What Are the Pros and Cons of a Vasectomy?

Vasectomy is one of the safest, most effective forms of birth control. And it's one of the few that puts the responsibility for not getting pregnant squarely on the male partner—a refreshing change of affairs, if you ask some women.

We'll look at what exactly a vasectomy entails, explore some reasons why people might choose vasectomy over other forms of birth control, examine the procedure itself and get into detail about how it's performed. Finally, we'll touch on some pros and cons of the vasectomy procedure.

What is a vasectomy?

A vasectomy is a procedure that provides a man with a form of permanent birth control. It's so safe and effective that it continues to be in common use more than 70 years after entering the mainstream around World War II.

It's a low-risk procedure and is usually performed using a local anesthetic in an office or clinic. For most men, it doesn't require sedation or an operating room, nor do they need a lot of downtime for recovery. Apart from heavy lifting, strenuous activity and sex, men can generally go back to normal activities within a couple of days.

A vasectomy works by cutting off the pathway sperm usually take in order to leave the body when a man ejaculates. The vas deferens is the tube that carries sperm from the testes to mix with the rest of the man's seminal fluid at the moment of ejaculation. A doctor snips this tube and seals each end during a vasectomy.

The procedure doesn't affect your ability to get an erection, nor does it affect your ability to ejaculate. Rather, it removes sperm from the equation. Since the actual sperm cells only make up about 2 percent to 5 percent of the total volume of a man's semen, the difference is not visible to the naked eye.

Note that just because your vas deferens have been snipped doesn't mean you're immediately firing blanks. Another form of contraception is necessary because some sperm may be alive in the urethra past the point of surgery. Before the vasectomy can be considered a success, you must have at least one confirmatory semen analysis, usually eight to 16 weeks after the procedure.

If the results meet the guidelines of the American Urological Association (AUA), then the procedure will be considered a success.

Why do people get a vasectomy?

Vasectomy is the most common non-diagnostic operation performed by urologists in the United States, according to the AUA. About 175,000 to 354,000 men have the procedure done every year, AUA said, based on a study that surveyed married men. Other sources put that figure closer to 500,000 for all men, single or partnered.

For a committed couple without concerns of sexually transmitted infections (STIs) and without the desire to have more children, a vasectomy is an attractive option for birth control.

The AUA guidelines on vasectomy cite studies that suggest dissatisfaction with other forms of birth control frequently leads couples to consider surgical sterilization. Many couples make this choice at least partly based on advice from medical professionals and with a belief that a vasectomy is safer than tubal ligation, the female equivalent—which it is.

In the U.S., couples most likely to choose vasectomy have a few things in common, including:

• They already have a higher number of children.
• They are more highly educated.
• They are white.

How is a vasectomy performed?

The basic premise of performing a vasectomy involves getting access to the man's vas deferens, a tube that is part of the spermatic cord inside the scrotum. Usually, it's done in an office or clinic and uses a local anesthetic to numb the area.

"You can make one incision in the middle of the scrotum, which is what I do, or you can make two small incisions on the left and right sides of the scrotum," said Amy Pearlman, M.D., a men's health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida. "You can easily palpate the vas deferens in most men because it feels like an al dente piece of spaghetti.

"You just isolate that vas, and you bring it right up to the skin where you made the incision so you can pull the vas out alone and leave the other spermatic cord structures in the scrotal area."

Once a small loop of the vas deferens has been pulled out through the opening in the scrotal sac, the doctor will cut through it while keeping each separate end outside until it can be closed.

"We're just cutting a part of the plumbing," Pearlman said. "Then [we'll be] sealing up both ends. We can use a variety of techniques. We can use suture, we can use clips, we can cut out a section and we can cauterize. Oftentimes, people will use a combination just to make sure we're separating those ends because the goal is to give permanent sterility."

Once each vas deferens has been separated and closed off, the urologist will release the separated ends and allow them to return to the inside of the scrotum. At that point, they may put a suture or two in the skin of the scrotum, but often—especially with a no-scalpel vasectomy—stitches aren't necessary.

A vast majority of men report no pain during the procedure, though slight discomfort and a "tugging" sensation are common.

Pros and cons of a vasectomy procedure

The pros and cons of getting a vasectomy first must be measured against the female counterpart, tubal ligation.

The pros of getting a vasectomy include the following:

• Vasectomy is very safe and simple to perform.
• It's effective. Whereas condoms fail 1 in 100 times, only about 1 in 10,000 vasectomies fail, according to Cleveland Clinic.
• It can be performed on an outpatient basis.
• Vasectomy is much less expensive than tubal ligation because it's minimally invasive and requires no operating room (OR) or anesthesiologist.
• It has fewer complications.

The potential cons of a vasectomy procedure include:

• Recovery can be uncomfortable; some men report feeling like they've been kicked in the balls for several days.
• Chronic, ongoing testicle pain following a vasectomy has been reported.
• A vasectomy takes two to three months to be effective at preventing pregnancy.
• It doesn't offer protection against STIs.

If you change your mind, the procedure can be reversed, with downsides. The vasectomy reversal process is expensive, much more complicated, often not covered by insurance and it isn't guaranteed.

"A pro and a con is that vasectomy is considered a permanent form of male contraception," Pearlman said. "So if the man wants to have a biological child at some point in the future, that would necessitate another procedure. Presumably, he has viable sperm in the testicle, so you can either go directly into the testicle to retrieve sperm and that can be used for in vitro fertilization, or you can reverse the vasectomy.

"That's a surgical procedure that's oftentimes done in the OR under anesthesia and involves reconnecting the vas deferens, but it doesn't have a 100 percent success rate."

Conclusions

There are many reasons vasectomy procedures remain so popular. Its high rate of effectiveness, not having to worry about condoms failing or your partner forgetting a pill, its ease of performance, the relatively easy recovery and its inexpensiveness all make vasectomy a sought-after birth control option.