Ralph A. Highshaw, M.D.

A vasectomy is a ligation (cutting, tying off with suture, disruption) of the flow of sperm through the vas deferens. The vas deferens is a tubular structure which is connected to another tubular structure called the epididymis, which is connected to the testicle, which produces the sperm.

Vasectomies are done when a man desires sterilization. It could be that his wife has had difficult pregnancies, and the next one would be a risk to her health or the unborn childs health. For instance, a woman who has had multiple cesearean sections or has had comorbidities (example, diabetes or hypertension) associated with pregnancy. Often the family has decided together that the wife’s child-bearing years are done ( because of advanced age, etc.). A vasectomy is often chosen as opposed to a tubal ligation for the woman, because it involves less risk to the patient and no anesthesia. A woman has to undergo anesthesia and have an abdominal incision in order to ligate the fallopian tubes (through which the ovaries travel for conception to occur). She also has a longer recovery. A vasectomy is performed in my office in 15 minutes, with a quick recovery, and minimally invasive.

There are three types of vasectomies performed. All three methods involve a small incision in the midline of the scrotum below the penis. The traditional method. The scalpel-less or non-scalpel method, and a laser vasectomy.

I perform the traditional method. It includes ligation of the vas deferens with removal of a 3-4mm portion of the vas deferens. This is followed by suturing of the two ends of the vas deferens, and cauterization (heating closed) the opened ends of the tubular structure.

The scalpel-less vasectomy was developed in China in the 1970′s. It involves bringing the vas deferens through a small incision in the scrotum using a clamp made for this type of structure and performing the ligation. I have been taught this method with use of a syringe needle to transect the vas deferens. There can be a higher failure rate with this method. The presumed benefit is less mobilization of the scrotal structures and vas deferens, hence decreased risk of swelling after the procedure.

The laser is a newer method of ligation and burning of the vas deferens inorder to sterilize a man. A small incision is still made in the scrotum to expose the vas deferens. This is a variation of the same theme.

I perform on average 5 vasectomies weekly for the last 6 years. It is covered by almost all insurances at minimal cost to the patient, if any. It takes approximately 15 minutes, and a local anesthetic is used to comfort the patient and prevent any pain. My patients usually take a couple of days off work or have it done on a Friday in order to relax over the weekend. I recommend no strenuous activity or exercise for the first two days after the procedure, so as to prevent potential swelling of the scrotum or testicles. Swelling occurs in less than 0.5% of my patients. The recovery is fast. Other potential risks include infection, which occurs rarely and is treated with antibiotics, and bleeding. Bleeding has not occured in my practice. I make sure patients are off medicines which can cause bleeding, such a ibuprofen or aspirin at least one week prior to the procedure. Sperm granuloma can develop in some men after a vasectomy. It is essentially scar tissue from the vasectomy that feels like a small bump in the scrotum above or around the testicle. It is not cancerous, and rarely causes pain. If pain results, this is handled with ibuprofen or rarely removal.

After a vasectomy, it takes 6-8 weeks of ejaculations or intercourse, in order to become completely sterile. Until this time, a patient is required to use a condom for prevention against impregnating a woman. After the vasectomy, the patient is given a laboratory slip and a sterile cup to collect a sample of semen (the ejaculate fluid) for examination 6-8 weeks later. I always confirm success of the vasectomy with a follow-up sperm count by your local laboratory. There are internet sources which claim 21 ejaculations are sufficient to remove the remaining sperm from the vas deferens after a vasectomy. This may not be true, since men do not all produce the same amount of sperm in the semen.

Myths about vasectomies include: loss of erections, loss of “manhood” (male hormones, testosterone), developing a high-pithced voice, sperm back-up/ build-up (“blue balls”), or vasectomy causing prostate cancer. None of these myths are true.

For more information about vasectomies, contact Dr. Highshaw at (714) 751-0100 or (951) 509-9000.

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