Possible Complications
Vasectomy provides the most effective, permanent means of surgical contraception. When compared with other contraceptives, it has one of the lowest incidences of side effects, considering that pregnancy is a side effect of alternative contraceptive failure. No deaths have been attributed to vasectomy in the USA. Large-scale studies show that the overall incidence of complications is less than 5 per 100 vasectomies performed.
Minor side effects immediately following vasectomy may include discomfort, swelling and/or bruising of the scrotal skin, all of which usually disappear without treatment. Some men (about 1 in 20) will experience swelling and a low-grade ache in one or both testes anywhere from three days to six months after the procedure. This is probably due to an exaggerated form of the body's natural response to the obstruction caused by the vasectomy. It usually responds nicely to an anti-inflammatory drug (such as ibuprofen) 400-600 mg 3 times per day and almost never lasts for more than a week or two but for rare patients, fewer than 1 in 100, swelling and discomfort will occur more than once and/or will be severe enough to require prescription pain medications, stronger anti-inflammatory drugs, and one or more days off from work. About 1 in 100 men will develop a grape-sized hematoma (blood clot) on one side after use of the spray applicator for anesthesia. That causes more intense and prolonged (7-10 days) discomfort on that side, but usually does not require prescription pain pills.
Early complications such as hemorrhage and infection can occasionally occur after any surgery. Based on large-scale studies, the overall incidence of either hematoma (a blood clot in the scrotum) or infection is less than 2% of the vasectomies performed.
The following data are provided by Dr. Stein and Dr. Curington of Tampa Florida. Together, they have performed over 40,000 vasectomies.
Fifteen patients have developed blood clots in the scrotum. Twelve did not require surgical drainage, but swelling did keep them quite tender for 2 to 4 weeks post-op. One man did require same-day admission to the hospital and surgical drainage of the blood clot under general anesthesia in the operating room, another required surgical drainage through a 1-2 inch incision in the office, and a third opted to undergo partial removal of an old clot about one month after his procedure. Three severe infections have occurred: the patients had prolonged discomfort and progressive swelling on one side, not responsive to oral antibiotics, eventually maturing to a painful walnut-sized abscess requiring office drainage through a half-inch incision and a two-week period of local wound care. Two milder infections caused vasectomy site swelling and, in one case, even discomfort with urination, but they responded quickly to antibiotics. It should be understood that these are rates for their office but can be expected to be similar across different vasectomy practices. Long term, vasectomy can lead to the following conditions:
1. A sperm granuloma is a pea sized sometimes-tender mass which results when the body reacts to and walls off sperm which may leak from the lower (testicular) end of the cut vas. A sperm granuloma may actually enhance the likelihood of reversal success.
2. A few (perhaps 5%) of patients will experience periodic tenderness of the epididymis, the tube behind the testis in which sperm are resorbed by white blood cells after vasectomy. Since this resorption process is a form of inflammation, it nearly always responds to a short course (3-7 days) of an over-the-counter anti-inflammatory drug such as ibuprofen. Post-vasectomy pain syndrome is defined as testicular pain (on one or both sides) for greater than 3 months after having a vasectomy, severe enough to interfere with daily activities and causing a patient to seek medical attention. Because pain is so subjective, reported rates vary but compiled data would suggest that this is a significant problem for 1-2% of vasectomy patients. Vasectomy reversal, removal of the epididymis, or a special procedure called neurolysis (all major procedures) may be required to alleviate the discomfort. Two of my vasectomy patients have been bothered enough by low-grade discomfort on one side that they have considered removal of the epididymis on that side; three others have had intermittent discomfort on both sides severe enough that they underwent vasectomy reversal; and three others have undergone neurolysis, which is division of nerves through small groin incisions to relieve pain. Since 1983, a number of patients have experienced prolonged vasectomy site pain. For one patient, the pain was so severe that he was unable to work for a month after the procedure. About 2 patients per year (about 1 in 1500) develop prolonged vasectomy site tenderness for which they eventually choose to undergo another minor office-based vasectomy procedure on one side to remove the tender spot.
Thus, out of over 40,000 patients, eight (about one in 5000) have considered or required a second major procedure to manage pain, and another 20 (about 1 in 1500) have required a second minor procedure to manage pain.
3. Recanalization is the re-establishment of sperm flow from the testis up to the rest of the reproductive tract by virtue of the cut ends of the vas growing back together after vasectomy. Most early recanalizations occur during the healing process, are detected at the time of follow-up semen checks (live sperm are seen), an unwanted pregnancy does not occur if the couple has used other forms of contraception as advised. It obviously requires that the procedure be repeated and there is no charge for the second procedure. Up until late 1990, when Dr. Stein started separating the vas ends with a tiny clip, he had 3 patients with this complication out of about 1500 (1 in every 500). Since then, and of about 38,000 vasectomies, there have been 10 early failures (1 in every 3500). One was in a man who presented quite a vasectomy challenge because of scarring from scrotal surgery as a baby. Four other men had live sperm on all samples checked for 6 months after their vasectomies, and six others had no live sperm but enough non-living sperm eight months after vasectomy that he chose to repeat the procedure. Late recanalization, return of live sperm to the semen at some time after the semen has been confirmed to be sperm-free by microscopic examination, is also very rare. Dr. Stein describes experiencing this problem 13 times. Examples: (1) a man whose vasectomy was performed in 1988 and whose semen was sperm-free three months later got his wife pregnant in 1991 and his semen at that time showed live sperm (she never got pregnant again and he returned for a vasectomy reversal in 2005 at which time he was again sperm-free), (2) another patient whose vasectomy was performed in 2000 had no sperm in his semen two months later, but his wife became pregnant nearly 4 years later and a semen check revealed a very low sperm count, (3) a man whose wife became pregnant about 16 months after a vasectomy and negative semen check (she miscarried, so it did not result in a live birth); (4) a man whose vasectomy was performed and whose semen was sperm-free in early 2005 got a partner pregnant in late 2006; no sperm could be found in his semen even then, but DNA tests confirmed his paternity (the veritable “one got through”); (5) a man whose semen showed no sperm at 8 weeks got his wife pregnant at 14 weeks and was confirmed to have sperm in his semen at 20 weeks (super-early recanalization); and (6) a 29-yo man without children got his 24-yo partner pregnant about 3 years after his vasectomy; he had sperm in his semen, and had a repeat vasectomy while she had the pregnancy terminated. From these 13 cases and reports in the literature, late failure resulting in pregnancy is possible but rare, odds being about one in 3000, a rate of failure much lower than with any other form of contraception.
4. Antisperm antibodies do appear in the blood of about half of the patients who undergo vasectomy and patients who develop antibodies have a lower chance of causing a pregnancy even when a successful vasectomy reversal allows sperm to re-enter the ejaculate. These antibodies have no influence on health status otherwise.
5. An article reporting a modest association between vasectomy and prostate cancer was published in the Journal of Clinical Oncology (JCO) on September 20, 2014. Based on an updated meta-analysis of this and many other articles that have addressed this topic through the years, the American Urological Association reaffirmed on November 7, 2014 that vasectomy is not a risk factor for prostate cancer and it is not necessary for physicians to routinely discuss prostate cancer in their preoperative counseling of vasectomy patients. The latest article confirming this absence of an association appeared in the Journal of Clinical Oncology on March 6, 2017.
Satisfaction
There are reports on the Internet in which contributors claim that they experienced a decrease in erectile function, libido, or climax intensity after vasectomy. In 2006, Dr. Stein mailed 400 surveys to men whose vasectomies had been done more than six months prior to the survey. One hundred nineteen (119) surveys were returned and these are the results:
There is no physiological explanation for these changes, either positive or negative, but men should consider the slight possibility of a negative influence of vasectomy on their sexual responses.
Alternatives To vasectomy
There are a number of alternatives to vasectomy:
1. Barrier methods. You could wear a condom, your partner could use a diaphragm, or you could use both together.
2. Spermicides. There are foams and creams that can be placed into the vagina before intercourse to kill sperm before they can fertilize your partner’s eggs. Spermicides can be used alone or in combination with barrier methods.
3. Hormonal methods. Your partner may use birth control pills, shots, patches, or implants to prevent the release of eggs from the ovaries or the implantation of fertilized eggs into the uterus (womb). Emergency Contraception (EC, Plan B, or the “morning-after” pill) will prevent pregnancy if taken within 72 hours of intercourse during which no contraception was used, or during which a condom slipped off or broke.
4. Intrauterine device (IUD). Your partner may have a small device placed into her uterus to decrease the likelihood of fertilization (sperm and egg coming together) and to prevent implantation of fertilized eggs into the uterus.
All of these alternatives are less effective than vasectomy, but they are reversible. You should be familiar with them before proceeding with vasectomy. Please ask us if you would like more information, and feel free to postpone your vasectomy if you need more time to evaluate information about alternatives.
There is no form of fertility control except abstinence that is free of potential complications. Vasectomy candidates must weigh the risks of vasectomy against the risks (for their partners) of alternative means of contraception as well as the risks associated with unplanned pregnancy and either induced abortion or childbirth. Vasectomy provides a means of permanent birth control with a minimum likelihood of complications and maximum chances of effectiveness and safety.
CONSENT FOR STERILIZATION
I, the undersigned, request that Chirag A. Patel MD, PhD perform a bilateral vasectomy, a procedure to produce obstruction of the vas deferens for the purpose of producing sterility. I understand there can be no absolute guarantee that this or any procedure will be successful. It is understood, however, that my semen will be checked following the operation. I understand that contraception must be practiced until there are no sperm present. I also understand that while the reversal success rate is quite good, it is not 100%, and vasectomy should therefore be considered a permanent or non-reversible procedure. I recognize a small chance that I might have to come to Dr. Patel’s Elk Grove office or go to a hospital for evaluation and treatment of a very rare complication. By consenting to vasectomy and accepting the risks outlined above, I release Dr. Chirag A Patel from liability for time lost from work, salary unearned, and medical expenses incurred to treat complications. I have read and understand all paragraphs of this double-sided single-spaced document.
Patient's signature ________________________________Wife's signature (optional)___________________________
Witness______________________________________________Date______________________________________