how does a vasectomy work and can we reverse it?

Some men may shudder at the thought of "cutting". But vasectomies are a safe and effective form of contraception for men who have completed their family or do not wish to have children.

Medicare data show that more than 25,000 Australians have had a vasectomy in the last fiscal year. The relatively simple surgical procedure involves disrupting sperm-bearing tubes in the scrotum to prevent sperm from entering the seminal fluid when a man ejaculates.

Sperm usually only accounts for about 2 to 5% of the total volume of ejaculation. This means that after a successful vasectomy, it will remain at least 95% of the final product, while eliminating the risk of pregnancy.

The procedure

Generally, vasectomies are performed under local anesthesia. The surgery can usually be completed within 15-30 minutes.

In the "without scalpel" method, a single sting is practiced in the scrotum with the aid of specialized equipment. The tubes can then be accessed without having to make an incision. This method is considered a best practice because it is minimally invasive, does not require stitches and causes very little scarring.

There is also the more traditional incision method in which a scalpel is used to create one or two small access points through which the doctor performs the procedure.

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For anyone worried about the function of the penis after the procedure, the penis actually has very little to do with a vasectomy. An incision, or a puncture, is practiced in the scrotum. The small internal tubes connecting the testicles to the penis, called vas deferens, are at the center of the procedure. The vas deferens carry sperm from the testes to the prostate, where they are mixed with sperm for ejaculation.

In most procedures, approximately 1 to 2 cm of the vas deferens will be removed to minimize the risk of re-adhesion of the tubes later.

Techniques for closing the ends of the vas deferens include cautery (electrical or thermal burning to create scar tissue) and ligation (ligation of tubes).

Some of the highest success rates involve an "open" technique (at least 99.5% of the time). It is there that the upper part of the tube is either cauterized or ligated, while the closest end of the testes remains open. This presents a lower risk of complications than other methods and seems to be a popular choice among Australian physicians.

What is the success of vasectomies?

Vasectomies are generally very effective, with success rates well above 99% and minimal complications in the long term.

Potential complications immediately after surgery include infection and hematoma (internal bleeding), but the risks of such complications are low (1-2%). The risk is even lower when the "without scalpel" method is used.

The pain at the base of the scrotum is the most common long-term complication of a vasectomy. It only affects about 2% of men, however. The "open" method is thought to reduce the chances of this happening.

It is important to note that vasectomies are only fully effective after about three months because the sperm needs time to clear the vas deferens completely. It is therefore wise to continue using another form of contraception immediately after the procedure, until the doctor gives you the green light.

setback

A person who has had a vasectomy may want the procedure reversed for a variety of reasons.

All services offering vasectomy do not offer a vasectomy reversal, called vasovasostomy. But this can be done. The procedure essentially consists of reconnecting the previously disconnected vas deferens.

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Among vasectomized men, about 3-6% choose to undergo a vasectomy reversal, after which a successful pregnancy can be achieved in 80% of cases.

Many factors could affect this chance. The age of the partner is among the most significant.

It is also important to note that the longer the vasectomy lasts, the lower the chances of successful inversion and future pregnancy.

In some cases, if a couple wants more children after a vasectomy, a more realistic and faster option may be IVF. Sperm can still be extracted directly from the testicles of a man who has had a vasectomy.