Vasectomy

Everything you need to know about this method of contraception

Vasectomy

Vasectomy is a permanent method of male contraception. It is a simple, quick and very effective procedure (99.9% effectiveness). It has existed since the 1920s and has been increasingly popular since the 1960s. Approximately 15,000 vasectomies are performed every year in Quebec. Today, more men have vasectomies than women have tubal ligations. Vasectomy is much easier and has far fewer complications.

The principle

The testicles are the place where sperm are made. These go up the ducts (called vas deferens). They go up into the belly and are stored in a reservoir near the prostate (called the seminal vesicle). This is where the two ducts (left and right) come together. The spermatozoa then come out during ejaculation.

The testicles are the place where sperm are made. These go up the ducts (called vas deferens). They go up into the belly and are stored in a reservoir near the prostate (called the seminal vesicle). This is where the two ducts (left and right) come together. The spermatozoa then come out during ejaculation.

Vasectomy involves blocking the ducts above the testicles to prevent sperm from traveling back to this reservoir.

Vasectomy involves blocking the ducts above the testicles to prevent sperm from traveling back to this reservoir.

The different techniques

Two vasectomy techniques exist; the so-called “classic” method and the so-called “no scalpel” method (sometimes called the Chinese technique and also, erroneously, the laser technique). The main difference between these two methods is the way in which the canal is sought and not how the canals are blocked. Therefore, there is no difference in their effectiveness.

The classical method

The classic method usually consisted of making 2 incisions of 2-3 cm (one on each side of the scrotum, “the sac”). Stitches were then used to close the skin.

Vasectomy without a scalpel

Scalpel-free vasectomy was invented in China in 1974 and introduced in Canada in 1992. With the development of two specially designed surgical instruments, a single, much smaller incision can be made in the center of the scrotum.

THE ADVANTAGES ARE :
  • the procedure takes less time

  • recovery is faster

  • there are no stitches

  • there is less pain and swelling

  • there is less risk of complications

To block the channels

There are several methods of occluding canals (plugging them).

Several studies show that cauterization increases the effectiveness of the occlusion.

  • Ligature (tying)

  • cauterization (burning)

  • excision (removing a piece)

  • clamping (installing a staple)

  • the interposition of a sheath (closing an end with its envelope)

Dr. Nélisse and Dr. Caouette’s choice

Because of the significant benefits to the patient, Dr. Nélisse and Dr. Caouette perform vasectomy without a scalpel. To close the ducts, they combine three techniques to allow for better occlusion. For each duct, they cauterize the inside of both ends (towards the belly and towards the testicle), install a tiny titanium staple on the one that goes towards the belly and cut 5 mm of the duct.

This minimizes discomfort and the risk of complications while maximizing effectiveness.

The technique in detail

First, a small patch of skin is frozen in the center of the scrotum, about 3-4 cm under the penis. Then, we go down to freeze the two ducts. The testicles and the penis are not touched. In about 20 seconds, the local anesthesia is completed. The same anesthetic is used as at the dentist (Xylocaine).

Once well frozen, a canal is identified by palpating it with the fingers.

It is immobilized under the anesthetized skin pellet with a small ring clamp.

An instrument with fine curved tips is then used to open the skin a few millimeters and pull a loop out of the canal.

The canal is then blocked in three ways. Cauterize (burn) the inside of the canal.

A tiny titanium clip is installed.

We cut 5 mm long of it.

The channel is released and returns instantly to its usual place. Then, the same technique is repeated for the second canal.

Since the perforation in the skin is only a few millimeters long, there is no need for stitches. The skin heals on its own, without leaving a scar.

The procedure takes 10 to 15 minutes.

Reversibility

Vasectomy should be considered a permanent and irreversible method of contraception. In fact, there is a method for reconnecting the ducts (vasovasotomy). However, this procedure is infinitely more complex than . It is performed in a hospital, usually under general anesthesia. It can last more than 2 hours. The pain and the risk of complications are also greater than with vasectomy.

“only 40 to 45% chance of reversibility”

Ultimately, only 40-45% of men who have had vasovasotomy will become fertile again. Note that the effectiveness of vasovasotomy does not depend on how the ducts were blocked during the vasectomy, but rather on the patient’s ability to heal and especially on the time elapsed since the vasectomy. In fact, the longer the time between the vasectomy and the vasovasotomy, the lower the possibility of becoming fertile again.

Therefore, since reconnection of the ducts is a much more extensive surgery and only works in 40-45% of patients, vasectomy should be considered final.

Contraindications

The main contraindication to vasectomy is your uncertainty about your desire to have children. As long as you have even a vague desire to have a child, you will have to use reversible contraceptive methods. Medically, there are very few reasons why a vasectomy cannot be performed: severe coagulation disorders, inguinal hernia that goes down into the scrotum, old surgery on the testicles that would prevent the doctor from feeling your ducts.

The costs

Costs vary depending on the surgeon performing the procedure. For more information, visit the page dedicated to costs.

See the costs

The costs

Costs vary depending on the surgeon performing the procedure. For more information, visit the page dedicated to costs.

See the costs

Videos

Animation

Video animation
Dr. Nélisse and Caouette’s technique

Vintage

Excerpt from the TVA report on our vasectomy debut