1. Male vasectomy
a. Vasectomy interrupts the vas deferentia. This prevents the passage of sperm into the seminal ejaculate. It is about half as common as female sterilization in the United States.
b. The failure rate of this method is about 0.1% in the first year. This does not include pregnancies that occur secondary to a couple’s failure to wait for sperm to be cleared from the distal vas deferentia.
c. Techniques: Sterilization is done under aseptic conditions with 1% lidocaine injection.
(1) Scalpel technique
(a) The vas deferentia are divided through an open skin incision.
Scalpel vasectomy. Vas deferens is located (A) and an incision made (B). The vas is isolated (C) and fulgurated or tied. Either one or two incisions can be used (D).
(b) The divided ends are either fulgurated (more effective) or tied. A portion of the vas may be removed (not necessary).
(c) The fascia may be sutured over one end of the divided vas; this may increase the effectiveness.
(2) No-scalpel technique
(a) The vas is grasped through the closed skin of the scrotum by a ring forceps .
No-scalpel vasectomy.The vas (dashed line) is grasped by special ring forceps, and the skin and the vas shealth are pierced by sharp-tippeddissecting (A). The forceps stretch the opening (B) , and the vas is lifted out (C).
(b) A sharp tipped forceps punctures the skin.
(c) The vas is drawn out.
(d) The same occlusion technique is used as for the scalpel technique.
(e) The no-scalpel technique avoids skin incisions, decreases the rate of hematoma formation, affords bloodless surgery, and may be more acceptable in societies where skin scrotum incisions are not acceptable.
Basal body temperature variations during a model menstrual cycle
d. Advantages: vasectomy versus female sterilization.
(1) Safer procedure than female sterilization
(2) More easily performed
(3) Less expensive than female sterilization
(4) Does not require general anesthesia
(1) There is no protection against sexually transmitted diseases.
(2) The procedure is permanent. Reversal cannot always be accomplished.
(3) This is a “male only” form of birth control.
(4) Five percent to ten percent of men regret having the procedure.
(5) One third to two thirds of men develop sperm antibodies postvasectomy.
f. Safety of vasectomy: continually studied.
(1) Fears of increased risk of cardiovascular disease have been allayed by the Sichuan study.
(2) Also, studies have shown that there is no increased risk of developing prostate cancer postvasectomy.