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Vasectomy FAQ

19 Frequently Asked Questions (FAQ) About the
No-Scalpel Vasectomy

1. What is a Vasectomy?
2. What is special about the "No-Scalpel Vasectomy" technique?
3. Can hemoclips cause a problem?
4. What about the "open ended technique"?
5. Does Dr. Silverstein use the "No-needle anesthesia" method to apply the pain medication?
6. Does the No-scalpel vasectomy utilize a laser?
7. What happens to the sperm cells after a vasectomy?
8. Is No-Scalpel Vasectomy painful?
9. Does vasectomy affect one's sex drive/performance?
10. Are there any long-term health risks of vasectomy?
11. Will a No-Scalpel Vasectomy prevent the spread of Sexually transmitted diseases?
12. What are some risks of having a No-Scalpel Vasectomy?
13. What should I do before the procedure?
14. What should I do after the procedure?
15. Is a No-Scalpel Vasectomy reversible?
16. What about pre-vasectomy sperm banking?
17. What are other alternative forms of birth control?
18. Where and when are the consultations and the procedures done and can they be done the same day?
19. Again, what are the advantages of No-Scalpel Vasectomy?

What is a Vasectomy?
Vasectomy is a minor surgical procedure. It involves the surgical disconnection of the tubes (vas deferens) that carry sperm from the testicles to the ejaculatory ducts. After a vasectomy men still have ejaculatory fluid (semen) but there are no sperm cells and thus can no longer make a women pregnant. After the procedure there is no noticeable decrease in ejaculate volume. Vasectomy is one of the most effective forms of birth control for men who are sure that they do not want to have any more children. A vasectomy performed by an experienced physician is simple, safe and more than 99% effective as a male contraceptive method. About 1 in 6 men over age 35 in the United States have had a vasectomy. More than 500,000 Americans undergo this procedure each year.

What is special about the "No-Scalpel Vasectomy" technique?
Newer methods of vasectomy, such as the "no-scalpel" vasectomy (NSV), have greatly reduced the side effects and complications of the procedure. Originally developed in China, Cornell urologist, Dr. Marc Goldstein, introduced the procedure to the United States in 1988. In 1990, Dr. Brett Mellinger, who worked with Dr. Goldstein at Cornell, trained Dr. Silverstein in the technique. Now, over 15 million men have undergone the NSV procedure worldwide.

Men who would not consider vasectomy because of fear can now feel comfortable, relaxed and confident with this simple procedure. With NSV there is no knife and no cutting incision. Instead of a scalpel, two special instruments are used. The vas deferens is gently guided up through a tiny midline puncture in the scrotal skin. This tiny hole is stretched just enough to lift out the vas deferens. The blood vessels and nerves are pushed aside instead of cutting across them. The chances of bleeding, pain, infection and all other complications are significantly reduced.

No-scalpel vasectomies are performed in Dr. Silverstein's office. The entire procedure takes 15- 20 minutes. In most cases, only local anesthesia is necessary.

Can hemoclips cause a problem?
Titanium hemoclips and cautery are used to seal closed the ends of the vas deferens. The clips used in vasectomy are very small and cannot be felt. The clips are made of medical grade titanium, and will not interfere with MRI studies, nor will they set off metal detector alarms.

What about the "open ended technique"?
The "open-ended" method refers to a vasectomy technique in which the testicular end of the divided vas is not closed off with a stitch, hemoclip, or electrocautery. The theory is that by not closing off the testicular end of the vas there is no increased backpressure on the epididymis compared to the conventional vasectomy technique of occluding the vas. The proponents of the open-ended technique assert that this decreased backpressure decreases the chance of inflammation and pain. Dr. Silverstein does not do the "open ended technique" for three important reasons. First, in his experience the "post vasectomy inflammatory syndrome/chronic pain" is rare even with the standard technique of vasal occlusion. When chronic pain does occur it almost always responds to anti-inflammatory agents such as Advil or Motrin. The second reason is that with an open end sperm can leak out and cause a granuloma (inflammatory mass) to form at the end of this vas. The granuloma can sometimes be the cause of pain after a vasectomy. The final and most important reason against the open-ended technique is that it may be associated with an increases risk of vasectomy failure.

Does Dr. Silverstein use the "No-needle anesthesia" method to apply the pain medication?
The No-needle anesthesia method uses a "jet injection" device that uses pressure generated by a gas or a spring mechanism to push an anesthetic solution through the skin. A small 'pop' is felt; the feeling is similar to releasing a small rubber band against the skin. Dr. Silverstein does not utilize this technique due to concern he has about the ability to optimally sterilize the device. Unlike standard needles and syringes, with jet-injectors the fluid pathway is used more than once. The high-pressure of injector devices have been reported to cause a "splash-back" of blood onto or into the device. This splash-back can theoretically contaminate the device nozzle, the fluid pathway, or the lidocaine medication reservoir. The entire fluid pathway is not sterilized between each patient use. The design of single use devices, and/or better studies of existing devices need to be done to be absolutely certain that the devices are free of any risk of blood-borne transmission of infectious agents. Similar concerns regarding jet injectors have been brought up by the Center for Disease control and by the Department of Defense. An outbreak of Hepatitis B infection had been linked to a jet injector used at a weight loss center: HCVets.com, CDC MMWR, CDC Caccine Safety.

Dr Silverstein presently utilizes an advanced technique to anesthetize the scrotum effectively and with minimal discomfort, but without the use of a jet-injector. A local anesthetic is injected into the skin and alongside each vas tube with a very fine needle. The patient feels a tiny poke in the skin, and then a bit of a squeeze as the anesthetic is applied.

Does the No-scalpel vasectomy utilize a laser?
No. Although lasers have many uses in surgery today, there is no benefit to using a laser in Vasectomy. Dr. Silverstein had done research on the use of laser for vasectomy, and for vasovasostomy (vasectomy reversals), and had found no advantage to using the technology for either procedure.

What happens to the sperm cells after vasectomy?
A vasectomy prevents sperm from traveling from the testicle to the ejaculatory duct. Restricted in their movement, the sperm degenerate and are broken down into proteins and reabsorbed into the bloodstream.

Is No-Scalpel Vasectomy painful?
Since we use a special nerve block anesthetic technique, the No-Scalpel Vasectomy is an almost painless procedure. You may experience mild discomfort when the local anesthesia is administered. However, once it takes effect you should feel no pain. Some men feel a slight "tugging" sensation as the vasa are manipulated.

Before the vasectomy, you can request the doctor to give you a mild sedative such as Valium to relax you. Most of Dr. Silverstein's patients, however, do not require any sedative. If you do opt for Valium you need to have someone drive you to and from your vasectomy appointment.

After the procedure you may be a little sore for a few days. The discomfort is usually less with the no-scalpel technique, because there is less injury to the tissues. Generally, two or three day's rest is enough time for recovery before men can return to work and most normal, non-strenuous physical activity. After the procedure, ice packs, and Tylenol ® or ibuprofen is all that is required for pain relief. Tylenol with codeine Rx is given to our patients and can be filled at pharmacy if needed. You may resume light activity and shower the very next day. Sex can usually be resumed the fifth day after the procedure. When sexual activity is resumed you need to use birth control for 12 weeks and until two clear semen specimens are obtained. These specimen checks are provided free of charge and no appointment is needed. Please call the day before you or your partner plans to drop off the specimen to confirm that the doctor will be in the office to examine the specimen.

Does vasectomy affect one's sex drive/performance?
Vasectomy does not affect sex drive, erections, or the sensation of orgasm. Additionally, as the procedure only prevents sperm from entering the ejaculate fluid and since sperm comprise only 2-5% of the ejaculate volume there is no noticeable change in the volume of the ejaculation fluid. Male sex hormones are not affected by a vasectomy. This means there will be no changes in your beard, muscles, or voice. Some men even report that without the constant worry of an unwanted pregnancy and the hassle of other birth control measures, they are able to relax and enjoy sex more than ever.

Are there any long-term health risks of vasectomy?
Men having a vasectomy are no more likely to develop cancer, heart disease or other health problems. The National Institutes of Health, the Association for Voluntary Surgical Contraception (AVSC International), and the National Cancer Institute reaffirmed the conclusion of most medical experts that vasectomy is safe and effective.

In 1993 there were two articles in the Journal Of The American Medical Association that suggested that vasectomy was associated with a small increased risk of prostate cancer. JAMA 1993 Feb 17; 269:878-882, JAMA 1993 Feb 17; 269:873-877. However, since then there have been numerous studies to show that there is no cause and effect relationship between vasectomy and prostate cancer. http://www.cancer.gov/cancertopics/factsheet/Risk/vasectomy, http://www.nih.gov/news/pr/jun2002/nichd-18.htm (Journal of Urology 1999,161: 1848-1853, Journal of the American Medical Association 2002, 287:3110-3115, Journal of Urology 2002,168: 1408-1411). Epidemiologists, scientists, and clinicians who have thoughtfully reviewed this matter agree that there is no cause for concern. The American Urological Association formed a committee to review this issue. They concluded that there was no convincing evidence of a link between vasectomy and prostate cancer. They recommend that men over age 40 who have had a vasectomy should have an annual test for prostate cancer with a digital rectal exam and a PSA blood test. This is the same recommendation the AUA and the American Cancer Society makes for all men age 50 to 70.

Will a No-Scalpel Vasectomy prevent the spread of Sexually transmitted diseases?
No. Vasectomy can only prevent pregnancy. Only abstinence or barrier contraceptives such as condoms can offer protection against the transmission of sexually transmitted infections.

What are some risks of having a No-Scalpel Vasectomy?
While vasectomy itself is a relatively safe and simple procedure, No-Scalpel Vasectomy has fewer complications. A few postoperative complications of vasectomy include:

• Swelling and/or tenderness of the scrotum
• Bruising
• Pain at the site of incision

These problems are usually minor, subside within 1-2 weeks and can be treated with mild non-aspirin painkillers, sitz baths, and ice application. Severe cases of postoperative pain are uncommon.

Significant complications are extremely rare, but may include:

• Infection or Bleeding (hematoma) formation. Studies indicated that NSV has a lower incidence of infection and hematoma due to small puncture wound, and minimal dissection and tissue trauma. A prospective, randomized study in Thailand comparing the side effects of two vasectomy techniques showed that of 523 men, 1.34% developed an infection and 1.72% developed hematoma or bleeding after traditional vasectomy procedure. Of 680 men who underwent NSV, 0.15% developed an infection and 0.3% developed hematoma or bleeding. Overall percentage of complications after NSV is 0.4% versus 3.1% for conventional vasectomy.
• Sperm granulomas (small lumps, the size of a pea, caused by sperm leaking from the vas into the surrounding tissue). Most sperm granulomas do not produce any symptoms, rarely require treatment, and almost always resolves over time. If they cause tenderness anti-inflammatory medications like Advil usually resolves this.
• Failure of the procedure. Vasectomy is not guaranteed to be 100% effective. Even when the procedure is performed perfectly, recanalization, (sperm finding their way across the blocked ends of the vas deferens), can occur. If it does occur, recanaliztion usually occurs in the first 2-3 months after vasectomy. Thus, the use of birth control until Dr. Silverstein confirms the absence of sperm in the ejaculate in two consecutive semen specimens is very important. The specimens are dropped off at the doctors office at 6 and then again at 12 weeks after the procedure. In extremely rare cases, recanalization has been reported to occur even years after vasectomy.
• Post vasectomy pain syndrome/chronic pain. Temporary or chronic testicular pain may be secondary to congestive process in the epididymis and testicular portion of the transected vas deferens. Episodic or recurrent epididymitis or tenderness of the epididymis has been reported in 0.3-6% of men who underwent vasectomy. A trial of antibiotics may be indicated but usually these cases respond to anti-inflammatory agents like Motrin or Advil. Resolution of the symptoms usually occurs but chronic testicular pain may occur in 1 of every 10.000 vasectomies.
• Testicular atrophy -This is an extremely rare complication since the testis have an elaborate blood supply network. Patients at increased risk include patients with preoperative compromised testicular blood flow (e.g. recent varicocelectomy or hernia surgery where testicular artery is not preserved)

What should I do before the procedure?

• Avoid taking Aspirin-like analgesics in the week before your vasectomy.
• Do not consume alcohol on the day of the procedure.
• Shave the underside of the penis and the front wall of the scrotum the day before the procedure.
• It might not be a good idea to use a depilatory because this can cause painful sensitivity in some cases.
• On the day of the procedure, clean the genital area thoroughly.
• Do not use powder on the scrotum.
• Wear jockey type underwear, not boxers. Scrotal support or Jock strap is not needed.
• Valium not needed, but if you want it we can prescribe one dose. If you do opt to take Valium, someone must drive you to and from your appointment.
• Remember to bring your signed consent form to the office the day of the procedure. Wife's signature is suggested, but not required.

What should I do after the procedure?
You do not have to confine yourself to the bed, but do take adequate rest after surgery. The care you take during the first week is a major factor in the success and safety of the procedure. A few guidelines:

• You may shower and resume light activity and deskwork the very next day.
• No strenuous activity or sexual activity for four days.
• When you do resume sexual activity be sure to use a method of birth control until you have two post op semen analyses, one at 6 weeks post op, and another at 12 weeks postoperatively, to assure there is no sperm in ejaculate.
  You or your partner must use some other form of birth control until Dr. Silverstein tests your semen, tells you it is free of sperm on two consecutive tests, and that it is o.k. to have unprotected relations.
• Avoid swimming for four days.
• Use ice packs on the scrotum the day and evening of the procedure. You can place the ice pack over the underwear (not directly on the skin) for around 20 minutes at a time every 30 minutes or so. After 24 hours you need to use an ice pack only if you want to.
• Advil, or extras strength Tylenol is likely all you will need for pain.

Is a No-Scalpel Vasectomy reversible?
There are microsurgical procedures to reverse a vasectomy and reconnect the cut ends of the vas deferens. However, this technique, called vasovasostomy, is expensive ($5,000-$10,000), usually not covered by insurance, and is not always successful in restoring sperm in the ejaculate or in guaranteeing a return of fertility. Thus, vasectomy, and, NSV, should be considered irreversible. Before you choose to have a vasectomy, make sure that you and your partner do not want any more children.

What about pre vasectomy sperm banking?
Prior to vasectomy, sperm can be frozen and stored at a sperm bank. In case of unforeseen situations such as the death of a spouse or child, separation, divorce or any other situation when you might desire to father a child, these sperm can be used for assisted reproduction. However, sperm storage is an expensive option.

What are other alternative forms of birth control?
Temporary methods of birth control include condoms, diaphragms, spermicidals, IUDs, hormonal implants, and the female birth control "pill." Birth control pills are a popular form of birth control, however, not a good long-term method, as they are associated with cardiovascular complications, and there hormonal influences may increase the risk of some cancers. Tubal ligation is a permanent form of birth control for the woman. The fallopian tubes are blocked to prevent the eggs from traveling to the uterus from the ovaries. A No-Scalpel Vasectomy is a simpler procedure, requires a shorter recovery period and also costs less than a tubal ligation. Additionally vasectomy can be done in the office whereas tubal ligation requires general anesthesia in the hospital. The failure rate of tubal ligation is slightly higher than that of a vasectomy.

Where and when are the consultations and the procedures done and can they be done the same day?
Thorough counseling before vasectomy is very important. It permits couple to ask questions, express any concerns and to become sure of their decision. Counseling is scheduled to give the patient full details on the benefits and possible drawbacks of vasectomy. It is beneficial, but not required, for both the patient and his wife to be present during the counseling visit.

The consultation consists of an opportunity to meet Dr. Silverstein, who would be doing your procedure. The doctor will sit down with you and your partner and explain the procedure, discuss complications, risks and failures. The doctor will answer any questions, and then will perform a history and detailed physical exam. At the conclusion of the consultation you will be provided with written pre-and postoperative instructions and a consent form. The consent form is to be read and then signed by the patient, and preferably, also by his wife. The procedure can be scheduled at a convenient time for the patient.

Consultations and the actual vasectomy procedure is done at our Freehold office. At our Freehold office we have 25 time slots available for vasectomy each week. As we block out this time, patients can usually reserve a vasectomy slot within one week of a request.

Many men like the convenience of having their consultation and the actual vasectomy procedure the same day. If you are over 25 or have children, and are convinced that vasectomy is for you may precede this way. As "all in one" method is more efficient for the patient and the office alike, a discount is applied to the regular consultation plus procedure fee. If you opt for the "all in one" method please advise the staff of this at the time you call to make your initial appointment.

The "all in one" is particularly convenient to our out of town patients. Those patients from out of town should also be aware that they can bring their two post procedure semen specimens (we will provide an Rx) to a lab in their area (Quest, Lab Corp etc) thus obviating the need to drive back to Freehold with the specimens.

We participate in many insurance companies that cover vasectomy including Aetna, Blue Cross/Blue shield, Healthnet, and many Union plans.

Patients with plans that we do not participate with, or with no insurance, will be asked to pay in full at time of service. If you have "out of network benefits" you may be eligible for reimbursement from your insurance company and we will be happy to give you an insurance form to submit to your carrier.

Again, what are the advantages of No-Scalpel Vasectomy?

In-office procedure No incision Quicker procedure 40 to 50% quicker recovery than conventional vasectomy Ten times fewer complications than conventional (scalpel) technique. Less discomfort.