When guys first hear the word – vasectomy – they cringe a little, right? And what’s with the scalpel or cauterization? Or the long weekend on the coach with the ice pack? Dr. Mark Makhuli is here to answer all your vasectomy questions and dispel a few myths he’s encountered along the way.

Men's Health | 3 years ago

Everything You Wanted to Know about a Vasectomy But Were Afraid to Ask

Maybe you’ve heard some horror stories. Maybe you heard it’s a walk in the park. Either way, Mark Makhuli, MD, a urologist with Atrium Health's McKay Urology, is here to provide all the answers you ever wanted to know about vasectomies.

Like a splash of ice-cold water on a hot Carolinas summer day, the ear-piercing screaming of an infant in the middle of the night jolts you from your slumber. Another feeding? Diaper? A crib escape attempt gone awry? You love your family and your partner but you’re not ready to go through this again. 

When men reach this point, that’s when they call Mark Makhuli, MD, a urologist with Atrium Health's McKay Urology, to begin discussing their options. And although pop culture may have sensationalized the procedure, it still remains one of the most effective forms of birth control – about 99.5 to 99.9 percent, Dr. Makhuli says.

For those guys who are now ready to hang up their reproductive hats and have exhausted Dr. Google and pestered friends or family who have already undergone the procedure, Dr. Makhuli is here to answer your most-asked vasectomy questions.

Question No. 1: So, what is a vasectomy?
Dr. Makhuli: A vasectomy is a male sterilization procedure in order to prevent pregnancy. A section of the vas deferens – the tube that connects the testicles and carries sperm to the urethra – is removed and the two ends are then usually tied, clipped and/or cauterized. This prevents sperm from mixing with seminal fluid during ejaculation. 

Q2: What happens to sperm and semen after you have a vasectomy?
Makhuli: You’re still producing sperm so when you ejaculate, the sperm don’t have anywhere to go and are then reabsorbed. The sperm is still being produced by the testicles but unable to be in the ejaculate because of the blockage of the vas. The sperm will live, die and be broken down and the small metabolic pieces are carried away in the blood stream to be excreted. Sometimes a lump, caused by leaking sperm, can form at the site where the vas deferens is tied off. Usually these small lumps cause no problems.

Q3: How effective are vasectomies as a form of birth control?
Makhuli: Very effective. A vasectomy is about 99.5 to 99.9 percent effective. As long as a physician is removing the appropriate amount of the vas deferens and uses the standard technique per American Urological Association guidelines, it’s extremely effective.

Q4: Does it affect anything else?
Makhuli: Vasectomies do not impact sexual function (i.e. erections), hormone (testosterone) levels, or the urinary system. Following the procedure, no sexual activity for seven to 10 days. After that, we recommend using protection during sex until a post-vasectomy semen sample can be reviewed.

Q5: What does that entail?
Makhuli: After the vasectomy, we recommend at least 18 to 25 ejaculations (two to three months post-procedure) before we check a semen analysis. We will then have the patient provide us with a sample -- which can be deposited at home – to be analyzed in the office. I suggest two negative specimens.

Q6: Can you walk me through a typical procedure?
Makhuli: On the day of the procedure, we ask patients to come with a driver. When they arrive in the office they bring with them a Valium tablet that helps to ease any anxiety. Prior to taking the Valium, I have the patient ask any remaining questions they may have. They’re lead to an exam room where the preparation begins – shaving of the area if need and the scrotum is prepped and draped for the procedure. I will then administer a local anesthetic – lidocaine – to the skin area near the vas deferens tube. And depending on the type of procedure – either the traditional way, making a small incision with the scalpel; or puncturing the skin with a scalpel-less method – I will find the vas deferens, divide it, suture and/or clip it and cauterize it. I’ll do the same thing on the other side and then place one dissolvable stitch on the skin. From initial injection, the whole process only takes about 20 to 25 minutes.

Q7: What kind of reaction does the procedure produce from patients? Can it be painful?
Makhuli: I always tell my patients to let me know if they’re experiencing any discomfort during the procedure. I can always inject more numbing medicine to the area if necessary. Typically they’re OK after the initial injection of numbing medication (lidocaine). They may feel some tugging and pulling. But from a pain standpoint, they shouldn’t feel any sharp pain. There’s a small risk of bleeding and infection. But for most men, the risk is low. For young, healthy guys, they won’t need any antibiotics unless they have any other predisposing factors.

Q8: So how do you recover?
Makhuli: When they get home, the recovery is typical of other procedures – rest, elevation and ice. A good rule of thumb is if you’re watching a show on TV, put an ice pack on the area during the commercial breaks and then take it off when it returns to regular programming. Also, I advise no heavy exercise for about a week. No showering until the day after the procedure and no swimming for a week to 10 days. Most guys who have the procedure on a Thursday or Friday can be back to work on Monday.

Q9: Can a vasectomy be reversed?
Makhuli: Yes, the procedure – called a vasovasostomy – is a very meticulous and delicate surgery and the success is variable. I advise any of my patients that if you’re not sure or hesitant at all, to hold back from the procedure.

Q10: Can vasectomies fail?
Makhuli: Yes, but that is extremely rare.

Q11: Are there any associations with vasectomies and disease?
Makhuli: No, studies have not shown any definitive associations with vasectomies and cancer or other diseases.

Q12: Is it a procedure covered by most insurances?
Makhuli: Yes, but I have patients speak with our billing office prior to scheduling so the patients know definitively.

Q13: Is it true that scheduled vasectomies spike around certain sporting events throughout the year?
Makhuli: I get a lot of patients that want to schedule it for that first weekend of March Madness (college basketball) – it gives them an excuse to watch all the games. I also see many referrals in early spring around the time of the Master’s golf tournament.

Q14: What are some of the wildest questions or concerns you’ve heard from patients?
Makhuli: Many are worried about their sexual function. Some patients are convinced thought that we’re taking out their testicles. I have to remind them that we’re just removing a small piece of tubing.

Q15: What do you tell your patients to put them at ease during the procedure?
Makhuli. The Valium helps with their anxiety quite a bit. I’ll then reassure them. After the injection of numbing (lidocaine) medication, their concerns fade away. Usually, we end up talking throughout the procedure.

Q16: What is the popularity level of vasectomies?
Makhuli: They’ve always been popular. From an age standpoint, I have patients from their mid-20s, all the way up until their 60s and 70s. But it goes in waves and seasons. I typically average three to four a week.