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Around 50 million American men have had a vasectomy. More than 500,000 undergo the procedure each year and roughly 5% of married men choose the procedure as their form of birth control. Of course, vasectomy is a personal life choice that requires careful consideration.

Semen is a combination of seminal fluid, produced by the seminal vesicles, and sperm cells which develop in the testes. Those sperm cells move from the testes to the penis through two tubes called the vas deferens. During sexual activity, the sperm cells mix with seminal fluid to form semen. But after a vasectomy, sperm can't get into the semen or leave the body. That means a man who has had a vasectomy still makes semen and is able to ejaculate, but the semen no longer contains the sperm necessary to fertilize an egg and result in pregnancy.

If you are seriously contemplating having a vasectomy, the first step is to discuss the pros and cons with your doctor. You may also choose to start by seeing a urologist, the doctor who will be performing the surgery. The urologist can answer your questions and discuss the procedure with you. Most men's concerns regarding vasectomy surgery revolve around these topics:

• Effect on sexual health. Vasectomy does not cause erectile disfunction and there is no noticeable difference between sex before and after a vasectomy. You are still able to produce testosterone and ejaculate. In fact, your love life may actually be enhanced once you and your partner aren’t stressed over the risk of an unwanted pregnancy.
• Cancer risk. There is no truth to the persistent fallacy that vasectomies increase cancer risk.
• Damage to sexual organs. There's very little risk that your testicles, penis, or internal reproductive organs will be injured during surgery. Increased heart attack risk. There is no link between vasectomy and heart disease. Reversal potential. Advances in microsurgery have allowed urologists to perfect a minimally invasive "no scalpel" approach for reversing vasectomies. With this technology â€� and provided their partner has no fertility issues -- most men have an 80% to 90% chance of getting their partner pregnant after a vasectomy reversal.

How the Procedure Is Performed

The "no scalpel" vasectomy is a minimally invasive procedure. A tiny incision is made in the scrotum, and the doctor then pulls out a small section of the vas deferens, severs it, and closes off both ends so that sperm can no longer get through to mix with seminal fluid. The procedure, which takes about 15 minutes, can be performed in the office with local anesthesia. The incision closes easily, without the need for sutures.

Most men have very little discomfort. For those who prefer to be asleep during their vasectomy, the procedure can be performed in an outpatient facility, using IV sedation or light general anesthesia.

Recovering Immediately After a Vasectomy

You shouldn't drive for at least two hours after surgery, so plan to have someone take you home after the procedure. During recovery:

• Get plenty of rest, stay off your feet, and elevate your feet when lying down on the couch or in bed.
• Do not lift heavy objects or perform strenuous activities. Limit physical activity, such as biking or working out, for 3-7 days and wait a few days to get back to work if your job involves heavy physical labor.
• Wear tight-fitting underwear or a jock strap. Be sure to purchase these items before your procedure as you will want to wear one or the other home and for the next few days to give your scrotum extra support and minimize discomfort.
• Don't shower or bathe for 24 - 48 hours to reduce the risk of infection and help your incision heal faster.
• Use cold packs on your scrotum, no more than 20 minutes at a time, for three days to help reduce swelling and discomfort.
• Take Tylenol (acetaminophen) for minor pain but avoid ibuprofen and aspirin, which can increase your risk of bleeding and bruising around the incision.
• Call your doctor right away if you experience severe swelling or bruising, fever, chills, or discharge around the incision.
• Continue to use other birth control for several weeks, as it takes some time for the seminal fluid to be cleared of sperm. Talk to your doctor for specific guidelines.

A Serious Decision

Vasectomy is very effective. The failure rate is extremely low -- roughly one in 10,000 cases. It's best to think of the procedure as permanent � if you have any doubts, choose an alternate form of birth control. While vasectomy reversal is often very effective, it becomes more difficult over time, as scar tissue continues to form. Reversal is most effective when performed within ten years of vasectomy surgery. The procedure is performed using a powerful surgical microscope (microsurgery) and requires special expertise. Rarely covered by insurance, vasectomy reversal can be expensive. Some men choose to store sperm in a sperm bank prior to having a vasectomy. This gives them a non-surgical option should they someday change their mind about having children.

If you think a vasectomy might be the right choice for you, talk to your doctor or make an appointment with a urologist.

This article first appeared in the September 2023 edition of the HealthPerks newsletter.