Will I have a local or general anaesthetic?

In Ireland, over 96% of vasectomies are performed using local anaesthetic, with minimal pain or discomfort. A local anaesthetic is much safer than a general anaesthetic and the man can leave for home immediately afterwards.

Can I have a No scalpel Vasectomy?

Absolutely. Both Morehampton Clinic and Churchfields Clinic now offer ‘No Scalpel Vasectomy’ as our standard procedure. This is a new development where instead of making a small incision in the scrotal skin and then grasping the vas, here the vas is held through the skin with a specialised instrument and the skin pierced with a pointed haemostat. There may be fewer risks of complications with this method. The rest of the open ended vasectomy operation is the same no matter which method – no scalpel or traditional – is used, and either way there are no skin sutures. We are not dogmatic. Some men are definitely more suited to traditional vasectomy, some to no scalpel. We decide on the day, and you are always offered either option.

Open ended Vasectomy? What is it, and why?

Traditionally, during a vasectomy, a section of each vas was removed, and there were now two open ends; one being the tube end coming up from the testicle, the other being the one going to the outside. A traditional vasectomist would block both ends.

Blocking the testicular end has been known for decades to create a ‘back pressure’ down the tube to the epididymis and to the testicle, and was presumed to be a common cause of post vasectomy discomfort. However, this double blocking was felt to be necessary for contraceptive reliability.

In the early 1980s, some Australian vasectomists questioned the need for this. In theory, leaving the testicular end open, and not blocking it, should remove the ‘back pressure’ problem. They devised a technique that left the testicular end open, and quickly found that far fewer men complained of this discomfort. The big worry was – would this technique be contraceptively safe? It took a few years before this could be answered, but thankfully the ‘open ended’ technique has exactly the same success rate as blocking both ends, and with less complications.

The Australians initially used a suture around the tissue enclosing the open end to keep it separated from the upper end, which is always closed, but in the early 1990s changed to using a tiny titanium clip instead of a suture. This has now become the ‘gold standard’. The clip does not block the tube, instead it keeps the two vas ends in different tissue planes – a type of belt and braces approach. The clip is miniscule and cannot be felt. Titanium is non ferrous, so it is not detected by metal detectors in airports, and it is safe to have an MRI scan with it in place.

Why will I have an injection, instead of the ‘no needle’ method?

We feel that the ‘no needle’ technique has no advantage and some problems. Yes, we use a needle, but it is a tiny 28 gauge needle. It is more like a pinch than anything else. ‘No needle’ uses a pressurized spray gun to blast the same local anaesthetic through the skin. There is a similar amount of discomfort either way, but blasting the pressurized jet of local anaesthetic through the skin has none of the accuracy of the needle technique, and for this very important reason very few experienced vasectomists use the spray gun.

One incision or two?

It depends. Most of the time -in 98% of men – it is done through one tiny ‘keyhole’.  With most men it is easy to bring each vas to the mid-line and do the operation with one keyhole – but occasionally it is difficult. Everyone is different, and we only know when we have examined you. If there are two incisions instead of one, each is tiny, and we do not use a skin stitch. Most of the surgery is under the skin, whatever method is used.

If you block the tubes, how can a vasectomy fail?

Vasectomy failures are classified in two ways – an early failure picked up on sperm testing and a late failure after ‘all clear’ sperm tests.

Early failures are proven to be dependent upon the skill and experience of the operator, with more experienced vasectomists having fewer failures.

Late failure, that is a failure after clear sperm count, should not happen in theory but unfortunately does. International studies have shown that the rate is the same irrespective of the operators’ skill or the technique used. The cause is unknown. Vasectomy is ten times more reliable than the next most reliable contraceptive method, which is female sterilisation, and statistically 3000 times more reliable than condom use.

Can a vasectomy be reversed?

Most vasectomies can be reversed but the success rate for functioning reversals is deemed to be about 50% of those reconnected. The longer the interval between the vasectomy and the reversal, the less chance there is of success. It also depends upon the experience of the operator. Reversal is a far more complex operation than vasectomy, and often requires a general anaesthetic.

Can vasectomy cause cancer?

There is no link between vasectomy and any form of cancer. A recent American study suggested a link with Prostate cancer, but this has been questioned and is now not believed.

Will it affect our sex life?

No, and with less pregnancy concerns or problems associated with other contraceptive methods, will often improve it.