A bilateral vasectomy is a procedure where the right and left vas deferens are cut. The procedure is 99% effective, and should be considered a permanent sterilization procedure. Since the amount of fluid that comes from the vas is about 5% or less of the total ejaculate volume, the amount of ejaculate fluid should not be appreciably different. The procedure should not affect your ability to achieve an erection or your desire to have intercourse.

By California law, a consultation is required before every vasectomy that predates the vasectomy by at least 72 hours. This involves meeting the surgeon who will do your procedure, a detailed history and physical exam, and a discussion regarding the technique and what to expect.



You will be asked to shave the scrotum the night before the procedure. If you are going to get intravenous anesthesia (this takes place in a surgery center), you should not eat after midnight. If you are not going to be sedated, you can eat something light prior to the procedure. The Emla cream should be applied one hour prior to coming to the office or center, and covered with cellophane. Two 500mg Keflex antibiotic pills should be taken one hour prior to the procedure as well, for a total of one gram. If you are going to have some form of sedation, you should have someone there to drive for you. You should also bring a scrotal supporter (jockstrap) with you.



In most patients, we are able to use the "No Needle" jet injector. The jet injector delivers a small volume of anesthesia, which is a fraction of what normally would be used. The sensation that the injector produces feels like the snapping of a rubber band against the skin. The Emla cream, if applied correctly, should take away the discomfort associated with the injector. You may feel some pressure during the procedure, but most people tolerate it very well.



When you are to have the procedure, the nurse will bring you into a room, and you will be given a gown to change into. The room is intentionally made warm so that the scrotum will relax. If it is too thick, won't relax, or too tense, the jet injector cannot be used. A sterile fluid called betadine is used as a preparation to prevent infection. You are then covered around the sac with drapes to keep the area sterile.



The instruments used for this procedure are precise, and have made the procedure the better for the both the patient and the surgeon. They allow the surgeon to open the sac without making an incision and, because they are small, allow this opening to be small as well. The vas is grasped using a special clamp shaped to grab only the vas deferens. The vas is then separated from the nerves and vessels intimately associated with it so that only the vas itself is left. I then use titanium clips to block the flow of fluid from the testicle on the one side, and I clip the other side as well. In order to ensure the success of the procedure, I cut the vas and remove a portion of it. I cauterize the ends so that the opening of the vas deferens is sealed. I then use a suture to turn the end still associated with the testicle back away from the other end.

While other surgeons may not perform these steps, it is important for me to ensure that the patients are sterile following the procedure. Once this is done, the sac is closed with a single suture, which will ultimately dissolve on its own. A sterile dressing is applied, and helps compress the area overnight.

You will be given instructions at the consultation regarding your pre- and post-procedure care. Ask for a specimen cup following the procedure to take home. We examine the 16th ejaculate that you make. If this is negative, we have you bring another specimen to confirm this. If not, we then look at the 20th ejaculate, and so on.



The risks of the vasectomy procedure are infection, pain, bleeding, failure, recanalization, testicular injury, and post-vasectomy pain syndrome. Infection, pain, and bleeding are potential complications of any procedure, and are minimized by the steps I take in meticulously performing this procedure. Failure means that the structure that was cut was not the vas. (I have not had this happen in any of my patients.) Recanalization means that even after performing the procedure, the two ends find each other. The published rates of recanalization are less than 1%. If there is sperm that persists in the ejaculate, the procedure is repeated. Testicular injury can occur if the artery to the testicle is injured. It may result in the loss of the testis. Fortunately, each of these complications is rare.

Post-vasectomy pain syndrome is the sensation of pain beyond the immediate post-op period. This is reported in the literature to occur about 10% of the time. It usually resolves on its own. There is a rare patient who will have pain for a long period of time following the procedure. Most people tolerate the vasectomy, and do well with it.