Overview of vasectomy
- Theodore J Ongaro, MD
Theodore J Ongaro, MD
- Assistant Professor of Surgery (Urology)
- Harvard Medical School
- Section Editors
- Michael P O'Leary, MD, MPH
Michael P O'Leary, MD, MPH
- Section Editor — Urology
- Professor of Surgery, Harvard Medical School
- Senior Urologic Surgeon, Brigham and Women's Hospital
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Vasectomy is the most effective available mode of male contraception. The procedure involves interruption or occlusion of the vas deferens and is typically performed in an outpatient setting under local anesthesia.
Worldwide, in 2004 almost 43 million men had undergone vasectomy . Slightly more than one half million vasectomies were performed in the United States (US) in 2002 . Approximately 79 percent of vasectomies in the US were performed by urologists, 13 percent by family practitioners, and 8 percent by general surgeons. Procedure costs range from $350 to $1,000, which is below costs associated with long-term pharmacologic contraception or female sterilization procedures.
The most common sterilization procedure for women, tubal ligation, requires entering the peritoneal cavity to access the fallopian tubes, and is usually performed under general anesthesia. Compared to tubal ligation, vasectomy is safer, less costly, and has a significantly shorter post-procedure recovery time. Nonetheless, worldwide, tubal ligation is performed five times more often than vasectomy . This suggests lower acceptance of vasectomy, which may be attributed to a variety of reasons, including misperceptions of the procedure and its side effects.
Reported rates of successful infertility for vasectomy exceed 98 percent [4,5], though data are limited by lack of long-term follow-up. Most studies report outcomes only within two years of the procedure, and might not account for subsequent failures due to later recanalization.
This topic will present an overview of vasectomy, and will discuss patient selection, and preoperative and postoperative considerations for the primary physician. The technique of vasectomy is reviewed separately. (See "Vasectomy and other vasal occlusion techniques for male contraception".)
- Peterson HB, Curtis KM. Clinical practice. Long-acting methods of contraception. N Engl J Med 2005; 353:2169.
- Barone MA, Hutchinson PL, Johnson CH, et al. Vasectomy in the United States, 2002. J Urol 2006; 176:232.
- Awsare NS, Krishnan J, Boustead GB, et al. Complications of vasectomy. Ann R Coll Surg Engl 2005; 87:406.
- Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril 2000; 73:923.
- Jamieson DJ, Costello C, Trussell J, et al. The risk of pregnancy after vasectomy. Obstet Gynecol 2004; 103:848.
- http://www.auanet.org/education/guidelines/vasectomy.cfm (Accessed on July 16, 2014).
- Sandlow JI, Winfield HN, Goldstein M. Surgery of the scrotum and seminal vesicles. In: Campbell-Walsh Urology, 9th ed, Wein A, Kavoussi L, Novick A, et al (Eds), Saunders, Philadelphia 2000. p.1098.
- Aradhya KW, Best K, Sokal DC. Recent developments in vasectomy. BMJ 2005; 330:296.
- Dassow P, Bennett JM. Vasectomy: an update. Am Fam Physician 2006; 74:2069.
- Li SQ, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol 1991; 145:341.
- Kendrick JS, Gonzales B, Huber DH, et al. Complications of vasectomies in the United States. J Fam Pract 1987; 25:245.
- Griffin T, Tooher R, Nowakowski K, et al. How little is enough? The evidence for post-vasectomy testing. J Urol 2005; 174:29.
- Hancock P, McLaughlin E, British Andrology Society. British Andrology Society guidelines for the assessment of post vasectomy semen samples (2002). J Clin Pathol 2002; 55:812.
- Barone MA, Nazerali H, Cortes M, et al. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision. J Urol 2003; 170:892.
- Clarkson TB, Alexander NJ, Morgan TM. Atherosclerosis of cynomolgus monkeys hyper- and hyporesponsive to dietary cholesterol. Lack of effect of vasectomy. Arteriosclerosis 1988; 8:488.
- Massey FJ Jr, Bernstein GS, O'Fallon WM, et al. Vasectomy and health. Results from a large cohort study. JAMA 1984; 252:1023.
- Giovannucci E, Tosteson TD, Speizer FE, et al. A long-term study of mortality in men who have undergone vasectomy. N Engl J Med 1992; 326:1392.
- Coady SA, Sharrett AR, Zheng ZJ, et al. Vasectomy, inflammation, atherosclerosis and long-term followup for cardiovascular diseases: no associations in the atherosclerosis risk in communities study. J Urol 2002; 167:204.
- Bernal-Delgado E, Latour-Pérez J, Pradas-Arnal F, Gómez-López LI. The association between vasectomy and prostate cancer: a systematic review of the literature. Fertil Steril 1998; 70:191.
- Dennis LK, Dawson DV, Resnick MI. Vasectomy and the risk of prostate cancer: a meta-analysis examining vasectomy status, age at vasectomy, and time since vasectomy. Prostate Cancer Prostatic Dis 2002; 5:193.
- Hiatt RA, Armstrong MA, Klatsky AL, Sidney S. Alcohol consumption, smoking, and other risk factors and prostate cancer in a large health plan cohort in California (United States). Cancer Causes Control 1994; 5:66.
- Siddiqui MM, Wilson KM, Epstein MM, et al. Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study. J Clin Oncol 2014; 32:3033.
- Rohrmann S, Paltoo DN, Platz EA, et al. Association of vasectomy and prostate cancer among men in a Maryland cohort. Cancer Causes Control 2005; 16:1189.
- Cox B, Sneyd MJ, Paul C, et al. Vasectomy and risk of prostate cancer. JAMA 2002; 287:3110.
- Schwingl PJ, Meirik O, Kapp N, et al. Prostate cancer and vasectomy: a hospital-based case-control study in China, Nepal and the Republic of Korea. Contraception 2009; 79:363.
- Holt SK, Salinas CA, Stanford JL. Vasectomy and the risk of prostate cancer. J Urol 2008; 180:2565.
- Jacobs EJ, Anderson RL, Stevens VL, et al. Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort. J Clin Oncol 2016.
- Møller H, Knudsen LB, Lynge E. Risk of testicular cancer after vasectomy: cohort study of over 73,000 men. BMJ 1994; 309:295.
- Hewitt G, Logan CJ, Curry RC. Does vasectomy cause testicular cancer? Br J Urol 1993; 71:607.
- Strader CH, Weiss NS, Daling JR. Vasectomy and the incidence of testicular cancer. Am J Epidemiol 1988; 128:56.
- Aitken RJ, Parslow JM, Hargreave TB, Hendry WF. Influence of antisperm antibodies on human sperm function. Br J Urol 1988; 62:367.
- Goldacre MJ, Wotton CJ, Seagroatt V, Yeates D. Immune-related disease before and after vasectomy: an epidemiological database study. Hum Reprod 2007; 22:1273.
- Kronmal RA, Krieger JN, Coxon V, et al. Vasectomy is associated with an increased risk for urolithiasis. Am J Kidney Dis 1997; 29:207.
- Kronmal RA, Alderman E, Krieger JN, et al. Vasectomy and urolithiasis. Lancet 1988; 1:22.
- Hendry WF. Vasectomy and vasectomy reversal. Br J Urol 1994; 73:337.
- Sharlip ID. What is the best pregnancy rate that may be expected from vasectomy reversal? J Urol 1993; 149:1469.
- Belker AM, Thomas AJ Jr, Fuchs EF, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol 1991; 145:505.
- Potts JM, Pasqualotto FF, Nelson D, et al. Patient characteristics associated with vasectomy reversal. J Urol 1999; 161:1835.
- PATIENT COUNSELING
- OVERVIEW OF PROCEDURES
- Conventional vasectomy
- No-scalpel vasectomy
- Percutaneous vasal occlusion
- Follow-up to confirm sterility
- Vasectomy failure
- ASSOCIATED MORBIDITY CONCERNS
- Prostate cancer
- Testicular cancer
- Immune dysfunction
- Kidney stones
- VASECTOMY REVERSAL
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS