Vasectomy: Common Questions and Answers

Vasectomy is a highly effective form of permanent contraception. It is as effective as tubal sterilization and is safer, less costly, and associated with quicker recovery. In the United States, only 4% of men ages 18 to 45 years have had a vasectomy, indicating that it is underused despite the benefits. Vasectomy is typically performed in the outpatient setting, and most patients return to regular physical and sexual activity after 1 week. Opioids and antibiotics are not routinely needed. The no-scalpel vasectomy and other minimally invasive techniques for approaching and isolating the vas deferens have the lowest occurrence of adverse events such as hematoma, infection, sperm granuloma, recanalization, and chronic scrotal pain. After the vas deferens is isolated and segment is removed, mucosal cautery alone or facial interposition with mucosal cautery of both ends or abdominal end have occlusion failure rates of less than 1%. The addition of fascial interposition improves rates and decreases the time to azoospermia on semen analysis without a significant increase in adverse outcomes. Sterility is confirmed 3 months after vasectomy with a semen analysis that shows rare, nonmotile sperm (100,000/mL or fewer) on microscopy. Although vasectomy should be considered permanent, up to 6% of patients seek reversal. Successful reversal rates (return of sperm to semen) are high; however, pregnancy rates are variable.