No-scalpel vasectomy.

What it is

A vasectomy is the most effective form of permanent contraception available. The vas deferens — the tube that carries sperm from each testicle — is interrupted on each side, preventing sperm from entering the ejaculate.

No-scalpel vasectomy is a refinement of the traditional approach. Instead of a scalpel incision, a specialized instrument makes one small puncture in the midline of the scrotum, through which both vasa are reached. The puncture is so small it does not need a stitch. Compared to scalpel vasectomy, the no-scalpel technique has lower rates of bleeding, hematoma, and infection.

What the appointment looks like

• Done in the office, typically under local anesthesia
• Oral Valium and nitrous oxide ("laughing gas") are available if you'd like something to relax — most men choose local only
• Total time in the office: about 30 minutes on average; the procedure itself takes about 7–10 minutes
• You can drive yourself unless you take oral sedation — in which case, bring a driver
• Most men have it done on a Thursday or Friday and are back at desk work on Monday

Recovery, in plain terms

• Plan to spend the rest of the day on the couch with a bag of frozen peas
• Tight, supportive underwear for the first week
• No heavy lifting or strenuous exercise for one week
• No sexual activity for one week
• Most pain is well controlled with Tylenol and ibuprofen

Two important caveats

1. You are not sterile immediately. Sperm remain downstream for weeks to months after the vasectomy. Sterility is confirmed with a semen analysis at about 12 weeks. Use another form of contraception until that test is clear.
2. Consider it permanent. Vasectomy reversal is possible but expensive, not always covered by insurance, and not always successful. If there is any chance of wanting biological children in the future, this is not the right contraception.

What a vasectomy does not do

• It does not affect testosterone, libido, or erectile function
• It does not change the appearance or volume of ejaculate noticeably (sperm are a tiny percentage of semen)
• It does not increase the risk of prostate cancer, testicular cancer, heart disease, or anything else of consequence — large studies have looked exhaustively for any such link and found none

Risks worth knowing

• Bruising and mild swelling — common, resolves over 1–2 weeks
• Hematoma (a collection of blood) — uncommon, usually self-resolves
• Infection — rare
• Post-vasectomy pain syndrome — rare; risk factors are screened for at the consult
• Failure of the vasectomy — extremely rare (roughly 1 in 2,000 to 1 in 4,000)
• Sperm granuloma (a small inflammatory nodule at the cut end of the vas) — usually painless, very rarely needs treatment

Frequently asked questions