Vasectomy and vasovasostomy (sterilisation/reversal)

The medical term ‘vasectomy’ is a sterilisation procedure carried out on men. Sterilisation is a very safe method of contraception in which the two vas deferens in the scrotum are severed, which stops sperm from entering the semen.

A vasectomy is usually performed on an outpatient basis, either under local or general anaesthetic.

There are various surgical procedures available for performing the vasectomy. It can be carried out using a laser, a scalpel or even without a scalpel, and usually takes between 30 minutes and an hour.

Laser or scalpel vasectomy

After anaesthesia of the scrotum and the groin area, two small incisions are made in the scrotum, either by laser or using a scalpel. These incisions allow the doctor to extract the two vas deferens from the scrotum. These are then cut and a section (approximately one centimetre) of each one is removed. The ends of the vas deferens are then sealed and moved to different levels of the scrotum to prevent them from growing back together. The two incisions are then sewn back up using stitches that dissolve after a few days.

Vasectomy via sclerosis without scalpel

In the procedure not involving a scalpel, a special medical instrument is used to snip a small opening in the skin of the scrotum and the outer layer of the spermatic cord, in order to provide access to the two vas deferens. For this purpose, the small opening is then spread open. Now the vas deferens are pulled out a little through this hole, severed and isolated. Once the vas deferens have been returned to different layers of the scrotal tissue, the small opening in the scrotum is sealed with a plaster. Skin sutures are usually not required for this surgical method.

After the operation, the patient is advised not to have sexual intercourse for a few days and, if possible, not to resume sporting activities until two weeks after the operation.

Effectiveness

Regular medical check-ups are essential after a vasectomy to ensure that the semen no longer contains any sperm that may be able to fertilise an egg. As there may still be sperm in the upper parts of the vas deferens after sterilisation, it may take several months before the patient is actually infertile. This means that additional contraceptives will need to continue to be used until sperm can no longer be detected in the semen.

Vasovasostomy

Vasovasostomy (i.e. vasectomy reversal) aims to reverse the vasectomy and restore the man’s natural fertility.

A microsurgical procedure is carried out to reconnect the severed vas deferens. At this point, however, it must be pointed out that it is not always possible to restore male fertility, as the individual’s sperm production may have deteriorated since the vasectomy was carried out.

A vasovasostomy begins with the surgeon exposing the severed vas deferens. Saline solution is then used to check that fluid can still flow through vas deferens. If this is successful, the separated vas deferens are joined together using microsurgical threads (which are half as thin as a strand of human hair) and a multi-layered sewing technique.

After a vasovasostomy, the patient needs to rest for several days. In addition, the scrotum needs to be cooled and elevated, and the patient must not do any heavy lifting. In order to check fertility, the doctor will draw up regular spermiograms (which present the results of an analysis of the ejaculate and are used to assess the male’s fertility).

FAQs

Can the vas deferens grow back together by themselves after a vasectomy?

Yes, this can happen in the first few months after the operation. This is known as ‘recanalisation’. In the course of the aftercare, the doctor will check that the vas deferens are still separated from each other or have not grown back together.

What are the possible side effects of a vasectomy?

The good news is that vasectomy rarely has any side effects. If these occur, they usually manifest themselves in the form of a feeling of pressure in the testicles, bruising or wound infections. In addition, the inability to procreate as a result of the vasectomy can sometimes cause psychological distress for the patient. For this reason, it is advisable to carefully weigh up all the advantages and disadvantages before opting for a vasectomy.

How safe is a vasectomy?

Vasectomy is one of the safest methods of contraception. Its so-called Pearl Index – a measure of the effectiveness or reliability of contraceptive methods – is between 0.1 and 0.15, which means that, on average, only one out of every thousand women becomes pregnant if their sexual partner has undergone a vasectomy.

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