Ask the Flight Surgeon / By CPT Jessica Warneke, D.O.: Q: My wife and I have been talking and we feel the size of our family is perfect. We discussed our options and we agreed I should get a vasectomy. What can I expect from the procedure?
FS: A vasectomy is minor surgery to block sperm from being released during sexual intercourse. After a vasectomy, the testes still make sperm, but they are absorbed by the body. Despite the possibility that a vasectomy can be reversed, the success rate for reversal is only 50 to 70 percent. I am glad to hear that you have had a serious discussion with your wife about the procedure, as this procedure is best viewed as a form of permanent sterility and is not a decision to be taken lightly. With regards to the serious thought that needs to be put into this decision, many physicians will spend a considerable amount of time not only discussing the risks, benefits, potential outcomes and how the procedure is performed, but they will also make sure you appreciate the potential permanency.
To understand the procedure, let’s discuss the anatomy of the male reproductive system. Sperm is stored in the scrotum in a small organ on each testicle called the epididymis. Each epididymis is connected to the penis via a tube called the vas deferens. During ejaculation, the epididymis contracts and sends sperm into the penis to be released from the body. In order to keep the sperm from reaching the penis, the physician enters the scrotum, the sack of skin that holds your reproductive organs, and cuts or clamps each vas deferens. Using various techniques, the physician secures each vas deferens so that they should not be able to reconnect or reopen. Once the vas deferens are secured, the incision in the scrotum is closed and the procedure is complete.
The procedure will take about an hour and can be done under local anesthetic. Pain and swelling can be expected for around the first week. Pain medication, physical support of the area (as in the use of a jock strap or similar medical support), ice and rest are usually adequate measures to control the pain and swelling. There are a few other post-procedure complications that can occur such as a hematoma (blood clot), infection, pain and swelling in the epididymis due to sperm congestion, or post-vasectomy pain syndrome (PVPS). PVPS is prolonged pain following the procedure. PVPS can occur in 1-15% of cases and, most of the time, is due to chronic congestive epididymitis. In these cases, much of the treatment relies on anti-inflammatory use and warm baths. If these treatments do not help, a vasectomy reversal is often recommended and has a PVPS symptom relief rate of 70-82%. However, with today’s procedure techniques and antibiotics, complications are rare. If you are concerned about possible complications make sure to discuss them with the physician performing the procedure or your flight surgeon.
A vasectomy is a relatively routine, straightforward procedure that can usually be done in an office setting. However, there may be a certain amount of apprehension on the day of the procedure. Your physician may give you the option of taking a medication that will help calm and relax you.
Following the procedure, you will typically be grounded for 1-2 weeks. However, this timeframe is dependent on numerous variables such as your flight surgeon’s recommendations, continued pain or discomfort, continued pain medication use, and if complications occurred during the procedure. Much of this will be discussed with your flight surgeon prior to and/or following the procedure.
For the first week following the procedure, sexual activity should be avoided. However, when sexual intercourse is reinitiated, a method of pregnancy prevention should be used for approximately three months. A follow-up is conducted around three months after the procedure in which an ejaculate sample is provided and checked for sperm content. In the three months leading up to the follow on testing you should have at least 20 ejaculations. This ensures that the vas deferens has been cleared of any sperm that remain. So, the bottom line is that the first three months following the procedure, sexual intercourse still has the possibility of causing pregnancy.
In summary, a vasectomy is a permanent procedure that prevents a man from being able to father any more children. The decision to have a vasectomy is something to consider seriously with one’s partner because there is no guarantee that the procedure can be reversed. A vasectomy is a safe, routine procedure that is 98% effective at preventing pregnancy with relatively few prolonged side effects. Be sure to speak with your flight surgeon if you have questions or are interested in having this procedure.
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The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.
CPT (Dr.) Jessica Warneke is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.