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Vasectomy and other vasal occlusion techniques for male contraception

Anthony J Viera, MD, MPH
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD


Vasectomy is the most effective mode of permanent male contraception, and the only method that is widely available. The techniques used for interruption or occlusion of the vas deferens are discussed here. An overview of vasectomy including patient counseling is discussed elsewhere. (See "Overview of vasectomy".)


Vasectomy is a minor surgical procedure which divides the vas deferens [1]. The procedure takes about 15 minutes and can be performed in an appropriately equipped office or ambulatory surgery center [2]. No-scalpel vasectomy is the preferred vasectomy technique in the United States (US) because of its lower complication rates, but it has yet to be adopted world-wide. Because reversal of vasectomy cannot be guaranteed, other methods of vasal occlusion are being investigated.

Three techniques are used for interruption or occlusion of the vas deferens. This topic will focus primarily on vasectomy; vasal occlusion and vasal injection techniques have been described but are not in general use.

Vasal transection — Vasectomy involves transection of the vas deferens, and is typically performed in an outpatient setting with local anesthesia.

Conventional vasectomy — The traditional vasectomy approach involves bilateral scrotal incisions through which the vas deferens is mobilized and transected. This technique accounts for a small proportion of vasectomies performed in the US, but remains the most common technique in many other areas of the world [3]. (See 'Vasectomy procedure' below.)


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Literature review current through: Jul 2017. | This topic last updated: Jun 06, 2016.
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  1. Lohiya NK, Manivannan B, Mishra PK, Pathak N. Vas deferens, a site of male contraception: an overview. Asian J Androl 2001; 3:87.
  2. www.engenderhealth.org/pubs/family-planning/vasectomy.php (Accessed on May 27, 2008).
  3. Aradhya KW, Best K, Sokal DC. Recent developments in vasectomy. BMJ 2005; 330:296.
  4. Peterson HB, Curtis KM. Clinical practice. Long-acting methods of contraception. N Engl J Med 2005; 353:2169.
  5. Li SQ, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol 1991; 145:341.
  6. Cook LA, Pun A, Gallo MF, et al. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev 2014; :CD004112.
  7. Soebadi DM, Gardjito W, Mensink HJ. Intravasal injection of formed-in-place medical grade silicone rubber for vas occlusion. Int J Androl 1995; 18 Suppl 1:45.
  8. Mruk DD. New perspectives in non-hormonal male contraception. Trends Endocrinol Metab 2008; 19:57.
  9. Guha SK, Singh G, Ansari S, et al. Phase II clinical trial of a vas deferens injectable contraceptive for the male. Contraception 1997; 56:245.
  10. Chaki SP, Das HC, Misro MM. A short-term evaluation of semen and accessory sex gland function in phase III trial subjects receiving intravasal contraceptive RISUG. Contraception 2003; 67:73.
  11. Seenu V, Hafiz A. Routine antibiotic prophylaxis is not necessary for no scalpel vasectomy. Int Urol Nephrol 2005; 37:763.
  12. Cooper TP. Use of EMLA cream with vasectomy. Urology 2002; 60:135.
  13. Hahn IH, Hoffman RS, Nelson LS. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004; 26:85.
  14. Li PS, Li SQ, Schlegel PN, Goldstein M. External spermatic sheath injection for vasal nerve block. Urology 1992; 39:173.
  15. Weiss RS, Li PS. No-needle jet anesthetic technique for no-scalpel vasectomy. J Urol 2005; 173:1677.
  16. White MA, Maatman TJ. Comparative analysis of effectiveness of two local anesthetic techniques in men undergoing no-scalpel vasectomy. Urology 2007; 70:1187.
  17. Kaplan KA, Huether CA. A clinical study of vasectomy failure and recanalization. J Urol 1975; 113:71.
  18. Labrecque M, Hoang DQ, Turcot L. Association between the length of the vas deferens excised during vasectomy and the risk of postvasectomy recanalization. Fertil Steril 2003; 79:1003.
  19. Mason RG, Dodds L, Swami SK. Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? A prospective randomized trial. Urology 2002; 59:424.
  20. Eisner B, Schuster T, Rodgers P, et al. A randomized clinical trial of the effect of intraoperative saline perfusion on postvasectomy azoospermia. Ann Fam Med 2004; 2:221.
  21. Pearce I, Adeyoju A, Bhatt RI, et al. The effect of perioperative distal vasal lavage on subsequent semen analysis after vasectomy: a prospective randomized controlled trial. BJU Int 2002; 90:282.
  22. Chen-Mok M, Bangdiwala SI, Dominik R, et al. Termination of a randomized controlled trial of two vasectomy techniques. Control Clin Trials 2003; 24:78.
  23. Cook LA, Van Vliet H, Lopez LM, et al. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev 2007; :CD003991.
  24. Esho JO, Cass AS. Recanalization rate following methods of vasectomy using interposition of fascial sheath of vas deferens. J Urol 1978; 120:178.
  25. Sokal D, Irsula B, Chen-Mok M, et al. A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition. BMC Urol 2004; 4:12.
  26. Li SQ, Xu B, Hou YH, et al. Relationship between vas occlusion techniques and recanalization. Adv Contracept Deliv Syst 1994; 10:153.
  27. http://www.auanet.org/content/media/vasectomy.pdf (Accessed on April 09, 2013).
  28. Sharlip ID, Belker AM, Honig S, et al. Vasectomy: AUA guideline. J Urol 2012; 188:2482.
  29. Schmidt SS, Minckler TM. The vas after vasectomy: comparison of cauterization methods. Urology 1992; 40:468.
  30. Sokal D, McMullen S, Gates D, Dominik R. A comparative study of the no scalpel and standard incision approaches to vasectomy in 5 countries. The Male Sterilization Investigator Team. J Urol 1999; 162:1621.
  31. Reynolds RD. Vas deferens occlusion during no-scalpel vasectomy. J Fam Pract 1994; 39:577.
  32. Cook LA, Van Vliet HA, Lopez LM, et al. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev 2014; :CD003991.
  33. Schmidt SS. Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases. Br J Urol 1995; 76:373.
  34. Denniston GC. Vasectomy by electrocautery: outcomes in a series of 2,500 patients. J Fam Pract 1985; 21:35.
  35. Labrecque M, Nazerali H, Mondor M, et al. Effectiveness and complications associated with 2 vasectomy occlusion techniques. J Urol 2002; 168:2495.
  36. Errey BB, Edwards IS. Open-ended vasectomy: an assessment. Fertil Steril 1986; 45:843.
  37. Denniston GC, Kuehl L. Open-ended vasectomy: approaching the ideal technique. J Am Board Fam Pract 1994; 7:285.
  38. Shapiro EI, Silber SJ. Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia. Fertil Steril 1979; 32:546.
  39. Kendrick JS, Gonzales B, Huber DH, et al. Complications of vasectomies in the United States. J Fam Pract 1987; 25:245.
  40. Christensen P, al-Aqidi OA, Jensen FS, Dørflinger T. [Vasectomy. A prospective, randomized trial of vasectomy with bilateral incision versus the Li vasectomy]. Ugeskr Laeger 2002; 164:2390.
  41. Cook LA, Pun A, van Vliet H, et al. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev 2007; :CD004112.
  42. Awsare NS, Krishnan J, Boustead GB, et al. Complications of vasectomy. Ann R Coll Surg Engl 2005; 87:406.
  43. Tandon S, Sabanegh E Jr. Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU Int 2008; 102:166.
  44. Manikandan R, Srirangam SJ, Pearson E, Collins GN. Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years. BJU Int 2004; 93:571.
  45. McMahon AJ, Buckley J, Taylor A, et al. Chronic testicular pain following vasectomy. Br J Urol 1992; 69:188.
  46. Leslie TA, Illing RO, Cranston DW, Guillebaud J. The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int 2007; 100:1330.
  47. Morris C, Mishra K, Kirkman RJ. A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men. J Fam Plann Reprod Health Care 2002; 28:142.
  48. Schmidt SS. Spermatic grauloma: an often painful lesion. Fertil Steril 1979; 31:178.
  49. Nangia AK, Myles JL, Thomas AJ JR. Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. J Urol 2000; 164:1939.
  50. Polackwich AS, Tadros NN, Ostrowski KA, et al. Vasectomy Reversal for Postvasectomy Pain Syndrome: A Study and Literature Review. Urology 2015; 86:269.
  51. Padmore DE, Norman RW, Millard OH. Analyses of indications for and outcomes of epididymectomy. J Urol 1996; 156:95.
  52. Dassow P, Bennett JM. Vasectomy: an update. Am Fam Physician 2006; 74:2069.
  53. Black T, Francome C. The evolution of the Marie Stopes electrocautery no-scalpel vasectomy procedure. J Fam Plann Reprod Health Care 2002; 28:137.
  54. Alderman PM. The lurking sperm. A review of failures in 8879 vasectomies performed by one physician. JAMA 1988; 259:3142.
  55. Griffin T, Tooher R, Nowakowski K, et al. How little is enough? The evidence for post-vasectomy testing. J Urol 2005; 174:29.
  56. Marshall S, Lyon RP. Variability of sperm disappearance from the ejaculate after vasectomy. J Urol 1972; 107:815.
  57. Arango Toro O, Andolz Peitivi P, Lladó Carbonell C, et al. [Post-vasectomy semen in 313 males. Statistical analysis, medical aspects, legal implications]. Arch Esp Urol 1993; 46:29.
  58. Marwood RP, Beral V. Disappearance of spermatozoa from ejaculate after vasectomy. Br Med J 1979; 1:87.
  59. Spencer B, Charlesworth D. Factors determining the rate of disappearance of sperm from the ejaculate after vasectomy. Br J Surg 1976; 63:477.
  60. 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.
  61. 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.
  62. Klotz KL, Coppola MA, Labrecque M, et al. Clinical and consumer trial performance of a sensitive immunodiagnostic home test that qualitatively detects low concentrations of sperm following vasectomy. J Urol 2008; 180:2569.
  63. 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.