Don't fear the vasectomy

Politics, religion and vasectomies. These are some things people refuse to go “on the record” about.

Yes, many men will tell you they had a vasectomy, but they don’t necessarily want to talk details.

A vasectomy is the surgical procedure for male sterilization/permanent contraception. WebMD claims about 500,000 of them are performed each year in the United States, and is widely considered to be cheaper, faster, safer and far more reliable than female sterilization. Still, they claim only 9 percent of sexually active men in the U.S. get vasectomies, compared to more than 25 percent of women who get tubal ligations.

“It was a little sore for a couple of days. No big deal,” one acquaintance told me. “But this guy at work I know had a horrible time.”

“It’s easy - you get to sit back for a weekend on watch March Madness,” my chiropractor explained to me one time.

The March Madness connection is real. Michelle Froehlich, administrator for North Idaho Urology, said the NCAA Basketball Tournament provides ample opportunity for recovering men to stay off their feet and watch basketball for a weekend.

This year North Idaho Urology cross-promoted the procedure with Clean Cut - Haircuts for Men in Coeur d’Alene, a business Froehlich said has been recommending North Idaho Urology to customers for some time. Every March vasectomy “player” at North Idaho Urology earns a gift card for a free haircut at Clean Cut.

Still, guys still don’t like talking about the actual procedure.

“We have a lot of men who have had great experiences,” Froehlich said. “Some men find the subject a private matter.”

Dr. Edward Ellison has been practicing urology in Coeur d’Alene since 2000. He said men are almost always nervous when coming into the procedure, but that most are surprised by how easy it goes.

“Most patients breeze through it easily,” Ellison said, especially if they follow instructions to take it easy and rest the first two days.

“The patients who get active too quickly can have a longer recovery - with just more chance of swelling or bruising,” Ellison said.

Ultimately, the take-home message from Dr. Ellison has nothing to do with the procedure, which only takes about 20 minutes and is done on site at North Idaho Urology. It’s about the repercussions.

“This is a permanent technique - this is for when you know you’re done (having children). You want to know for sure,” Ellison said.

About the procedure

With every medical consent form, North Idaho Urology provides a brief anatomy lesson and explanation of the vasectomy process:

Sperm cells that originate in the testicles and collected in the epididymis are transported through the vas deferens (basically a shoestring-sized tube) and stored near the prostate gland. The prostate gland makes prostatic fluid, which forms about 95 percent of the fluid of ejaculation, with only five percent comprised of sperm cells.

In a vasectomy, the vas deferens is cut and tied/deactivated so that the sperm cells accumulate in the epididymis, die and then absorbed by the body. After a vasectomy, the mechanisms for sex (erection, ejaculation and sensation) are the same. Sex hormones made by the testicles also remain the same, therefore no decrease of sexual desire.

Dr. Ellison said there are two standard procedures for vasectomies, with doctors at North Idaho Urology performing them based on their personal preference and expertise. One method involves making two small incisions, the other involving a single poke of a needle to reach the tube, where the doctor will (essentially) cut and scar the inside of the tube.

The big thing to remember here is the patient doesn’t feel the procedure itself. A local anesthetic is injected well above the testical around the vas deferens - that causes an initial sting and burning sensation, but it numbs the remainder of the process. North Idaho Urology also offers patients an anxiety medication prior to the procedure, so long as the patient has a driver to take them home safely afterward.

The first night and following day present the most chance for pain, though many feel only some pain and discomfort. Dr. Ellison said the percentage of patients who experience more swelling, bruising and risk of infection is below five percent.

“We can’t really predict it ahead of time, it’s just based on how your body heals and how your body reacts to the procedure itself,” he said. “Basically we want people hanging around the house and avoiding their basic routines (for a couple of days).”

Patients should also avoid sex and rigorous exercise for the first week, he said.

For most, local tenderness continues for a week, then may be noticed occasionally for about a month.

As for cost, many insurance providers offer some coverage for vasectomies. Out-of-pocket costs without insurance are generally under $1,000.

Effectiveness and reversal

It takes about six weeks for a vasectomy to be considered effective - that’s how long it takes the sperm in the vas deferens to be gone from the location below the incision. Even while as few as 1 in 1,000 vasectomies fail to be effective, Dr. Ellison said men should use another form of birth control until the sperm count is tested around the six-week mark.

Again, permanent is the key word. Vasectomies can be reversible, Dr. Ellison said, but it isn’t a guaranteed thing and is definitely a more complex surgery.

“If done within the first eight years, the success rate can be as high as 85 percent, but the further out you go, the rate goes down - 50-60% chance,” Ellison said. “If you’re still thinking about maybe you might want to reverse it at some point down the road, then maybe you shouldn’t have the procedure.”

For more information on the subject and process, contact North Idaho Urology at (208) 667-0621 or visit www.NIUrology.com