Question: Persistent sperm after a vasectomy?


My husband had a vasectomy 8 months ago he has had more then 40 ejaculation since his surgery, or maybe even more. The semen analysis came back with more then 20 hpf. Motile and non motile sperm were seen. Could his vasectomy have failed, or can it take a long time to become sterile? Thank you.

Dr. McHugh’s answer:

There two scenarios here. It is possible that the vasectomy has successfully divided the vas and that the sperm are, for whatever reason, slow to completely clear. If this is the thinking you would re check after another twenty or so ejaculations. On the other hand this may represent a recanalization of the vas tubes, a small channel, that has reconnected the vas tubes. In this case another vasectomy would be performed. A couple of things: You could have a formal semen analysis performed to actually get a count, it is possible that 20 per highpower field correlates with a very low total count. Some feel that after a vasectomy less than 100,000 on a semen analysis is acceptable. I have experienced your particular situation about five times in my career and I have repeated the vasectomy. Interestingly each time it corrected the small numbers of sperm that persistently showed up on microscopic exam.

Convincing your partner to have a vasectomy.



Convincing Your Partner / Myths About Vasectomy


Convincing your partner that vasectomy is the right choice for birth control is a simple task. That is because vasectomy truly is the safest, cheapest, and most effective form of birth control. To convince your partner, just present the following facts:

  1. Vasectomy does not cause any hormonal changes, nor will it change his sexual function or desire.
  2. Vasectomy will not significantly change the character or quantity of his ejaculation. It simply blocks the sperm cells from being in the seminal fluid.
  3. The local anesthetic used is injected into the skin of the scrotum, not into the testicle.
  4. The no scalpel vasectomy is an innovative method of performing a vasectomy. It is done through a single small puncture through the scrotal skin, not an incision. It does not even require a stitch or a suture to close the skin.
  5. MAN UP! The burden of birth control and child bearing needs to be shared. Tell him that stepping up for a vasectomy is an important way for him to do his share.
  6. A Board Certified Urologist is a fully trained surgeon, and the no scalpel vasectomy is commonplace and easy for him. The procedure is safe and easy to perform.
  7. Show him the less than perfect options in our COMPARING OPTIONS section.
  8. Again: Vasectomy is the safest, cheapest, and most effective form of birth control.

Vasectomy: Risks, Complications, and Side Effects

From’s Website

All surgeries carry some risk, but complications from vasectomy tend to be rare, minor, and seldom require intensive medical treatment. Below, find some of the most common risks and side effects for a vasectomy.

If you have concerns or want more information about the possible risks, complications, and long-term effects of a vasectomy, talk to your doctor.

Vasectomy risk factors

Allergic Reaction – Rarely, some men may experience itching and hives, as the result of an allergic reaction to the local anesthetic.

Antibodies – After a vasectomy, sperm produced in the testicles are absorbed by the body. This process may cause the immune system to produce antibodies to the sperm. These “anti-sperm antibodies” are mostly harmless, but they can affect the success of a later vasectomy reversal. (They have not, however, been linked to other immune-related diseases. For more information, see “Is there a link between vasectomy and disease?“)

Bruising – Bruising may occur on the skin of the scrotum or the penis. This is a normal side effect of a vasectomy, and the bruises should be gone after about two weeks.

Chronic Scrotal Pain – Fifteen to 19 percent of men who have had a vasectomy experience pain that lasts more than three months and interferes with daily activities. This type of pain, however, can also have causes unrelated to the vasectomy—such as inflammation of the epididymis, trauma, or twisting of the testicle (torsion).

Epididymitis – One of the more common post-vasectomy complications, occurring in up to 6 percent of vasectomies, epididymitis is caused by inflammation and swelling of the epididymal tube. Heat and anti-inflammatory medications (alone or combined with antibiotics) can usually clear it up within a week.

Hematoma – Pooling of blood within the tissue occurs in up to 29 percent of all vasectomy patients. It usually starts within the first week after the procedure, and can cause pain or swelling. While it is rarely serious, you should report any bleeding to your doctor.

Infection – Infections occur in about 3.5 percent of vasectomy patients. These are usually minor and respond favorably to antibiotic treatment, antimicrobial creams, and hot baths. More serious infections are rare.

Postoperative Pain – Short-term pain after a vasectomy is normal and usually resolves within a day or two, although a slight ache can remain for a while longer. Surgeons usually recommend acetaminophen (e.g. Tylenol) with or without codeine for the first 48 hours, since aspirin and ibuprofen (such as Advil or Motrin) can cause bleeding.

Sexual Difficulties – A vasectomy should not affect your sex drive, or your ability to have erections or ejaculate. If you experience sexual difficulties after a vasectomy, contact your doctor. They may be a sign of either emotional or physical issues, including heart disease.

Sperm Granulomas – These small, usually painless lumps occur when sperm leak out of the vas and cause an inflammatory reaction. The resulting cluster of immune cells does not pose a danger and usually resolves over time. Granulomas do cause pain in a small number of men, typically about two to three weeks after the vasectomy.


Adams CE, Wald M. Risks and complications of vasectomy. Urol Clin North Am. 2009; 36(3):331-6.

Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990; 143(5):936-9.

Kendrick JS, Gonzales B, Huber DH, Grubb GS, Rubin GL. Complications of vasectomies in the United States. J Fam Pract. 1987 Sep;25(3):245-8.

Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril. 2000 May;73(5):923-36.

Using the form below you can leave your number 24/7 and we’ll call with an appointment or you can ask a question and Dr. McHugh will answer it. 

Vasectomy patients say the darnedest things.

1306060431-frontSo, my husband had a vasectomy this morning. The procedure was a breeze, and he’s fine, aside from feeling a little embarrassed at some things he said. He had to take a Valium before the procedure, and his comments reminded me of the time he was drugged up and had his wisdom teeth out. I […]

via Funny Friday: Valium — That’s What Anxious Mom Said

Birth control after vasectomy?



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


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.


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?


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.


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).

Epididymitis after Vasectomy-How common?



Epididymitis and Vasectomy

Epididymitis is an inflammation or infection of the epididymis—a long coiled tube that is attached to the upper part of the testicle and is used to store sperm. It’s a rare complication that, if it occurs, usually hits during the first year following a vasectomy. Occasionally, however, it can manifest years after the procedure.

Common symptoms of epididymitis include:

  • swelling of the testicles
  • mild to severe pain in the scrotum
  • low-grade fever
  • pain when ejaculating
  • pain in the groin when lifting
  • pain during intercourse

Epididymitis Treatment

Consequently, since epididymitis can be caused by bacteria (and may or may not be a direct complication of vasectomy), treatment often starts with a course of antibiotics to get rid of the infection, combined with conservative therapies of reduced activity and pain management (including non-steroidal anti-inflammatories such as ibuprofen, scrotal support, and applying heat or cold).

If you still experiencing significant discomfort after a few months of conservative pain management, additional treatments for chronic pain may be necessary. These include the use of local steroids, tricyclic antidepressants, or transcutaneous electrical nerve stimulation analgesia.

For the few whose pain is not relieved by non-surgical approaches, surgery can offer relief.

Surgical options include:

Reducing the Risks of Epididymitis

These days, urologists have made some modifications to the vasectomy technique to decrease a man’s risk of developing post-vasectomy epididymitis.

Because one potential cause of inflammation is pressure from sperm building up in the epididymis, an open-ended vasectomy procedure—in which one end of the vas deferens is left uncauterized, thereby relieving pressure and decreasing the likelihood of sperm granulomas, or masses that develop in an immune reaction to sperm that have leaked from the cut vas.

Another technique is preemptive analgesia, in which the urologist floods the vas deferens with a local anesthetic before it is cut. Early evidence suggests that both these procedures can reduce the chances of epididymitis post-vasectomy, but further study is needed for conclusive results.

There is still much researchers and physicians don’t yet understand about epididymitis as a post-vasectomy complication, including what causes it and how to further prevent it. Controlled studies focusing on newer vasectomy techniques, the role of sperm granuloma in the condition and the role of the immune system post-vasectomy will help build a more comprehensive understanding of epididymitus and how best to treat it.

Updated on June 27, 2016