Birth control after vasectomy?

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From Vasectomy.com

After a vasectomy, it can take many months before your semen is free of sperm. During this time, you will need to continue using another form of birth control while having sex.

Anatomy of a Vasectomy

Sperm travel from the testicles through several tubes before they are mix with the semen. One of these tubes is the vas deferens, which runs from each testicle. During a vasectomy, both vas deferens are cut. This prevents new sperm made in the testicles from being ejaculated along with the semen.

However after a vasectomy, some sperm still remain in the part of the vas deferens closer to the penis — the upper part. It can take 20 to 30 ejaculations before all the sperm are cleared from these tubes. In most men, it may be three or more months before they have no sperm — or very few non-motile (non-moving) sperm — in their semen.

It only takes one sperm to fertilize a woman’s egg. So until the vas deferens is free of motile sperm, there is still a chance of pregnancy. During this time you will need to use another type of contraception every time you have sex.

Follow-up Testing

Your doctor will retest your semen about eight weeks after your vasectomy to see if there are still sperm present. This shows whether the vasectomy was successful, meaning you are infertile. If the tests show that your semen is free of sperm, then you no longer have to use additional birth control.

Some men, though, will continue to have a small number of non-motile sperm in their semen. Because the sperm are non-motile, the risk of pregnancy may be low.

One study found that around 10 percent of men undergoing a vasectomy reversal still had sperm in their semen. However, no pregnancies occurred in the partners of these men since their vasectomy.

If sperm is still present in your semen during the follow-up test, your doctor will talk to you about your options. This may include further testing. Your doctor may also decide that the chance of pregnancy is low enough that you don’t need to worry.

Vasectomy Failures

A vasectomy failure means that sperm continue to be present in the semen after a certain amount of time has passed since the vasectomy. This can happen during the period before the vas deferens tubes were cut. In rare cases, men may have two vas deferens on one side, and one of these is missed during the surgery.

In other cases, the two cut ends of the vas deferens can rejoin to form a complete tube. Your doctor may suspect this if you continue to have motile sperm after a vasectomy, or your sperm count continues to increase.

When the vasectomy is a failure, men will either have to continue using another form of contraception or undergo another vasectomy.

Question- Does vasectomy cause prostate cancer? Northeast Georgia Urology

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This is probably one of the most common questions asked at a vasectomy consultation.

The second most common? “What is the success rate of a vasectomy?” (I’ll address that next time.) J.M.

Vasectomy Not Associated With Prostate Cancer

Urology – February 28, 2009 – Vol. 25 – No. 04

There is no association between prostate cancer and age at vasectomy or years since vasectomy.

Article Reviewed: Vasectomy and the Risk of Prostate Cancer. Holt SK, Salinas CA, Stanford JL: J Urol; 2008;180 (December): 2565-2568.

Background: The majority of the literature now has shown no association between vasectomy and prostate cancer. The effect of vasectomy on men with a family history of prostate cancer or on those who underwent a vasectomy at a young age or had an extended period of time since the procedure has been poorly studied due to small sample sizes and short study follow-up.

Objective: To assess the risk of prostate cancer in men by age and length of time to exposure from vasectomy to disease.

Design: Population-based, prostate cancer case-controlled study.

Participants: 1327 men aged 35 to 74 years residing in King County, Washington, with a diagnosis of prostate cancer.

Methods: Cases of prostate cancer were identified from the SEER database for this population. Structured in-person interviews were conducted. Eligible controls were identified by random digit telephone dialing. Analysis based on prostate cancer Gleason score and stage was performed. Analysis was also performed based on demographics, age, prostate cancer screening history (within the last 5 years), family history of prostate cancer, and vasectomy parameters.

Results: 1327 men were eligible for study from the SEER database; 1001 completed the personal questionnaire. In total, 1340 controls were identified, of which 942 were interviewed. The control population showed that men who had undergone vasectomy were older, white, married, non-smokers with higher income and education, and had undergone PSA screening. Of men with prostate cancer and controls, 36% had undergone a vasectomy. Mean number of years since vasectomy in cases and controls was 21.1 years. No significant association was seen between prostate cancer and vasectomy status, age at vasectomy, years since vasectomy, or year of vasectomy. There was no evidence of risk estimates across vasectomy parameters. Risk did not change if men with prostate cancer within 2 years of vasectomy and controls with no PSA screening within 5 years (n=136) were excluded.

Conclusions:

No association was found between prostate cancer and vasectomy, even in men who had a vasectomy performed at a young age or had an extended period of time since vasectomy.

Reviewer’s Comments: This paper is a well-conducted, large case-control study that answers the concern about possible limitations of previous work that reported the lack of association between prostate cancer and vasectomy. This criticism often indicated inadequate follow-up since vasectomy to make this claim. In this study, average time since vasectomy in cases of prostate cancer and controls was 21 years. Multiple variables were looked at including vasectomy in the face of prostate cancer family history and screening. This large study should end the criticism on previous work that did not answer the question of prostate cancer and time from vasectomy. (Reviewer–Ajay K. Nangia, MBBS).

Question: What is this lump after my vasectomy?

From Vasectomy.com

I had a vasectomy a year ago and now I have a small pea size lump on my vas deferns and it feels as if the two ends have connected. Is this possible?

This is a common finding following a vasectomy. It can be nothing more than the normal healing process that would occur with any procedure as the body attempts to heal the trauma of the transected vas deferens.

A sperm granuloma again is a natural body response to the leakage of sperm that may have occurred at the vasectomy site.  These areas are sometimes tender to the touch or in certain sitting positions. Uncommonly if the pain is significant enough, a course of antibiotics or anti-inflammatories are necessary. Rarely the discomfort is often enough and bad enough that a patient will request that the can be removed surgically.

I did a vasectomy on a friend of mine who developed a sperm granuloma and it was painful to him about every six months or two years and responded to antibiotics, although there is no real scientific reason for this. The after a few years, it stopped bothering him.  He would call and say, “John, my sperm “granola” is back.” J.M.

ANSWERS FROM DOCTORS (3)


2 months ago by Steven K. Sterzer, MD

Yes, you may have had a sperm leak early on post-vasectomy that the ever magnificent body healing process took care of. The pea-sized lump is probably what is called a granuloma. This is of no clinical significance, unless you wish to get a reversal of the vasectomy. In that case, the reversal success rate will be higher than if this did not occur. Best wishes!


2 months ago by Mark J. Saslawsky, MD – Memphis Office

It’s typical for the vas ends to “approximate”, but they rarely reconnect. The knot could be scar tissue or a cyst from back pressure.


2 months ago by Randy Brett Ackerman, MD

If the semen analysis shows no sperm, then you should not be able to father a child. Small pea-sized lumps following a vasectomy can happen, but there is no indication from them that the procedure has failed.

What’s the skinny on the No Needle Vasectomy?

I have been using the Madajet Injector for many years. It works better on thin scrotal skin than that with prominent rugae. For the anxious male, of whom there are many, the urologist stating “I am not using a needle” and the patient not seeing a needle is a beneficial aspect of this device.

No-Needle Anesthesia Reduces Pain Before No-Scalpel Vasectomy

Urology – March 15, 2008 – Vol. 24 – No. 01

No-needle jet anesthesia results in reduced pain only at initiation of vasectomy compared with traditional needle administered anesthesia.

Article Reviewed: Comparative Analysis of Effectiveness of Two Local Anesthetic Techniques in Men Undergoing No-Scalpel Vasectomy. White MA, Maatman TJ: Urology; 2007; 70 (December): 1187-1189.

Comparative Analysis of Effectiveness of Two Local Anesthetic Techniques in Men Undergoing No-Scalpel Vasectomy.

White MA, Maatman TJ:
Urology; 2007; 70 (December): 1187-1189

Background: Improvement in vasectomy technique occurred with the introduction of the no-scalpel vasectomy. This still requires anesthesia of the skin, which traditionally requires use of local anesthesia via a hypodermic needle and associated pain. Introduction of the no-needle jet injection of aerosolized local anesthesia has claimed to reduce pain from vasectomy further. Objective: To compare the visual analogue pain scores after using no-needle jet anesthesia versus needle delivery anesthesia at the time of no-scalpel vasectomy. Design: Prospective, single blinded, nonrandomized study. Participants: 50 men (age range, 26 to 45 years) undergoing no-scalpel vasectomy. Methods: With each patient, 1 vas deferens was anesthetized with the MadaJet XL no-needle jet injector utilizing 0.3 mL of 2% lidocaine with epinephrine and the other side was anesthetized with mepivacaine through a 27-gauge needle. The patient was blinded to which method was used on each side. Visual analogue score questionnaires were given to each patient to assess pain at time of anesthesia and for the procedure to follow.

Results: The average visual pain score for the jet injection side was 1.56 of 10 and the needle injection side was 2.12 of 10 (P <0.029). There was no significant difference in the visual pain score for the vasectomy procedure itself after the 2 anesthetic methods.

Conclusions: No-needle jet infiltration of local anesthesia results in less pain at the time of the injection, but does not change the pain score for the vasectomy itself.

Reviewer’s Comments: This is the first study to compare a different anesthetic delivery system, the jet infiltration, versus traditional injection therapy. The study was powered appropriately to ensure a potential difference could be seen although only 50 patients were included in the study. The study was unique because both techniques were performed in each patient, and therefore eliminating any immediate differences between patient populations. It was also a single surgeon experience. As new technology develops to make vasectomy as “pain free” as possible and thereby more acceptable to men, more attempts at evidence-based practices like this should be performed. (Reviewer–Ajay K. Nangia, MBBS).