No-Scalpel Easy Vasectomy® FAQs

No scalpel Easy vasectomy® is a minimal invasive procedure done in a doctor’s office in less than 10 minutes, using only local anesthesia. The procedure is incredibly simple, safe and pain free- it involves making a small incision in the scrotum, where the vas deferens are severed and prevented from joining back together. Discomfort afterwards is minimal and patients can quickly return to their everyday lives. There is no stitch in no-scalpel vasectomy. The patient who gets a no scalpel vasectomy typically feel no change in libido, as vasectomies cause no physical change in sensation, testosterone levels, blood flow to the penis, amount of semen, or satisfaction of an orgasm. The only difference is that the semen has no sperm in it.

No scalpel Easy vasectomy® is the preferred type of vasectomy since it’s considered simpler and less painful for patients compared to the traditional method. There’s also less risk of complications and scarring.

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No-scalpel vasectomy instruments, used in China since the mid-70’s and introduced into the United States in 1989, are simply a very pointy hemostat, used initially to make a tiny opening into anesthetized skin of the scrotal wall, and a ring clamp, used initially to secure each vas tube in turn beneath this opening. The pointy hemostat is then used to spread all layers (the vas sheath) down to the vas tube itself and to then deliver a small loop of the vas through the opening as the ring clamp is released. In turn, the ring clamp is used to hold the vas, while the pointy hemostat spreads adherent tissue and blood vessels away from the vas under direct vision, so that the vas can then be divided with a fine surgical scissors and the upper end cauterized with a hand-held cautery unit so that it will seal closed.

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A local anesthetic is usually injected into the skin and alongside each vas tube with a very fine needle, as small as diabetics use to inject themselves with insulin. One could feel a tiny poke in the skin, then a bit of a squeeze as the anesthetic was applied to each vas tube. Dr. Shu is a well-known “Painless Doctor” for his excellent surgical skills in the office procedures. Most patients tolerate it very well. However, some people do not like needles of any size or have needle phobia.

A MadaJet® is a spray applicator which delivers a fine stream of liquid anesthetic at a pressure great enough to penetrate the skin to a depth of about 3/16″, deep enough to envelop the vas tube held snugly beneath the skin. Each vas is positioned in turn beneath the very middle of the front scrotal wall and given two or three squirts. That numbs the skin and both vas tubes adequately for 99% of men. The other 1% (usually men who have thick skin or scarring due to prior surgical procedures in the area) will require a bit more anesthetic delivered with a fine needle, usually with no pain at all because of the partial anesthesia achieved with the MadaJet.

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Certainly not. The vas tubes are most easily and safely divided under direct vision with a fine surgical scissors. But the expression “LASER” has great popular appeal, and use of laser energy in the performance of a simple vasectomy serves no purpose but to play up to this popular appeal. Lasers have proven indispensable for certain types of retinal (eye) and skin procedures, and they offer an alternative, though not necessarily better, means for destroying tissue (prostate and certain tumors) and kidney stones. But a laser (like any other form of light) cannot pass through opaque tissue without burning a hole in it, so a laser cannot be magically directed at internal organs such as the vas tubes without an access opening in the same way that sound waves can be used to destroy kidney stones without an incision. So lasers play no role in a procedure as simple as vasectomy and introduce an unnecessary element of risk. A recent search revealed no articles in the medical literature advocating use of a laser with vasectomy.

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After the vas is divided, the lower end is allowed to slide back down into the sheath, while the upper end is held outside the sheath. A tiny hemoclip (the size of a grain of rice) is then used to close the empty portion of the sheath between the 2 ends. It would be like making a lengthwise opening in a wire’s insulation, reaching in and dividing the wire, lifting one cut end out through the insulation, then putting a clip on the empty portion of the insulation, thereby holding one end outside and one end inside, the insulation itself serving as a barrier between the two ends. Most hemoclips are made of titanium, a non-ferromagnetic metal used for many types of implanted medical devices such as dental implants, heart valves, and joint replacement.

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Of the millions of vasectomized patients, there have not been any clip-related problems, and no reports of problems in the medical literature that we are aware of. Surgeons have used hemoclips for many years to occlude bleeding blood vessels during many operations in the abdomen and chest, sometimes over 50 clips in a single procedure. Hemoclips have been used by vasectomists for decades. In fact, during vasectomy reversal procedures, as many as 4-5 clips can be discovered on each side, clips of which the patient was unaware and which could not be felt by the surgeon before the reversal. Most hemoclips are made of medically inert titanium, the same metal used for dental implants, many artificial joints, and mechanical heart valves. Not ferromagnetic, titanium will not interfere with MRI studies and the small amounts used in hemoclips and dental implants do not set off metal detector alarms. Some men ask, “Why not just use suture?” Dr. Shu replies, “Yes, I could use a suture instead of a titanium clip, and that would be just as easy if I had 3 hands. It is much easier, more efficient and effective to use clips to close the fragile tissue around the vas”.

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The vasectomy guru Dr. Stein in Tampa, FL did a study on this issue. During 104 consecutive follow-up calls on the day after vasectomy, men were asked (1) if they had taken any non-prescription pain pills (Tylenol or ibuprofen), (2) how many times they had taken pain medication, and (3) whether they had taken the medication because they were uncomfortable or just as a precaution to prevent expected discomfort. (Note: All men had received a small packet of 2 Tylenol pills in their “goody bags” following their vasectomies.) Here are the results:

45% of men took no pain medication following their vasectomies, not even the Tylenol that was provided. They had so little discomfort that they saw no need to take anything.
15% of men took pain medication (the Tylenol that was provided or home supplies of ibuprofen) one time “just in case”, that is, as a precaution to prevent expected discomfort, not because they needed it.

29% of men took pain medication one time for discomfort, then did not need any additional doses.

11% of men took pain medication more than one time (two or three times), though at least 4 of these 11 men said that they had taken it more to prevent expected pain than because they were actually having discomfort.

0% of men felt that they needed something stronger than Tylenol or ibuprofen.

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The expression “open-end” or “open-ended” refers to a vasectomy technique in which the lower (testicular) end of the vas is not occluded with a stitch, hemoclip, or electrocautery. The internet contains many web pages that laude the benefits of the open-end technique. The theory is that if the lower end is occluded, in effect “slamming the door” on the normal egress of sperm from below, there may be a sudden increase in pressure within the epididymis and the portion of the vas tube below (“upstream”) from the vasectomy site, potentially causing an increase in the level of inflammation normally required for the resorption of sperm. This exaggerated inflammatory response, so the theory goes, increases the likelihood of post-vasectomy discomfort and decreases the likelihood of reversal success, should the individual ever opt for vasectomy reversal in the future. After an open-ended vasectomy, a sperm granuloma may form at the vasectomy site with a transfer of the inflammatory sperm-resorption process to the vasectomy site, thereby sparing the upstream tubules (epididymis and vas) from this inflammation, decreasing the likelihood that they will become scarred and secondarily occluded, and enhancing the chances of reversal success.

Dr. Shu performs open-ended vasectomies, and while there is some merit to this technique, the web pages lauding it are probably overstating the benefits.
First, not all open-ended vasectomies result in a sperm granuloma at the vasectomy site. A natural seal of the lower vas end must occur soon after an open-end vasectomy in many patients.
Second, some open-end vasectomy patients (about one in 50) will still develop post-vasectomy discomfort and tenderness of the epididymis. The likelihood of this occurring is lower with the open-end technique: 2% of patients as opposed to 6% of patients with the closed-end technique (Contraception 46(6):521-521, 1992). This “congestive epididymitis” usually responds quickly to an anti-inflammatory drug like ibuprofen, but serves as proof that an open-end technique is not a sure way to avoid post-vasectomy epididymal inflammation.
Third, a vasectomy site granuloma can be just as tender as epididymal inflammation, though it too usually responds quickly to anti-inflammatory drugs.
Fourth, while reversal success rates may be better after open-end vasectomies, performance of this technique is no guarantee of reversal success and many men with closed-end vasectomies have undergone successful reversals.

In summary, while an open-end technique offers theoretical benefits, use of it is not a “standard of care” and the closed-end technique has worked well for years.

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I adopted the summary on this issue from Dr. Stein, Tampa, FL. The February 17, 1993 issue of the Journal Of The American Medical Association contained 2 studies (by the same research group) that suggest that vasectomy was associated with a small increased risk of prostate cancer in their study groups (almost 30,000 patients in 1 study and almost 40,000 patients in the other study). Because the question was initially raised by 2 studies back in 1990, the World Health Organization convened a 1991 meeting of 23 international experts to review all research regarding vasectomy and prostate cancer. They concluded that there was no plausible biologic mechanism for a relationship between vasectomy and prostate cancer. Some medical researchers interpreted the small increased risk noted in the 1993 studies as a weak association that may be due to chance or bias. A systematic review of the medical literature in 1998 (Fertility & Sterility, 70: 191) further documented the lack of a significant relationship between vasectomy and prostate cancer. Additional convincing evidence of no relationship has been published in the Journal of Urology in June 1999 (161: 1848-1853), in the Journal of the American Medical Association in June 2002 (287:3110-3115), in the Journal of Urology in October 2002 (168: 1408-1411), and in Fertility and Sterility in November 2005 (84:1438-1443). Because the question of a relationship has been raised, however, the American Urologic Association recommends that men who have had vasectomy and are over 40 have an annual rectal exam and prostate cancer screening blood test (PSA). This is the same recommendation made by the AUA for all men of age 50-70.

The question of an association between vasectomy and subsequent cardiovascular disease was raised back in 1978 and 1980 by two studies which reported an increase in atherosclerosis (hardening of the arteries) in vasectomized laboratory monkeys. The last article listed above (Cancer and cardiovascular disease after vasectomy: an epidemiological database study. Fertility and Sterility 84:1438-1443, November 2005) provides an excellent bibliography of studies showing no association in humans as well as its authors’ own data comparing 24,773 vasectomized men with 159,480 non-vasectomized men as a control group. Their findings “strengthen the evidence that vasectomy is not followed by an increased risk of myocardial infarction [heart attack], coronary heart disease as a whole, or stroke. In particular, we add strong support to the evidence that there is no elevation of risk of cardiovascular disease in men after long periods after vasectomy.”

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Dr. Shu performs the vasectomy on the candidate who “is at least 21 years old and appears mentally competent”.

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Vasectomy is one of the most common methods of male contraception in Minnesota, and is popular due to its efficacy and permanence. The first mention of an association between vasectomy and prostate cancer were in the late 1980s, where a study showed a positive link between vasectomy and risk in developing prostate cancer. Further studies throughout the years since then have been contradictory or inconclusive as to whether or not vasectomies actually increase the risk of prostate cancer.

For the most part, prostate cancer is nothing to fear for men considering a vasectomy. A recent 2015 meta-analysis of 9 different cohort studies was statistically analyzed in order to determine if a possible correlation between vasectomies and prostate cancer. The study concluded that there was no evidence that vasectomy increased the risk of prostate cancer. While there was slight positive correlation, it was deemed not statistically significant. Furthermore, correlation does not equate causation- there is no reason why vasectomy would actually cause prostate cancer. There is no proven biological mechanism that relates these two together.

There are many reasons why early studies may have shown a correlation between the two; for an example, men who have had a vasectomy were more likely to have tests for prostate cancer under a urologist. Also, prostate cancer diagnoses in general have risen in recent decades in part due to an aging population and better testing methods. Most authorities, like the National Cancer institute and the American Urological Association, agree that vasectomy does not increase the risk of developing prostate cancer.

Regardless, the decision to get a vasectomy is not one to be made lightly. It is an important family planning decision and permanent as well- vasectomy reversals are becoming more and more easily attainable but they are still expensive compared to a vasectomy and are not guaranteed to work, especially if the vasectomy was done a long time ago. Please take the time to decide whether a vasectomy something that you really want.

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So you’ve finally made the decision to go for that vasectomy procedure—congrats! Knowing what’s best for your body and future is the first step, and now it’s time to make sure you’re well-versed in preparing for the surgery. The outcome and success of your vasectomy can depend on how well you prepare yourself pre-surgery, so we’ve compiled a list of essential pre-operation dos and don’ts.
 

DO

Do let your doctor know if you’ve undergone previous scrotal surgery.

Do inform your doctor about any other medications you may be taking.

Do eat a normal breakfast/lunch on the day of your procedure to avoid becoming lightheaded later on.

Do shave the front wall of scrotum and underside of the penis, then take a good shower before you leave home for vasectomy. You will be asked to refrain from doing so again until 2 days after your procedure.

Do arrange for a friend or family member to help drive you home after the surgery. You are able to drive home by yourself after the surgery although a flat tire or fender bender could lead to complications.
 

DON’T

Don’t take any aspirin, anticoagulants, or non-steroidal anti-inflammatory drugs such as Ibuprofen, Motrin, Aleve or Advil starting two weeks before your procedure. These medications can thin your blood and cause bleeding afterward.

Don’t drink alcohol starting 2-3 days before your surgery.

Don’t shave the scrotum the day before your surgery, as any nicks and cuts will not be fully healed by the next day and may harbor bacteria, which may increase the chance of infection.

Don’t apply any lotions, colognes or deodorants prior to surgery.

Don’t wear any jewelry or piercings to the surgery.

Don’t bring a jockstrap or athletic supporter to wear post-surgery. Our office will provide you one.

Don’t forget to sign a consent form before surgery. This is to protect both you and your doctor to ensure that you’re aware of what the operation entails and its potential risks.
 
For more on how to prepare for your vasectomy, check out our earlier post on how to prepare for an Easy Vasectomy®.

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Great news—so you underwent a vasectomy, and everything went smoothly. Now, it’s time to talk recovery process, downtime, and the timeline for easing back into your usual activities. For many patients, a regular routine involves some form of fitness and exercise, be it lifting weights at the gym, running, a pick-up basketball game, or biking.

But returning to your regularly scheduled programming takes anywhere from a few days to a few weeks, and rushing into strenuous activities too soon can cause extreme pain/discomfort in the surgical area. The key is to regain your fitness routine while being extremely mindful of anything that may cause infection in or reopen the surgical wound. Below is an overall guideline for regaining fitness levels after undergoing a vasectomy:

Immediately After Surgery

As soon as you complete a vasectomy procedure, you should not engage in any form of physical activity for 48 hours. This includes any form of exercise, sports, sexual activity, prolonged periods of standing, or even walking. Try to stay off your feet as much as possible, and follow care instructions provided by your doctor. Just turn on Netflix, ice the surgical area if you prefer, and rest. That’s it.

First Week After Surgery

In the 3-7 days following surgery, you can gradually increase your amount of physical activity ONLY if necessary. Rigorous exercise and sports should still be avoided, and do not lift objects (and babies!) heavier than 20 pounds.

If you feel fine after approximately four days and aren’t experiencing any discomfort/pain, walking or light exercises are allowed. Avoid anything more intense like weight-lifting, running, or biking, as this can cause significant build-up in pressure in the treated area. Furthermore, biking puts pressure on the penis and could hinder the healing process.

Two Weeks After Surgery

After two weeks of downtime, most men are able to resume their usual workouts (except extreme heavy lifting…more on that below). Non-contact sports such as golfing, bowling, tennis, and biking are allowed, but again, be extra aware of any pain or swelling. Stop activities immediately if aching occurs.

3+ Weeks After Surgery

While three or more weeks sounds like an excruciatingly long period of downtime, it’s best to err on the side of caution. Contact sports such as football, boxing, wrestling, hockey, basketball, martial arts, etc should not be resumed for at least three weeks after surgery.

**ATTENTION, WEIGHT LIFTERS: Wait at least four weeks before attempting heavy weights in low-repetition sets. Stick to lighter weights for now, as intense spurts of heavy lifting can significantly build up pressure in the surgical area and lead to massive internal bleeding in the scrotum. Not fun.

Ultimately, follow your doctor’s guidance on what is appropriate for your post-surgery timeline. Keep a close eye on signs of pain, swelling, and discomfort and judge your fitness abilities accordingly. In the event of any unpleasant side effects due to exercise, contact your physician immediately.

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The procedure itself takes only 10 minutes in the doctor’s office, but the entire process including paperwork may take up to 15-20 minutes. The vasectomy may cause mild tenderness, discomfort, and swelling the first few days after the procedure, but patients typically return to office work in two to three days and normal activities in a week.

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It is nearly 100% effective. The risk of pregnancy after vasectomy is less than 1 in 2,000 for men who have sperm free semen or the test showing rare non-motile sperm, a rate of failure much lower than with any other form of contraception.

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No, it may take up to 3 months before your semen is totally free of sperm. Therefore, couples are advised to use another form of contraceptive until the doctor can confirm that the man’s semen no longer contains sperm. You will be expected to collect your specimen after 3 months (at least ejaculate 20 times before collecting).

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Please review Vasectomy Cost page.

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Sperm continue to be produced in the testicles after the procedure. The sperm continue to be stored in the epididymis and are eventually dissolved and absorbed by the body. With the increase of stagnant sperm, the membranes of the epididymis increase in size to absorb more liquid. The immune system increases the amount of macrophages to handle an increase of solid waste.

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No. Erections, climaxes, and ejaculations should continue after vasectomy. Normal hormones are still produced. Some men may experience difficulty with erections or ejaculations, but this is usually a psychological problem rather than a surgical complication.

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Although a vasectomy is one of the safest procedures, there are still chances of minor complications, such as infection, bleeding or transient bruising, temporary swelling or fluid accumulation. A few patients experience a dull ache in the scrotal region, but this usually resolves with time. There is no evidence that suggests any increased risk of prostate cancer if a vasectomy is done.

The potential risks and complications:

• Hematoma (collection of blood) in the scrotum that should be reported immediately.
• Infection occurs more common if there is a hematoma, can be treated with antibiotics, hematoma evacuation, I&D drainage.
• Occasional chronic dull ache (congestion) in the testicles, usually disappears within six months.
• Epididymitis, when the larger tube behind the testicle becomes inflamed and swollen, can be treated with heat application and medication.
• Failure if the man has sex before all the sperm is confirmed to be gone.
• Sexual difficulties for the man due to psychological and emotional responses to a vasectomy.
• Sperm granulomas, a rare sperm collection from the testicular cut end of the vas, producing harmless lump.

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You can choose to reconnect the cut ends of the vas through vasectomy reversal procedure, the procedure is quite expensive, and it doesn’t guarantee restored fertility.

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