In our country, women generally use the contraceptive method. Men don’t use birth control a lot. For this purpose, surgical methods applied to women are more invasive than men. Again, there are some complications of the drugs used by women for birth control. However, in developed western countries, a male contraceptive method with a high success rate is preferred with a simple surgical method. In this article, I will talk about male birth control methods and especially the vasectomy surgery that we do frequently and also in the world.

What are male birth control methods?

Birth control is the contraceptive methods used by couples who have the potential to have children to avoid becoming pregnant. Usually used by women. Recently, it has started to become widespread among men as well. The most common birth control methods used by men are:

• Vasectomy
• Condom – use of condoms
• Withdrawal method

Informing patients before vasectomy

Patients should be informed before vasectomy. If the person wants a child, it should be explained that this procedure is not appropriate. It is usually done to men over the age of 30 who do not want children. Although this surgery is corrected later and there is a chance to have a child, the success rate is not one hundred percent.

Before making a vasectomy decision, the spouses should discuss the following issues among themselves;

• They must be sure that they do not want children
• If being pregnant is harmful to the health of the woman, vasectomy is an appropriate method.
• If there will be a child with some genetic problems, this surgery is a suitable method.
• If couples are not sure whether they want a child or not, they should reconsider this surgery.
• Vasectomy is a permanent method. If temporary contraception is desired, other methods should be tried.

What is vasectomy surgery and how is it done?

Vasectomy is an operation to prevent the ejection of sperm produced in the testicles by connecting the channels where the sperm are carried in men. It is the most effective method of birth control for men. No special preparation is required before surgery. It is beneficial for patients taking blood thinners to stop them one week in advance.

There are two types of surgery for vasectomy:

• Classical method: Vasectomy surgery is a simple operation that takes 20-30 minutes. It can also be performed in the office setting with local anesthesia. After local anesthetic is applied to the spermatic cord, it is opened with a small incision of 2 cm on the right and left and the vas deferens (semen canal) is found. It is cut by separating from the surrounding tissues and both ends are tied. Then, a piece of 1-2 cm is removed from the gap in order to prevent the canals from coming back to the end. The cut skin is closed and the process is terminated. We prefer this technique.
• Scalpelless method: It is done just like the classical technique. The difference from the classical method is that here only the vas deferens (semen canal) is opened with a very small incision and tied and cut in the same way. Because the skin incision is very small, there is usually no need for stitches.

Why should men choose a vasectomy?

Birth control methods can be used by any couple. The most suitable birth control method for men is vasectomy surgery. The advantages of men having a vasectomy as a birth control method are as follows;

• Its effectiveness is very high, around one hundred percent
• It is a permanent method
• Does not adversely affect sexual desire and erection
• Does not adversely affect hormone levels
• Nearly no side effects
• No hospitalization required
• It is not a major surgery
• It is a simpler procedure than gynecological birth control methods (typing the tubes).
• It is cheaper, it is done once. However, women need to take pills constantly.
• There is no need for other control methods and protection of the lady.

What are the disadvantages of the surgery?

This surgery has no serious disadvantages. Some of the insignificant issues that can be seen infrequently are as follows;

• If the person wants to have a child and wants to open the semen channels by surgery again, success may not always be achieved.
• There is a risk of pregnancy 2-12 weeks after the operation. During this period, other methods should be used.
• Recombination of self-connected channels may occur. This is extremely rare. This does not happen because we remove a long segment with our technique.
• Non-significant negativities related to the surgery may be seen. Such as wound infection, hematoma, pain.

What are the risks and complications of vasectomy surgery?

This surgery has no serious complications. There may be some simple problems that may occur in every surgery. Some complications that may occur in the early and late period after vasectomy are as follows;

Early complications;

• There may be little temporary swelling and leakage at the surgical site.
• There may be slight bleeding during ejaculation in the early stages.
• There may be temporary bruising and swelling in the scrotum.
• There may be infection at the incision site
• There may be mild pain and swelling at the incision site.

Some problems that can be seen in the late period;

• Approximately 2% of patients may have chronic pain.
• Slight collection of fluid may be seen around the testicles
• Granulomas (inflammation) may develop due to the collection of sperm
• Pregnancy may occur in early periods
• Spermatocele may occur
• Hydrocele may develop

What are the points to be considered after the surgery?

Vasectomy is a simple surgery. There is no serious problem at the end of the operation. The points that patients who have undergone vasectomy should pay attention to are as follows;

• Painkillers and antibiotics are started after surgery.
• If there is severe pain, swelling, discharge from the wound, high fever, the doctor must be informed.
• You can return to normal daily work after 1-2 days. It is recommended not to wear tight clothes and take a shower for the first few days.
• You can have sexual intercourse after one week. Other protection methods should be applied for 2-3 months. Because pregnancy can occur due to sperm remaining in the semen ducts. Or, after 20 ejaculations after vasectomy, sperm may become invisible in the seminal fluid. In order to be certain, a spermiogram test should be performed and no sperm should be seen.

Frequently asked questions and answers about vasectomy

There are some questions with vasectomy surgery that are asked by patients. The answers to frequently asked questions are summarized below;

Why is vasectomy a preferred method of birth control?

This method has a very high success rate, has very few side effects, and is a highly preferred birth control method as it has no risk.

Can this surgery be performed on single men?

The surgery can be done to anyone. The aim here is to prevent unwanted pregnancies. Before the procedure, detailed information should be given to the people and they should be told that they cannot have children. If the person does not want any children, surgery can be performed. In general, we prefer to perform this surgery on those who have children.

Does vasectomy negatively affect sexual life?

No, this surgery does not adversely affect the hormonal system, sexual desire and erection.

Does vasectomy cause prostate cancer?

Those who have this surgery may have prostate and testicular cancer later on. But this has nothing to do with vasectomy in any way.

If desired, can the surgery be canceled or is it reversible?

If the person later changes his mind and wants to have a child, the semen canals can be reopened with surgery. This surgery is an operation performed with microsurgery. It may not be 100% successful. This situation should be told to the patients in advance.

Is it possible for those who have undergone vasectomy to have children with in vitro fertilization (IVF)?

Yes, it is possible. Since sperm does not come in the normal way, it is possible to have a child with the IVF method with sperm taken from the testicles.

Is vasectomy protective against sexual diseases?

No. This surgery is not protective against sexually transmitted diseases. Protective measures such as condoms should be used against these diseases.

Should sperm be given to the sperm bank before vasectomy?

This is one of the frequently asked questions by our patients. It can be given if the person later changes his mind and wants to have a child. But it’s not really necessary, because it comes at a cost. In addition, it is possible to collect sperm from these patients and perform IVF with the TESE (sperm collection from testis) method.

Will this surgery cause any harm to the testicles?

The surgery does not have any negative effects on the testicles directly. However, if the testicular artery is damaged during the procedure, the blood supply to the testis may be impaired. This is a fairly rare occurrence.

Can vasectomy surgery fail?

This surgery is a very effective method. In cases where it is done properly, there is no possibility of opening the channels. Depending on the technique used in very, very rare cases, the connected blood lines may come together again.

Is vasectomy effective immediately after surgery?

no. For this method to be 100% effective, a certain amount of time must pass. On average, 2-3 months after the operation, the sperm count is found to be zero in the spermiogram. Or, after 20 ejaculations after surgery, the sperm count is reset. In the early stages, sperm in the semen fertilize the egg and lead to pregnancy.

Does vasectomy reduce the amount of seminal fluid?

The seminal fluid consists of sperms, the prostate, and fluid from the seminal vesicles. The amount of sperm in the ejaculate is about 2-5% and is quite low. Therefore, the amount of seminal fluid does not decrease significantly after this procedure.

How long after vasectomy can you have sexual intercourse?

After this surgery, there is no need to wait for a long time to have intercourse. After a week, sexual intercourse can be done.

Do private insurance companies cover the vasectomy surgery, how much does it cost?

This surgery is not covered by private insurance companies. Since it does not require hospitalization and is performed once and on an outpatient basis, it is not a costly operation.

Does vasectomy have advantages over tube ligation surgery in women?

Vasectomy is a simple and very effective procedure that can be performed under local anesthesia without serious complications. Tubal ligation in women as a birth control method is a larger surgical procedure performed under general anesthesia and takes a long time to heal.

What should be done if a child is desired after vasectomy?

These people can have children with the microsurgical reconnection of the semen ducts and in vitro fertilization (IVF) methods.

Will there be chronic pain after vasectomy?

It has been reported in some studies that there may be long-term, chronic pain after vasectomy. However, there are no serious studies supporting this. The pains are usually mild pains that are short-term and improve with painkillers.

In summary: Vasectomy is the most effective birth control method for men. The success rate is close to 100%. It is a procedure that can be done in a simple office environment with very few side effects. No hospitalization is required after the surgery, people can return to their normal daily work in 1-2 days.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY