The vasectomy is a definitive form of male contraception. This procedure is fast, simple and has a 99,9% efficiency rate. It has been around since the 1920’s and its popularity has greatly increased since the 1960’s. About 15 000 vasectomies are done every year in Quebec. Nowadays, more men have a vasectomy than women have a tubal ligation since the former is much simpler and rarely involves complications.
Sperm are produced by the testicles. They go up the two tubes called the right and left vas deferens and are then kept in a reservoir called the seminal vesicle, near the prostate. That’s where tubes meet. Sperm are eventually released during ejaculation.
The vasectomy consists of blocking the tubes above the testicles to prevent the sperm from reaching the seminal vesicles.
Detailed Description of the Technique
First, a small section of the scrotum (about 3-4 cm below the penis) is frozen with a product called xylocaine (which is also used by dentists). Then both tubes are frozen. The penis and the testicles are not affected by the local anesthetic. The effects of the anesthetic are felt after 20 seconds.
Once the area is numb, the doctor will find one of the tubes by feeling for it with his fingers over the skin of the scrotum.
He then immobilizes the tubes under the anesthetized skin with a pair of rounded pliers.
A specially shaped tool is the used to open the skin a few millimeters and take a small piece of one of the tubes out.
The doctor blocks the tubes in 3 ways. First, he cauterizes (burns) the inside of the tube.
Then a small piece of titanium is fastened around the tube.
Then he cuts and removes about 5 mm of the tube. One of the two tubes is now sealed.
The tube is then released and it naturally goes back to its original place.
The same procedure is repeated on the second tube. Because the initial incision is so small, no stitches are required to seal it. The skin will naturally heal without leaving any scars.
The entire procedure lasts between 10-15 minutes.
The main reason not to have a vasectomy is the doubt that you may want another child. If you have the slightest desire to have another child one day, it is important for you to use other methods of contraception.
From a medical perspective, there are very few contra-indications for having a vasectomy: coagulation problems, inguinal hernias which descend to the scrotum; previous surgery to the testicles that might prevent the doctor from feeling the tubes.
There are two different types of vasectomies; the ”classic” technique and the ”no-scalpel’‘ technique. The main difference between these techniques is the way the tubes are taken out of the scrotum, but not how the tubes are blocked. They are both equally effective.
THE CLASSICAL METHOD
This technique usually involves incisions of about 2-3cm long (one on each side of the scrotum). Stitches are necessary to close the incisions.
THE NO-SCALPEL METHOD
The no-scalpel vasectomy was invented in China in 1974 and introduced in Canada in 1992. Thanks to the refinements of two specially designed medical tools, it is possible to make just one very small incision at the center of the scrotum.
- The procedure is faster
- The recovery time is shorter
- No stitches are necessary
- There is less pain and less swelling
- There are less complications
BLOCKING THE TUBES
There are many ways of blocking the tubes. They can either be tied, cauterized (burnt); a part of the tube can be removed, or stapled. Nonetheless, a lot of studies have proven that the cauterization method is the most efficient technique for a successful vasectomy.
DR NÉLISSE AND CAOUETTE’S PREFERENCE
Because of the advantages for the patient, Dr. Nélisse and Dr Caouette both use the no-scalpel method. To make sure the patient’s tubes are completely sealed, they use three different techniques. They cauterize each tube, install a small staple made of titanium on one end of each tube and then remove 5mm of each tube.
This technique minimizes complications and discomfort while maximizing the efficiency of the operation.
The vasectomy should be considered as a definitive, permanent and irreversible method of contraception. The vaso-vasectomy is a procedure allowing the reconnection of the tubes, but it remains a very complex operation. It is practiced in a hospital under general anesthesia. This procedure can take one to two hours ans is riskier than the vasectomy.
Only 40% to 45% of the men who have had a vaso-vasectomy will be fertile again. It is important to know that the efficiency of the vaso-vasectomy is not affected by the way the tubes were blocked during the vasectomy but rather by the healing capacity of the patient and the length of time since the vasectomy. The longer ithas been since the vasectomy, the less chance there is of becoming fertile again.
Because reconnecting the tubes is a risky operation, it is important to understand that the vasectomy must be considered a permanent procedure.