Does it work instantly?

The operation is not immediately effective. Sperms present in the body at the time of the operation have to work out by sexual relations after the operation. This takes three to four months. During this time precautions against pregnancy must continue. To make sure the operation has been successful two specimens of semen are analysed under a microscope three and four months after the operation. If they both show complete absence of all sperms, the operation can be considered a success and all contraceptive precautions stopped. Sometimes more than two specimens of semen must be analysed before success of the operation can he confirmed. The operation can fail even after this stage, but very rarely.

What type of anaesthetic is used? What to expect during the operation?

The operation takes 15–20 minutes and is usually carried out under local anaesthetic.

If you are very sensitive in the genital area or if there are any associated conditions like Varicocele, general anaesthetic may be advisable. Any sensitivity or allergy to local anaesthetic agents must be made known to the surgeon. The operation is virtually painless apart from the two injections of local anaesthetic into the upper part of the scrotum. You may feel slight pulling sensation while the tube is being handled.

Do I need to have sutures removed?

We usually carry out a no-scalpel vasectomy, through small punctures, which seal off almost instantly. Sometimes you may need 1 or 2 stitches in the skin which will dissolve and fall out in a few days. The small wounds may discharge small amount of dirty looking fluid for a few days. The fluid will gradually dry up. A bath should be taken every day after the operation; the area carefully dried and the support put back on (and kept on during the night).

What are the after effects/complications and how to overcome these?

• Pain is experienced for three to four days after the operation. Strenuous movement exercises or work should be avoided over this time, particularly the first 48 hours. A tight scrotal support should be worn and Ibuprofen, paracetamol (or something similar) taken by mouth if needed for the pain. A tight pair of swimming trunks is perfectly satisfactory.
• There is often a little bruising and swelling of the scrotum after the operation. This is to be expected and will gradually disappear if the scrotal support is kept on. (One side only may he bruised, swollen or both.)
• If the operation site(s) obviously becomes infected all that is required is a week’s course of antibiotic from your general practitioner (and keep the scrotal support on).
• Excessive internal bleeding is rare, especially with no scalpel technique. It may happen in the first 48 hours after the operation hence the instruction to avoid undue exertion during that time. Internal bleeding is present if the scrotum becomes bruised, very swollen and extremely painful, If this happens advice should he sought at once from the surgeon or failing that your general practitioner.
• Pain in one or other side of the scrotum. It usually occurs several weeks and months after the operation. It is spasm like in nature and sometimes related to intercourse. The cause is unknown (possibly related to distension of epididymis where sperms are stored and have no way of coming out). It usually disappears after a variable length of time (usually months). A tight scrotal support is often helpful if worn continuously. The pain rarely occurs on both sides, or after several years following vasectomy. Fortunately the incidence of persistent pain is rare
• Failure of operation due to spontaneous re-joining of one (or both) of the tubes later in life, for no apparent reason. This is minimised by taking out a segment of tube, cauterising the ends and also tying them. Re canalisation may occur in one case in approximately several hundred cases of vasectomy carried out. I have not come across this complication in my practice.

Hopefully, none of these will happen to you!