen in a sterilized man is also not very different from that in a non-sterilized man, since sperm only make up about five percent of the ejaculate.

Vasectomy is also a comparatively simple surgical procedure that rarely causes complications. The sterilization of women (tubal sterilization), in which the fallopian tubes are severed during an abdominal operation, is more complex and associated with significantly higher surgical risks.

Possible complications

Overall, complications after a vasectomy are rare. How the procedure proceeds also depends on the experience of the surgeon. It is therefore advisable to have the operation performed in a practice or clinic that performs more than fifty vasectomies a year
performs.

In the days after the operation, one to two percent of men experience symptoms such as bruising, a feeling of pressure in the testicles, wound infections or inflammation of the epididymis. With appropriate treatment, they generally regress quickly.

A few months after the procedure or even later, small knot-like tissue inclusions of sperm cells (sperm granulomas) can form. They are usually a result of the pressure in the testicles caused by the sperm that continues to be produced. Normally they go unnoticed, but in individual cases they can contribute to the fusion of one of the vas deferens (recanalization).

In addition to unexpected psychological problems associated with infertility, chronic pain in the testicles is one of the possible long-term effects of a vasectomy. In some cases, they increase with sexual activity and, in rare cases, can significantly reduce the quality of life. How often this so-called post-vasectomy pain syndrome occurs has not yet been sufficiently researched. The information on how many men seek medical treatment for this reason varies between one and 14 percent.

The exact cause of the pain is not yet known. There are many indications that the pressure equalization in the testicles in the affected men does not work properly. Nerves may also have been damaged during the operation. Under certain circumstances, another operation may be necessary - such as targeted recanalization, the removal of the epididymis or the spermatic cord nerves.

Men who have had previous groin surgery, have pre-existing problems in the lumbar spine, and/or have occasional tightness in the testicles should be aware of this at the pre-vasectomy consultation. This also applies to all other types of chronic pain.

A number of studies have looked at whether there might be a link between vasectomy and prostate cancer. However, a current summary of the study situation comes to the conclusion that there is no reason for concern. It is highly unlikely that a vasectomy is responsible for later prostate cancer.

Well-considered decision

Sterilization is a very safe contraceptive method because it leads to permanent infertility. The step should therefore be well thought out and only considered if you are sure that you do not want to have children (any more). What applies at the moment can change quickly under other circumstances. It happens again and again that with a new partnership, the desire for a (further) child grows.

Advances in microsurgery make it possible, in principle, to reverse sterilization (refertilization). But the procedure is not only time-consuming and relatively expensive. There is also no assurance that this will actually restore fertility.

The earlier in life the procedure is performed, the greater the risk of later regretting the sterilization. Even in difficult life situations, for example after a separation or divorce, after an abortion or due to unwanted paternity, wrong decisions are more common. Especially in such crisis phases, it is important to take your time and not to act hastily.

You and your partner should agree that you do not want to have children (any more) and consider together what effects the step could have on your relationship - including sexually. This also applies to men and women who are not in a permanent relationship. No one should allow themselves to be pressured into sterilization, not even by their partner. Ultimately, every man has to decide for himself whether this step is the right one.

Can the operation be reversed?

In most cases, microsurgical procedures make it possible to reconnect severed vas deferens. However, this does not always mean that the man will then be fertile again. In the meantime, sperm production has often deteriorated for various reasons. The so-called refertilization is also a comparatively complex operation: It takes about two hours and requires general anesthesia.

It is possible to have one or more sperm samples (for a fee) frozen (cryopreservation) before a vasectomy. However, the procedure is usually only offered to male cancer patients who wish to have children before undergoing chemotherapy or radiation treatment. A healthy man considering cryopreservation of his sperm prior to a vasectomy is more advised to consider whether his decision is mature.

According to the German Society for Urology (DGU), a vasectomy is not recommended if the man is not in a stable partnership and

has no children yet, is under 30 years old, or has chronic pain in the testicles or a serious general illness. Nor should he be in a mental crisis.