Invented in 1974 by a Chinese physician, the no scalpel vasectomy is becoming the
most popular method of birth control in the United States.
If you read nothing else, please read #8.

1. A brief overview:
Please wear a T-shirt to the procedure. I’ll use an elastic band to hold your penis to your shirt, and then cleanse the entire area with Betadine.  A sterile drape is then placed over the site. The right vas is located and moved to the center of the scrotum. The skin is numbed with a small injection. Each vas is then numbed. These injections take about 10 seconds each, and within one minute, you should be pain-free. The right vas is then held still with a clamp (the instrument pointing to the right in the above picture) and is exposed with the vas dissecting forceps (the instrument pointing to the left above). This forceps is then used to remove the vas from it’s sheath, and the vas is blocked with a short scar inside the upper piece. The upper and lower sections of the vas are then separated with a scissors and the upper vas is sutured inside the sheath with dissolving suture. The lower vas is sutured outside the sheath. The left side is then done identically. Note that this is called an open-ended vasectomy. No stitches are necessary to close the skin opening. Operating time, start to finish, is usually 10-15 minutes. You should be out the door within a half-hour of entering it.

2. What's to fear?
Skin bruising is common, and is harmless. About 2% of patients have more pain than they like, but with antibiotics and pain medications, this almost always resolves soon. It is more likely to occur if there's bleeding into the scrotum from a broken blood vessel due to over-activity; the less you move for two days after the procedure, the more you reduce that risk. If bleeding occurs, one half of the scrotum would feel thick. With or without bleeding, the early part of the vas deferens near the testicle could get infected. Sometimes the leaking sperm from the lower vas causes a small bump of tissue in the scrotum. This is called a sperm granuloma, and if it occurs, it is usually painless.

3. Why an open-ended No-Scalpel Vasectomy?
A scalpel vasectomy takes twice the time and bleeds more, as it uses two incisions. Traditional vasectomy closes both ends of the vas, but this is unnecessary. After much research, I have decided to offer only the open-ended approach. This reduces back pressure on the testicles to near zero.

4. What about my sex life?
Your sex drive should not be bothered by a vasectomy. There is no connection between sperm in the semen and sex drive. You will still have orgasms, and you will still have semen come out when you do. It just won't contain sperm.

5. How effective is it?
It is over 99% effective at preventing pregnancy. That makes it more effective than any other method except abstinence.

6. Can it be reversed later?
It can be done, but there is only about a 60% chance (at best) of restoring fertility. Reversal is very expensive and insurance will not cover it.  Don't have a vasectomy if you aren't sure about it. 

7. What other options are there for birth control?
Tubal ligation (laparoscopic or hysteroscopic) is a much more invasive surgery.  It may also increase PMS, and has a higher failure rate. Birth control pills have nearly the same effectiveness as vasectomy, but are far more expensive, and are hormonal. Condoms and foam together are as effective as a vasectomy, but are inconvenient and costly. Either one alone is far less effective. The IUD (intrauterine device) is less effective and increases the risk of pelvic infections. A diaphragm is less effective and brings an increased risk of urinary tract infection. Withdrawal before climax is very ineffective and those who try this are usually called "parents." For all these reasons, it is my feeling that men who have vasectomies are picking the easiest and least expensive permanent birth control option.

8. How do I prepare?

Avoid aspirin, Motrin, Advil, Aleve or any similar pills for one week before the procedure. It's smart to save alcohol consumption for afterwards, too. All of these increase bleeding. Use of Tylenol or generic acetaminophen is safe.  On the day of the vasectomy, use antibacterial soap and water to wash your penis and scrotum. Trim the hair in a two by two-inch path down the front of the scrotum starting at the base of the penis.

Bring a fresh pair of tight fitting jockey-type underwear or jock strap to the procedure. This will help to keep your scrotum still. No boxer shorts, please. If you are a very nervous person, call us for an anti-anxiety prescription if desired. Feel free to bring an MP3 player to occupy your mind. That's it.

9. What about afterwards?
You will receive these instructions as you leave the office that day:
 
Sit still and do next to nothing for two days. No fishing, horseshoes, skiing, skating, golfing, or anything more strenuous than watching TV. You should move only from the bed to the couch to the table and to the bathroom.  Sex may be resumed in one week or when it is comfortable. You may shower at any time.  Hold off on hot tubs until your skin is fully healed. By Monday you should be walking nearly normally and telling your friends how much easier this was than you had feared.
 
Place ice packs on your scrotum to reduce bleeding, swelling, and pain, for 20 minutes every one to four hours, depending on pain intensity. "Gel Packs" intended to be kept in your freezer in the event of a sprain or zip lock bags filled with ice work well.

Take Motrin to reduce pain and swelling unless you are allergic or cannot tolerate it. Take it three times a day with food for seven days. Take Tylenol #3 if needed for severe pain, one to two every four hours.  This is rarely necessary. 

Wear snug fitting jockey shorts (not boxers) for 3-4 days, 24 hours a day. These will also hold the 3" x 3" gauze squares against your skin like a bandage, in case there should be any slight leakage of blood. Replace these as needed until all staining of the squares stops (usually 2-3 days).  No sutures are used on the outside so there are none to remove later.

Remember: you are not sterile until you have proven you are “shooting blanks.” Having had a vasectomy, in itself, is no proof that you are sterile without confirmation. Finish the job you started! The lab costs are pre-paid in your surgical fee. So, after at least 20 ejaculations, bring a semen sample to the Borgess at Woodbridge laboratory at 7901 Angling Road. You need to refrain from sex for 2-3 days to build up a larger sample, and then urinate before providing the sample. Ejaculate directly into the specimen container. Do not refrigerate or freeze the specimen, it must be fresh   within 1-2 hours. Remember to print your name, address, and phone number on the semen sample container. Please call our office 2 hours after you have handed in your specimen, to request results. We will then call and obtain them for you. If you have a few sperm still seen and therefore have to repeat the specimen (after 10 more ejaculations), use the second container and ask for a third container when you bring in the second sample.

Please repeat a post-vas semen check between 6 months and one year to ensure that the vas ends are not managing to grow back together.

I look forward to providing your no-scalpel vasectomy. If you have any concerns or questions about this, please call me.

Kurt P. Helgerson, MD
Office (269) 629-7137

If you do not find the answers to your questions above, please send me an e-mail and I will do my best to respond to you promptly.