Risks & Complications

Side Effects and Possible Complications

Vasectomy provides the most effective, permanent means of surgical contraception.  When compared with other contraceptives, it has one of the lowest incidences of side effects, considering that pregnancy is a side effect of alternative contraceptive failure. No deaths have been attributed to vasectomy in the USA. Large-scale studies show that the overall incidence of complications is less than 5 per 100 vasectomies performed.

Minor side effects immediately following vasectomy may include discomfort, swelling and/or bruising of the scrotal skin, all of which usually disappear without treatment. Some men (about 1 in 20) will experience swelling and a low-grade ache in one or both testes anywhere from three days to six months after the procedure. This is probably due to an exaggerated form of the body's natural response to the obstruction caused by the vasectomy.  It usually responds nicely to an anti-inflammatory drug (such as ibuprofen) 400-600 mg 3 times per day and almost never lasts for more than a week or two but for rare patients, fewer than 1 in 100, swelling and discomfort will occur more than once and/or will be severe enough to require prescription pain medications, stronger anti-inflammatory drugs, and one or more days off from work. About 1 in 100 men will develop a grape-sized hematoma (blood clot) on one side after use of the spray applicator for anesthesia. That causes more noticeable and prolonged (7-10 days) discomfort on that side, but usually does not require prescription pain pills.

Early complications such as hemorrhage and infection can occasionally occur after any surgery. Based on large-scale studies, the overall incidence of either hematoma (a blood clot in the scrotum) or infection is less than 2% of the vasectomies performed. Infections are rare, and usually managed by oral antibiotics. In rare occasions patients may need treatment with IV antibiotics or have the infections drained.

Long term, vasectomy can lead to the following conditions:

1. A sperm granuloma is a pea sized sometimes-tender mass which results when the body reacts to and walls off sperm which may leak from the lower (testicular) end of the cut vas.  A sperm granuloma may actually enhance the likelihood of reversal success.

2. A few (perhaps 5%) of patients will experience periodic tenderness of the epididymis, the tube behind the testis in which sperm are resorbed by white blood cells after vasectomy. Since this resorption process is a form of inflammation, it nearly always responds to a short course (3-7 days) of an over-the-counter anti-inflammatory drug such as ibuprofen. Post-vasectomy pain syndrome is defined as testicular pain (on one or both sides) for greater than 3 months after having a vasectomy, severe enough to interfere with daily activities and causing a patient to seek medical attention. Because pain is so subjective, reported rates vary but compiled data would suggest that this is a significant problem for 1-2% of vasectomy patients. Vasectomy reversal, removal of the epididymis, or a special procedure called neurolysis (all major procedures) may be required to alleviate the discomfort. About 2 patients per year (about 1 in 1500) develop prolonged vasectomy site tenderness for which they eventually choose to undergo another minor office-based vasectomy procedure on one side to remove the tender spot.

3. Anti-sperm antibodies do appear in the blood of about half of the patients who undergo vasectomy and patients who develop antibodies may have a lower chance of causing a pregnancy even when a successful vasectomy reversal allows sperm to re-enter the ejaculate. These antibodies have no influence on health status otherwise.

4. An article reporting a modest association between vasectomy and prostate cancer was published in the Journal of Clinical Oncology (JCO) on September 20, 2014. Based on an updated meta-analysis of this and many other articles that have addressed this topic through the years, the American Urological Association reaffirmed on November 7, 2014 that vasectomy is not a risk factor for prostate cancer and it is not necessary for physicians to routinely discuss prostate cancer in their preoperative counseling of vasectomy patients. There have been many articles since then confirming the absence of an association.

Alternatives to Vasectomy

There are a number of alternatives to vasectomy:

  1. Barrier methods. You could wear a condom, your partner could use a diaphragm, or you could use both together.
  2. Spermicides. There are foams and creams that can be placed into the vagina before intercourse to kill sperm before they can fertilize your partner’s eggs. Spermicides can be used alone or in combination with barrier methods.
  3. Hormonal methods. Your partner may use birth control pills, shots, patches, or implants to prevent the release of eggs from the ovaries or the implantation of fertilized eggs into the uterus (womb). Emergency Contraception (EC, Plan B, or the “morning-after” pill) will prevent pregnancy if taken within 72 hours of intercourse during which no contraception was used, or during which a condom slipped off or broke.
  4. Intrauterine device (IUD). Your partner may have a small device placed into her uterus to decrease the likelihood of fertilization (sperm and egg coming together) and to prevent implantation of fertilized eggs into the uterus.

All of these alternatives are less effective than vasectomy, but they are reversible. You should be familiar with them before proceeding with vasectomy. Please ask us if you would like more information, and feel free to postpone your vasectomy if you need more time to evaluate information about alternatives.

There is no form of fertility control except abstinence that is free of potential complications. Vasectomy candidates must weigh the risks of vasectomy against the risks (for their partners) of alternative means of contraception as well as the risks associated with unplanned pregnancy and either induced abortion or childbirth.  Vasectomy provides a means of permanent birth control with a minimum likelihood of complications and maximum chances of effectiveness and safety. 


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