Choosing a Birth Control Method – Male Sterilization

Description

A permanent form of birth control, vasectomy has been used for decades for male sterilization. The outpatient procedure is highly effective and has few side effects. Vasectomy is exceedingly safe.

Use

Two techniques are used to perform vasectomies: no-scalpel vasectomy (NSV) and no needle/no scalpel vasectomy (NNV). NSV is considered the standard of care. In NSV, the physician uses a small needle to inject anesthesia into the skin and vas deferens. In NNV, the physician uses a piston-like instrument to force anesthetic into the tissues. After anesthetizing the area, the provider creates a small opening (a few millimeters) in the skin of the scrotal sac and locates the vas deferens. The vas are then ligated or cauterized; there is no need for sutures.

Sexual activity may be resumed about 1 week after the procedure or the time at which the patient feels comfortable. A back-up contraceptive method is needed until the patient has had at least one negative sperm check after at least 3 months after the procedure AND at least 20 ejaculations.⁹⁵ These checks are essential to ensure the absence of residual sperm in the vas beyond the point of occlusion.

Effectiveness

This method is extremely effective, with a failure rate of 0.10 to 0.15 percent.¹⁹

Risks

• Reactions to local anesthesia are possible but rare.
• Some short-term tenderness and bruising may occur.
• Overall, NSV is associated with little pain and a low risk of infection.⁹⁶

Side Effects

None

Contraindications and Precautions

• Known allergy or hypersensitivity to any materials used for the procedure
• Uncertainty about desire to end fertility

Advantages

• Long-term method
• Discreet
• Low risk of side effects
• After up-front cost, no ongoing cost to maintain method
• No effect on hormonal milieu
• Very effective
• Quick recovery

Disadvantages

• Requires surgical procedure
• Requires trust between partners
• No protection against STIs

Counseling Messages

• Vasectomy should be considered a permanent method of male sterilization and should not be performed if there is a chance that the patient might desire to father children in the future.
• Reversal procedures exist but are technically complex, expensive, and have a variable success rate.
• Most activities can be resumed 3 days after the procedure. More strenuous activities, including sexual activity, can be resumed 1 week after vasectomy.
• Use of another form of contraceptive is essential until the patient has had at least one negative sperm check after at least 3 months AND at least 20 ejaculations.⁹⁵
• This method does not protect against STIs.