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by Julie J. Martin

Anatomy and Physiology
A man's reproductive system includes internal and external structures. The external structures consist of the scrotum, which is a thin-skinned pouch that houses the testicles, and the penis, which is the male sex organ.

Sperm are reproductive cells that contain a man's genetic material. They are produced in the testicles, or testes, which are two oval shaped structures surrounded and protected by the scrotum. After leaving a testis, sperm mature in the epididymis, a coiled tube, before moving into the vas deferens.

The vas deferens carries sperm through the seminal vesicles to the urethra, a channel in the penis that transports urine and semen. Semen consists of a combination of fluids that nourish and carry sperm. The seminal vesicles and the prostate gland, both located near the bladder, produce fluids that contribute to semen.

During ejaculation, sperm is transported to the urethra where it mixes with semen and is ejected out of the erect penis. During intercourse, sperm are carried into a woman's reproductive system where they can meet and fertilize an egg. A fertilized egg is the first stage of pregnancy.

Reasons for Procedure
A couple can use family planning methods to prevent or control the timing of pregnancy. Their options for preventing pregnancy fall into two categories: contraception-to temporarily avoid pregnancy or sterilization-to permanently avoid pregnancy.

Because contraception is temporary, it requires a man or his partner to continually take precautions to prevent pregnancy. Sterilization renders a man permanently incapable of fathering a child, and it eliminates the need to take alternative precautions.

Treatments
A vasectomy is the surgical procedure used to sterilize men. It involves cutting and sealing both vasa deferentia. A vasectomy is a minor surgical procedure done on an outpatient basis.

A vasectomy blocks sperm in the vasa deferentia, preventing them from reaching the seminal vesicles. Therefore, sperm are absent from the semen during ejaculation. There are two variations of this procedure: conventional and non-scalpel.

In conventional vasectomy, small incisions are made on either side of the scrotum. In the non-scalpel procedure, a special instrument is used to hold and expose the vas deferens. For both procedures, the vasa deferentia are located, pulled through the openings, cut, sealed, and replaced in the scrotum.

Procedure
Before your procedure, you and your doctor will discuss the most appropriate method of family planning for your situation. Sterilization should be considered irreversible, meaning if you decide to have a vasectomy, you must be certain you no longer wish to father a child.

Once you've made the decision to proceed, your doctor will: review your medical history and current medications, perform a physical exam, assess factors that affect your surgical risk, such as local infections and bleeding disorders.

In preparation for your procedure: do not take aspirin or similar medications, such as ibuprofen, at least one week before. If you regularly take medications, herbs, or dietary supplements, your doctor may have you temporarily discontinue them. Do not start taking any new medications, herbs, or dietary supplements without first consulting your doctor. Arrange for a ride home after the procedure. The night before your procedure, eat a light meal and do not eat or drink anything after midnight. The morning of your procedure, take a shower and thoroughly clean your scrotum, clip scrotal hair if requested, and dress in comfortable clothing and tight fitting underwear.

Before the procedure begins, your scrotum will be cleaned with an antiseptic solution and you will be given injections of a local anesthetic to numb the area.

In a conventional vasectomy, a scalpel will be used to make a small incision on one side of your scrotum. Your physician will locate the vas deferens and lift it through the incision. At this point, you may feel a pulling sensation. The vas deferens will be cut and a small piece may be removed.

Next, the newly cut ends of the vas deferens will be tied, sealed with surgical clips, or cauterized. The vas deferens will be returned to the scrotum and the incision closed with stitches. The same steps will be repeated on the other side of the scrotum. This procedure takes about 30 minutes.

In the non-scalpel method, your doctor will use a special ringed instrument to hold and expose the vasa deferentia. From this point on, the procedure is the same as the conventional vasectomy. This method is usually associated with faster healing and fewer complications, and is just as effective as the conventional method.

Immediately following either procedure, you will be asked to rest at the doctor's office for a short time. The incisions will heal in a few days, with little or no scarring.

Risks and Benefits
A vasectomy is a safe and effective procedure. However, it may be associated with a few complications, including: infection, bruising or hematoma, swelling and tenderness, bleeding, sperm granuloma, which is local inflammatory reaction to leaking sperm, emotional issues related to lack of fertility, restored fertility, including future pregnancy, if one or both vasa deferentia rejoin. The non-scalpel method reduces bleeding, and decreases the chance of infection, bruising, and other complications.

In some cases, sterilization can be reversed, but there is no guarantee of success. Therefore, a vasectomy should always be considered permanent.

In a vasectomy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.

After the Procedure
Once you are home: limit your activity for 1-2 days, don't shower for 24 hours, do not lift heavy objects, perform hard labor, or strenuously exercise for 5-7 days, avoid sexual activity for one week.

To decrease any discomfort or soreness in the days following your vasectomy: apply ice packs, covered in a towel, on and off for the first eight hours, wear an athletic supporter or snug cotton briefs, keep the area clean and dry, take a non-aspirin pain reliever, such as acetaminophen.

Contact your doctor if you have any of the following conditions or concerns: signs of infection, including fever and chills, pain or discharge at the incision site, redness, swelling, and/or bruising, persistent pain in and around the testes.

Sterilization is not effective immediately following a vasectomy. Typically 15-20 ejaculations are required to remove all sperm from your system. You are not considered sterile until you produce at least two sperm-free ejaculations, as determined by a laboratory test, which your doctor will help you arrange. Until that point, you must use contraceptive methods to prevent pregnancy.

Sources:

  • Beers, Mark H., Andrew J. Fletcher, Thomas V. Jones, et al. 2003.

  • The Merck Manual of Medical Information. Merck Research Laboratories: Whitehouse Station, NJ.Kasper, Dennis L, Eugene Braunwald, and Anthony S. Fauci. 2005.

  • Harrison's Principles of Internal Medicine, 16th ed. McGraw Hill Medical Publishing Division: New York.Planned Parenthood. Available at: www.plannedparenthood.com. Accessed October 2004.



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