from
 Dr. Paul Cragg,
founder of The Gentle Vasectomy Clinic

ASSESSMENT
A man interested in vasectomy has an initial assessment (consultation) mainly to ensure that there are no reasons to not have the operation. The appointment is arranged by phone either after he calls our office or after we call him back after receiving his registration form from the website.  We strongly encourage patients to read our information on the website.  If they don't have internet, we can fax or mail the information.  At the office the doctor does an examination and answers any questions.  Most men coming to our clinic have the consultation and procedure all in one visit.

 

PREPARATION
Here are the instructions for patients to prepare for the procedure:

  1. Shower on the day of the vasectomy, wash the penis, scrotum and groin areas thoroughly.
  2. Shaving. On the day of the vasectomy, use a good sharp safety razor to shave the hair on the front of the scrotum and base of the penis, or at least clip it very short. Since most fellows use the patch (see next item), it is a good idea to shave a wider area to allow the adhesive of the patch to stick to the skin rather than the hair, which makes it more uncomfortable to remove.  Try to leave an area of at least 3" diameter free of hair on the upper scrotum for the patch.  The purpose of shaving is simply to make the vasectomy easier and safer, reducing the risk of infection.  Do not use a beard trimmer as these have been found to cut the skin more than shaving.  We strongly advise patients to avoid using products like "Nair" which dissolve the hair but can be extremely irritating to the skin.
  3. EMLA patch. This is a circular patch that has medication in it that partially numbs the skin. It is applied to the area where the doctor will be inserting the needle for freezing and it helps to minimize the feeling of the needle passing through the skin. The needle is not very painful, but most patients prefer to keep the discomfort to a minimum and choose the patch.
  4. Tranquilizer. Diazepam ("Valium") 10mg, a tranquilizer, is an option for patients to choose to help them relax for the procedure.  We have it available at the clinic.  It can be taken when you arrive for your appointment to help with any anxiety.  It may also help the skin of the scrotum to relax, making the procedure technically easier to perform.
  5. Transportation home. Most men drive themselves home afterward without difficulty. However, if the diazepam is taken, patients must arrange for a driver as it can cause drowsiness and create a risk. We want to make sure the ride home is safe for everyone on the road.
  6. Time off work. While it is ok to go to work earlier in the day of the vasectomy, do not plan to go back to work afterward that day. Do plan to rest. Most men with jobs that are not very physical can work the next day.
  7. Athletic support. Wearing this supports the scrotum, reduces discomfort from the operation, and may decrease the chance of bleeding.
  8. Avoid taking any aspirin product (eg. ASA, 222, Anacin, etc.) or blood thinners (such as coumadin, Plavix or heparin) for at least a week before as this can cause excess bleeding.  If you are not sure what you are taking, be sure to give us a list of your medications when you arrange your appointment for us to check over.
  9. Wear loose trousers such as track pants. This helps to accommodate the ice pack.
  10. Please arrive on time. If a person is late, we may have to cancel or postpone the procedure. We try to avoid keeping patients waiting.
 

CONSENT
Patients will be given a Consent Form to complete. This gives the doctor legal permission to perform the vasectomy. It states that all the information needed to make an informed decision has been provided and that informed consent is being given.

 

HOW THE VASECTOMY IS DONE
The No-Scalpel Vasectomy begins with the man lying on the table and lowering his pants, jock strap and underwear to his ankles. There is no need to take them right off.
The doctor cleans the whole genital and groin area with antiseptic soap. Some shaving of hairs may be necessary. A sterile cloth drape is placed over the area and the scrotum gently drawn through a hole in the drape. The penis is kept out of the way by the drape.

Local anesthetic ("freezing") is injected with a very thin needle to block the nerves to the skin and to the vas on each side. This produces a brief sting in the skin, as with any injection, although the EMLA patch should minimize this. A mild aching during injection to each vas may be felt, but this also is brief and is a good sign that the freezing is in the right place. The freezing takes effect immediately.

The doctor makes a small opening in the skin about a centimeter long by piercing the skin and spreading it open with a special instrument. This is just enough to allow access to the vas, which is then lifted out of the scrotum. The upper end of the vas is cauterized (burned) to make it scar shut for several millimeters as it heals. The vas is then cut. Surrounding tissue is drawn over the upper end of the vas, held in place with a titanium metal surgical clip about 1/2 cm. long (click HERE to see a photo of the clip), and acts as a barrier, separating the two ends. This keeps sperm from reaching the upper cut end and it reduces the chance of the ends reconnecting. These clips (one on each side) remain inside permanently. They are standard surgical clips that cause no reaction or discomfort (and don't set off airport alarms!). A small lump may be felt by the man permanently on one or both sides at the site of the vasectomy. This is the healing scar and contained within it is the titanium clip. The clips cannot do any harm as they are not sharp and are well surrounded with scar tissue.

The lower end of the vas is left open, lying free in the tissues of the scrotum. This leads to fewer problems such as pain and swelling afterward. It is called "the open ended technique". A small flow of sperm spills out the end into the scrotum, it is broken down, then absorbed and removed by the body. As years go by, sperm production is gradually reduced as the body realizes it is not needed any more, but there will be some sperm produced indefinitely.

After a close check is made for any bleeding, the vas is allowed to slip back deep into the scrotum.

The procedure is then repeated on the other side through the same opening in the skin.
Once both sides are done and the doctor is confident that there is no bleeding, antibiotic ointment is applied to the opening in the scrotum and gauze is placed over it.

The procedure is now finished. The man pulls up his underwear and then his jock strap over it. This keeps the scrotum supported and applies gentle pressure. An ice pack is placed between the underwear and jock strap to reduce the risk of bleeding.

A man's wife/partner is welcome to be present during the procedure.

He will be given information on post-procedure care, as well as lab information for later testing for absence of sperm. 

Most men feel fine afterwards and many are pleasantly surprised at how quick, simple and painless it has all been. If the man is having a combination visit with consultation and procedure on the same day, he will likely be at the clinic for a total of  70 minutes.

 

INSTRUCTIONS FOLLOWING VASECTOMY

We advise patients who plan to drive home themselves to remain at our clinic for at least 30 minutes following the vasectomy to ensure that their condition is stable and they are fit to drive.
 Undertake only light activity for the remainder of the day of vasectomy.
For the first two weeks it is particularly important to avoid straining –activities that tighten the stomach muscles as in “grunting” such as heavy lifting, pushing and pulling. It is best to avoid lifting anything over 10 kg (22 lb.) for the first week and 25 kg (55 lb.) the second week. Avoid strenuous exercise (including hockey). Sexual intercourse should be avoided for a week as the movement may start some pain, swelling or bleeding. “Gentle sex” (getting an erection and ejaculating) should be safe to undertake at any time.

Apply the ice pack provided by the clinic between the underwear and the athletic support over the next 24 hours (except when sleeping during the night). It is recommended to leave the ice pack on as long as possible, taking breaks if it is too cold or needs refreezing.  Let comfort be the guide. 

Wear the athletic support for at least 4 days. If it feels too tight, try snug underwear.

Keep the area dry where the opening was made until the next day when a brief shower is all right. Be sure to place some ointment on the opening before every shower for a week to repel water and keep it out of the opening. Do not have a tub bath, hot tub or swim for a week.

Apply ointment and clean dry gauze to the site twice daily regularly for at least three days.  It's not uncommon to have some spotting of blood on that gauze and that's not serious.  If you find that there is no spotting, the gauze is not necessary, but keep applying the ointment as above.

Advil (ibuprofen) 400mg tablet, or 2 X 200mg tablets, can be taken 4 times daily after meals. DO NOT take this if you have a history of stomach ulcers, bleeding disorders or reactions to any anti-inflammatory medications. If there is no discomfort at all, it’s probably not necessary to use any medication.

Acetaminophen (Tylenol) 500 mg can be taken, 1 or 2 tablets every 4 hours at any time if needed for pain (maximum 8 tablets per day) as an alternative to, or along with, Advil.

Semen analysis can be done at a lab close to your home. We provide directions to help you find one. Be sure to have a semen test; it would be unfortunate to have a "little surprise" after your vasectomy. It is wise to call the lab prior to doing the test to make sure they can take the sample when you want to bring it in. The sample should be taken after both a minimum 20 ejaculations and a minimum 10 weeks. The reason for this waiting period is that the risk of the vas reconnecting is greatest during the active healing process in the first 10 weeks after the procedure. A microscopic channel can form and bypass the vasectomy site conveying sperm upward to be ejaculated. After this time things are stable and it is highly unlikely that they will ever change after the "all clear" results are obtained.

 

POSSIBLE COMPLICATIONS
This method has been found to have less than 10% of the risk of complications that occur with the older approach.

The problems that can occur with any vasectomy include:
-aching, pain and/or tenderness. This is usually mild and temporary. To reduce any pain or swelling the patient is advised to wear the support and take an anti-inflammatory drug if needed. Pain can be treated with Advil and/or acetaminophen as instructed above.
-rarely, the pain and/or tenderness may not completely resolve resulting in chronic pain. It is extremely unlikely with this method as very little tissue is handled or affected, but is still a remote possibility. The benefits far outweigh the risks of this happening.
- a sperm granuloma, a small tender lump, may develop at the site of the vasectomy deep inside the scrotum. Usually it resolves on its own in a few weeks. If not, contact the Clinic or your family doctor. A small non-tender lump at that location is the normal scar which is to be expected.
-bleeding within the scrotum ("hematoma") leading to swelling can occur in the hours following the operation. There is less chance of this when the patient rests after the vasectomy, using an athletic support and ice packs. Bruising of the skin is not uncommon and by itself is not a problem.
-blood may appear in the semen, but this is usually old blood from the time of the procedure and not serious.
-infection can occur after any operation. To reduce the chance of infection even further, an antibiotic ointment is applied when the procedure is finished and should be applied for the next few days.
-if severe pain, swelling and/or fever develop, call the Clinic, or else go to your local emergency department.

 

CONTRACEPTION
There is a very small chance, on average about 0.1%, that the vasectomy will not be successful in producing permanent sterility. Nature can create a connection between the ends of one vas, allowing sperm to pass through again.
We strongly advise couples to plan to use alternative methods of birth control for the 3 months after a vasectomy, until a semen analysis is done.  The semen analysis is done as noted above to confirm the success of the operation. A container and instructions for this are provided by the Clinic. The results are sent to the Clinic and we email or call the results to patients if they have requested this, or call them in to discuss the results at the Clinic. It is important to wait for the results and get the final "all clear" from us.

After this no other form of contraception is needed.

Recurrence of fertility is so rare after the "all clear" that it is not necessary to have further semen analyses done, but testing certainly is possible if people want to check periodically for reassurance. Contact us or the Family Doctor to get a lab requisition first.

Patients are welcome to return for a follow-up visit, but this is not done routinely as the vast majority do very well and a visit is not necessary.

Now, to continue with the registration process, click REGISTRATION on the  button below.

Rev. Oct. '07