Dossier: Sexuality

Vasectomy: voluntary sterilisation

Having a vasectomy is the most effective form of birth control. There’s no need to be scared of the procedure, but it’s a decision that needs careful consideration.

Text: Anna Miller; photo: Sanitas

Everything comes down to 1 to 2 centimetres. These make all the difference for a man when it comes to the question: Can I still produce children? Do I want to? Should I? Thousands of men in Switzerland every year wonder whether they want to have children and what they should do about contraception, and around 10,000 of them opt for the operation that will make them permanently infertile: a vasectomy.

During a vasectomy, the two vas deferens in the scrotum are cut and a small piece of the vas deferens is removed – around 1 to 2 centimetres. The ends are then tied to ensure that no more sperm enters the seminal fluid. It is a routine outpatient procedure that is performed under local anaesthesia and takes 30 to 40 minutes. “We do around three to six vasectomies a week here,” says Adrian Sieber, external chief consultant and head of training for andrology at the Biel hospital. The procedure is completely safe and has been performed successfully for years. The vasectomy is by far the most effective form of birth control. Long-term consequences? None known. Prostate cancer? That has now been disproved by numerous studies.

A vasectomy is the safest form of contraception, easy to perform, costs around CHF 1,000 in Switzerland and is practically pain-free. Health insurance doesn’t cover the costs, but some insurance models offer subsidies. It sounds like the ideal solution. But many men still have reservations about having a vasectomy. “Most men who express concern are either worried about the pain or the fact that the procedure may have a negative impact on their libido and sexual pleasure,” says Sieber.

“Sperm accounts for only around 1% of the seminal fluid. So you don’t even notice it’s missing.”
Dr Adrian Sieber, urologist

No difference to lust and love

Sieber confirms that a vasectomy has no influence on a man’s sex life. After the operation, the testicles are no longer able to send sperm into the lower sperm ducts. Although the supply of sperm is stopped, sperm production continues. “Sperm accounts for only around 1% of the seminal fluid. So you don’t even notice it’s missing,” says Sieber. The ejaculate itself, the white seminal fluid, is a secretion of the prostate gland. “The volume, quality, colour and taste of the seminal fluid remain unchanged.” Just like the man’s sensation.

Complications can also occur during a routine procedure such as a vasectomy. The man may experience bleeding, infections or a wound-healing disorder. Persistent pain after the operation, known as post-vasectomy pain syndrome, is also possible. Around 1% of men who have undergone surgery are affected by this. It can also lead to the formation of nodular connective tissue growths or to the formation of a sperm granuloma – a nodular, hard change in the spermatic cord caused by the leakage of sperm into the surrounding tissue. However, complications following surgery are rare and are usually easily treated.

Fully sterile only after a few months

Following the procedure, a man is only fully sterile when not a single sperm remains in his seminal fluid and a quota of 0.0 is achieved. This is because every sperm has the potential to conceive a child. After having the procedure, it usually takes several months until the man can be classed as sterile. Until then, another form of contraception continues to be required. The more frequently a man ejaculates after a vasectomy, the faster he will be sterile. Why? Because it’s about diluting the concentration of sperm. “It usually takes between 40 to 60 ejaculations before there is no more sperm in the fluid,” says specialist Adrian Sieber. However, this varies from man to man. After a few months, the man should provide the doctor with a semen sample to check the results.

The procedure is practically pain-free, if it proceeds without complications. It’s usually possible to exercise, do sport and have sex again without pain after just a few days. Sieber tells patients who have been sterilised to take it easy and remain at home for 36 hours: no biking, jogging, etc. It’s normal for men to feel some discomfort during the procedure, but they don’t have to worry about pain – it’s minimal. “Many men fear that a vasectomy is painful,” says Sieber. But it’s not. As I tell my patients, a visit to the dentist is worse. Perhaps women are simply braver when it comes to pain in their abdomen because they’re used to it. Worries about genital examinations, regular monthly pain or pregnancy and conception simply don’t belong to the experience of being a man.

“It’s important that the man makes the decision on his own terms, independently of his partner.”
Dr Adrian Sieber, urologist

Not for young men

So, is a vasectomy the perfect form of contraception for the modern world? Virtually pain-free, cost-effective and safe? After all, women have always been justified in complaining that men don’t play an active enough role in contraception. Condoms are practically the only male contraceptive available on the market that is suitable for general use. And more and more women are tired of taking pills and hormones, they’ve had enough of being solely responsible for contraception and having to pay much more for contraception, menstruation and medical check-ups just because they have a female body.

However, Sieber doesn’t recommend that younger men have a vasectomy if they aren’t 100% sure that they don’t want (any more) children. “In my professional life, I’ve turned away a handful of men who came to me for a vasectomy because I believed they were too young and their family planning was still undecided.” Sieber believes that mid-20s is too early for men to say they never want children because their personality hasn’t really taken shape yet.

On average, men who have a vasectomy are between their mid-30s and late 40s. The vast majority are in longstanding relationships – and the decision is taken together with their partner. The classic situation, says Sieber, is a stable partnership or marriage that has already produced several children and the couple don’t plan on having any more. “Nevertheless, it’s important that the man makes the decision on his own terms, independently of his partner,” says Sieber.

A reversible procedure

The procedure to reverse a vasectomy is known as a vasovasostomy. After more than 30 years of professional experience, Adrian Sieber has performed hundreds of these operations. A vasovasostomy isn’t a routine procedure. It is rarely performed in Switzerland and only by a few specialised urologists. “The chances that a man’s sperm ducts will be reopened are very high – 90% with an experienced surgeon. However, the pregnancy rate is a little lower because it is also influenced by the partner,” says Sieber.

The surgical procedure of reversal is somewhat more serious than a vasectomy. It is performed as an outpatient procedure using a surgical microscope. It takes up to four hours and is much more expensive than a vasectomy, costing around CHF 8,000 in Switzerland.

The classic candidate for a reversal is a slightly older man who has found love again. Thanks to their biology, men are fertile for decades longer than women. After the break-up of a long-term relationship, men are often suddenly faced once again with the question of having children as they embark on a new relationship with a woman who still wants to have children. “This is the most common reason for requesting a reversal in my consulting room,” says Sieber. In several decades, he has only very rarely experienced a man wanting to reverse a vasectomy without having begun a new partnership. “That’s why it’s all the more important when considering sterilisation that the patient has considered the decision maturely and carefully.”

Also an option for women – but less ideal

Women can also be sterilised as a safe method of contraception. The technical term for it is tubal sterilisation (ligation). In this case, the fallopian tubes are either sealed with an electric current or closed with a clip. Women are also advised only to have this procedure if they are completely sure they don’t want to have any (more) children.

Women are sterile immediately after the operation. The procedure has no influence on their hormones, libido or menstruation. Women who are sterilised have a lower risk of developing ovarian cancer. But if it’s about contraception, experts recommend male sterilisation over female because the procedure is more cost-effective, easier to perform and less likely to lead to complications. Even if women are sterilised they can still develop an ectopic pregnancy, which carries major health risks.

About the expert

Adrian Sieber is external chief consultation and head of training for andrology at Biel hospital and senior physician for urology in the affiliated doctor system at Emmental hospital. He has headed up his own practice for urology in Burgdorf since 1993.

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