Vasectomy - Frequently Asked Questions

Common facts about men and contraception:

Men represent half the world's population, but account for less than one-third of contraceptive use. (Gallen et al. 1986)
Male contraceptive methods are condoms, vasectomy, withdrawal, and periodic abstinence.
The only effective methods of preventing the spread of sexually transmitted infections (STIs), including HIV, require the participation and/or consent of men.
A study found that 65% of women surveyed want men to play a greater role in choosing a method of contraception, and 75% want men to play a greater role in ensuring contraception is always used. (Henry J. Kaiser Family Foundation, 1997)
A study of 550 adolescents who used school- and community-based clinics in the United States found that adolescent females who always talk with their male partners were at lowest risk--and those who did not were at highest risk--for pregnancy and STIs. (Edwards, 1994)
Another study found that involvement of male partners in family planning decision making is one of the factors that increases the likelihood of simultaneous use of two methods and protection against HIV infection. (Riehman et al., 1998)
For a couple seeking permanent contraception, vasectomy is a simpler procedure, with fewer side effects and health risks, than female sterilization. However, vasectomy rates consistently lag far behind those of female sterilization in all parts of the world.
Reproductive health services for men remain inadequate in many parts of the world. Many clinics and national programs focus primarily on female clients, sometimes to the exclusion of men. Many important reproductive health and family planning programs do not have a history of serving male clients and are unsure of how to do so.

Is there an increased Prostate Cancer Risk After Vasectomy?

In 1993, a noted team of Harvard epidemiologists published findings from two large studies in the Journal of the American Medical Association (JAMA). One of these studies was retrospective (backward-looking), while the other was prospective and followed new patients. Both found vasectomy to be associated with a moderately elevated relative risk of prostate cancer that increased with time after the procedure. After more than 20 years, a vasectomized man appeared to be twice as likely to develop prostate cancer as a nonvasectomized man of the same age. Although this conclusion may seem startling, scientists generally consider risk findings of this magnitude to be of doubtful significance.

The studies were examined by experts in several professional organizations as well as in a JAMA article. The authors of this article concluded that the studies could neither be relied upon nor ignored and that further research was essential.

These authors pointed out that, since the causes of prostate cancer remain unknown, it had been impossible to assure that risk factors for the illness were equally distributed between the vasectomized and nonvasectomized men. In one of the studies, the men who had undergone vasectomy had a lower overall death rate than the men who had not, supporting the likelihood that the two groups had different characteristics. Differences of this type might have affected prostate cancer risk, producing study results that misleadingly implicated vasectomy as a cause of prostate cancer.

Like others before them, these scientists also noted the lack of evidence for any biological mechanism that could link vasectomy with prostate cancer.

In 1993, NICHD convened a meeting at which an expert panel considered published data, preliminary results from studies in progress, and an analysis of eight epidemiologic studies, including the two reports mentioned above. The panelists concluded that the positive associations between vasectomy and prostate cancer found in some studies might or might not be valid. Scientists agree, however, that if any increased risk is caused by vasectomy, it is relatively small.

WHO is currently conducting a major study of vasectomy and prostate cancer in several developing countries, and three other studies are ongoing in the United States and Canada. Scientists expect these investigations to help resolve the issue.

In the interim, most physicians will be guided by NICHD's expert panel of 1993 which concluded there is insufficient basis for recommending any change in current clinical or public health practice. Providers should continue to offer vasectomy and to perform the procedure, the panel said. Vasectomy reversal is not warranted to prevent prostate cancer, and screening for prostate cancer should not be any different for men who have had a vasectomy than for those who have not undergone the procedure.

Vasectomy has been used for about a century as a means of sterilization. It has a long track record as a safe and effective method of contraception and is relied upon by millions of people throughout the world. On the basis of much evidence, experts believe that vasectomy can safely continue to be used as it has been in the past, while further research is carried out.

[Top]

What are the risks of vasectomy?

One study has shown that men who have had a vasectomy have an increased occurrence of prostate cancer after 20 years. Since this study, other results have noted that there is not an increase in frequency of prostate cancer. A panel of experts was convened by the National Institutes of Health to study the available research, and it concluded that the evidence for a link between vasectomy and prostate cancer was inconsistent and insufficient. No changes were recommended, including no increased screening for prostate cancer among men who have had vasectomies.

It is advised to use another form of birth control, for at least the first six weeks after the procedure. Subsequently, the man's semen is checked to ensure no sperm are present. The total charge for a vasectomy is typically less than $900.

Is a vasectomy effective?

While, the overall failure rate for vasectomy rate is 0.15 percent, this does not give an accurate picture of its real effectiveness. The majority of vasectomy failures happen during the first couple of months after the procedure, when live sperm may still exist in a man's semen. Couples must continue to use another method of birth control until the man has ejaculated about 20 times over as long as six months and tests have shown that no live sperm remain. If these tests are passed on, you may live to regret. There is a failure rate of 0.025 percent (one of every 4,000) because the vas deferentia manages to reconnect.

What if I change my mind?

It is easier to plan for the future than to predict the future. Nearly 1 in 100 men who undergo a vasectomy will attempt vasectomy reversal. Fortunately, microsurgical techniques developed in recent years have greatly improved the likelihood of success. Two types of surgical procedures are used to reverse vasectomy. In men who still have sperm present in their vas deferentia, vasovasostomy reconnects the vas. When no sperm are found (about one-third of all cases), the far ends of the vas deferentia can be directly connected to the epididymis, using a technique called vasoepididymostomy.

Neither method of reconnection is easy, definite or cheap. While both methods can often be done at an ambulatory surgery center, with the man going home the same day, vasovasostomy takes two to three hours, and vasoepididymostomy can take five. The range of cost is between $5,000 and $15,000. Overall, the rates of pregnancy are about 50 percent and 20 percent respectively, but the chances also depend on how recently the man had the vasectomy. For vasovasostomy, the chances of pregnancy are as high as three-quarters for the first three years, declining to about half for years three through eight, and as low as one-third after the fifteenth year. Vasectomy reversal actually turns up sperm in semen considerably more often than the pregnancy numbers suggest. It is commonly known that presence of sperm does not guarantee pregnancy, and pregnancy is the goal.

If reconnection fails, there is yet another option for couples who want children. In this procedure, sperm are aspirated directly from a man's testicle and injected into an egg removed from the woman. Once fertilization takes place, the egg can be implanted in the woman, where normal gestation can take place. Obviously, this is more complicated and expensive than reconnection, and the odds of success are lower.

Is sex different after vasectomy?

Not at all. Because the testicles supply less than 5 percent of the ejaculate, there's no noticeable difference in the semen. Erections and sex drive are unaffected. Freedom from worry of pregnancy often enhances a couple's sex life.

What about female sterilization?

A procedure in which a woman's fallopian tubes are severed or sealed off, which prevents the egg from being fertilized by sperm is known as tubal ligation. In contrast to vasectomy, which is a simple outpatient procedure, tubal ligation usually is more complex and may require a hospital stay. Occasionally tubal ligation can be performed at an ambulatory surgery center.

The most common tubal ligation procedure involves sealing off the woman's fallopian tubes with tiny metal rings or clips. This requires two incisions be made just below the navel. Tubal ligation charges, including surgeon's fees, operating room facility, and anesthesiologist's charges, range anywhere from $1,500 to $2,500. The procedure requires a general or regional anesthetic. A current study showed that there was an 18 percent incidence of reconnection after tubal ligation.

Regardless of the obvious advantages of vasectomy, more tubal ligations (about 600,000) than vasectomies (about 500,000) are performed each year. This is most likely due to the fact that women have traditionally taken the responsibility for birth control.

[Top]

Does insurance pay for vasectomy?

Although policies vary, most insurance companies provide coverage for vasectomy procedures. When your vasectomy is scheduled, our office personnel will contact your insurance company and determine if you will be responsible for paying any out-of-pocket expenses. We offer a cash discount for patients that don’t have insurance coverage for a vasectomy procedure. Contact our office for more details.

[Top]

Need more information on health and wellness?
Click here for a link to health and wellness recommendations from the National Institute of Health.