Is Vasectomy Right for You?

Since the Supreme Court ended the constitutional right to abortion in the Dobbs v. Jackson Women’s Health Organization decision, interest has increased dramatically for vasectomies, a surgical type of male birth control that prevents sperm from merging with semen. Sarah Vij, MD, a urologist with the Cleveland Clinic in Avon, Ohio, reports that inquiries for vasectomies more than doubled at the Clinic’s Center for Male Fertility in July 2022 compared with July 2021.

Puneet Masson, MD, the director of male reproductive medicine and surgery at University of Pennsylvania Medicine in Philadelphia, has seen a similar trend. “Normally I would do about 7 to 10 vasectomy consults on a typical urology telemedicine day. Now I’m doing more than 20. … Several patients, ranging from married couples with children to single childless men, have openly disclosed that the Dobbs decision encouraged them to be more proactive about their reproductive health,” he says.

The spotlight on male contraceptives has become so bright in post-Roe America that you can now find T-shirts with slogans like “Vasectomies Prevent Abortions,” and those undergoing the procedure can buy special vasectomy underwear with a pouch for a cold pack.

But there is a lot of misinformation circulating about the procedure: Some men fear it will worsen sexual performance and prevent ejaculation, or that a reversal later on down the line will be easy.

If you are considering a vasectomy, the top experts below have some answers about the reality of the procedure.

1. When Is a Vasectomy the Right Choice?

Performed about 500,000 times per year in the United States, according to the American Urological Association, vasectomies should be considered permanent birth control, and you should only go for one when you (and your partner) are sure you are done growing your family. “This is really a personal decision, and one you shouldn’t just jump into. Some people say it’s not a good time to do it if you have a newborn because you’re sleep-deprived and you may later regret it. Others say, if you’re a younger childless male, you really shouldn’t do it, even if you feel pretty confident you don’t want kids. But I believe that any adult male who has the ability to make his own healthcare decisions can make a decision about contraception,” says Dr. Vij

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2. Doesn’t It Make More Sense for My Partner to Deal With Birth Control? She Is the One Who Might Get Pregnant

People often see contraception as the woman’s problem, but for a woman, effective birth control often entails birth control pills or an intrauterine device (IUD). “We always say that a vasectomy is an act of love. It's wonderful to see so many men taking responsibility for the reproductive health of themselves and their families, and not asking their partner to bear the total burden,” says Dr. Masson.

3. Is a Vasectomy 100 Percent Effective?

Keep in mind when family planning that no birth control is totally fail-proof. “The failure rate, depending on the study you look at, is about 1 to 2 in 1,000. That's over 99 percent effective, which is pretty comparable or exceeds pretty much all forms of birth control that we have,” says Vij.

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4. Am I Sterile Immediately Following the Procedure?

No, a man has to ejaculate after the procedure before all the sperm clear, and the rate at which different patients clear varies tremendously. “Some guys might clear all the sperm in three ejaculations, and some might still be fertile after 30 or 40 ejaculations,” Vij explains. “I generally have patients get a semen test at three months, because the great majority of men will have cleared by then. A man should not consider himself sterile — and needs to continue using birth control — until he's had confirmation from his doctor that he’s had clearance.”

5. I Get So Squeamish Just Hearing About the Old Snip-Snip, I Can’t Even Think About It. Does a Vasectomy Hurt?

This is a minimally invasive procedure, done on a same-day outpatient basis, and takes about 20 minutes. Vasectomies entail cutting tubes called the vas deferens, located inside the scrotum. This prevents sperm from being released into the semen. There are two types of procedure — one that uses an incision and one that doesn’t. You will receive local anesthesia and light tranquilizers.

You will be sore in the area for a few days after that; discomfort can be managed with complete rest, nonsteroidal anti-inflammatory drugs (NSAIDS), and an ice pack. Fun fact: Surgeons have started referring to the NCAA March Madness basketball tournament as Vas Madness, because so many men elect to have their vasectomies right before the championship so they can relax on the couch with their ice pack and watch a lot of TV.

6. What Are the Risks of Vasectomy?

The complication rate is a less than 1 percent risk of bleeding, infection, inflammation, or ongoing pain, says Masson. “However, a small percentage of patients may have ongoing pain beyond just the recovery process. Should this happen, it’s important to regroup with your physician who performed the procedure.” He adds there is a 1 in 2,000 chance of recanalization, whereby the tubes reconnect, making the man fertile once again.

7. Will a Vasectomy Affect My Sexual Performance? Will Sex Feel Different?

“It doesn’t impact sexual functioning at all,” Masson says. “Erections are going to be completely unaffected, and you will still have orgasms and ejaculations. The reason behind that is that only a small percentage of the ejaculate comes from the testicles. Most of it comes from the prostate and seminal vesicles,” he explains. “Thus, everything will still look and feel the same; just microscopically, there will be no sperm in the semen.”

8. If I Change My Mind Later, Can a Vasectomy Be Reversed?

Yes, it can, but it’s a much more complicated procedure, necessitating a surgeon who is experienced with microsurgery. This is generally not covered by insurance, making it prohibitively expensive for many. Also, while success rates are high, they are not 100 percent. The good news for older men is that a study published in the November 2020 issue of Urology found that men older than 50 had the same reversal success rate as younger men.

9. Is There Any Other Way to Father a Child After Vasectomy?

Men who are interested in paternity after a vasectomy can choose to undergo surgical sperm extraction. The pros: It's a lot faster than a reversal (about 20 minutes), and can be done as an outpatient procedure. The cons: “These sperms can only be used in context with in vitro fertilization. It's never going to be able to swim to or penetrate the egg. Then the partner must undergo the IVF process,” explains Masson. You can also bank sperm before the procedure.