Birth Control Bingo: Vasectomy

Vasectomies are: 

• Almost 100 percent effective, according to Planned Parenthoodexternal link, opens in a new tab.
• One of the most effective forms of birth control⁠ (birth control: Any number of methods people use to intentionally prevent unwanted pregnancy, including the condom, the cervical barrier, the implant, the patch, the pill, the rhythm method, the ring, the shot, the IUD, spermicide and withdrawal.) , according to the U.S. Department of Health and Human Servicesexternal link, opens in a new tab.
• “The procedure fails in less than 1 out⁠ (out: Short for ‘out of the closet’. When someone’s LGBTQ+ identity is known to other people.) of every 1000 cases when performed by an experienced surgeon,” says board-certified urologist Philip Werthman, MD, director of the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles, CA.  

In addition to being effective, even though they are surgeries, vasectomies are minimally invasive, virtually painless, highly accessible, and offer fast recovery, according to board-certified physician Dr. Stacy De-Lin, M.D. the associate medical director of Planned Parenthood Hudson Peconic in Hudson, New York. 

The What, the Why, the Where, the When, and the How-to: A vasectomy⁠ (vasectomy: Surgical blocking of the vasa deferentia (each vas deferens) for permanent birth control.) is a surgery that is typically performed by a urologist, but some family and sexual⁠ (sexual: About or relating in some way to sex or sexuality.) health medicine doctors are also trained in and can perform the procedure. 

There are two main variations, though they have more similarities than differences: 

• Traditional vasectomy
• No-scalpel vasectomy 

Both procedures, which take about 20 minutes from start to finish, are fairly straightforward. 

The technician begins by swiping a lidocaine wipe over your groin to dull the ‘pinchy’ feeling associated with the needle-inserted local anesthetic. Next, they will use a small needle—similar in size to the one used during dental fillings—to inject a stronger anesthetic into the skin of the scrotum to temporarily desensitize the area. 

You’re awake during a vasectomy, so once you’ve confirmed that your bits are nice and numb, the actual procedure begins. Even though you are awake, you don’t have to see or watch what’s going on unless you want to.

The surgeon makes a tiny incision in the front of the scrotum, which allows them to access the vas deferens⁠ (vas deferens: A long tube that carries sperm from each epididymis to the seminal vesicles during ejaculation.) . The vas deferens is a little tube shaped like a hollow strand of spaghetti, that delivers sperm⁠ (sperm: Reproductive cells of people with penises which can fertilize an ovum and create pregnancy.) from the testicles to the urethra⁠ (urethra: The urinary tract, where people pee from. On a penis, the opening to the urethra is at the head of the penis; on a vulva, the opening is above the vaginal opening and below the external clitoris.) , where the sperm gets added to the rest of the seminal fluid. 

A vasectomy interferes with this function by snipping, tying off, or cauterizing (sealed off with heat) the tubes—and more likely, using a combination of all three. 

During a traditional vasectomy, a scalpel is used to make this incision and during a no-scalpel vasectomy, a smaller sharp object is used to puncture and then stretch the opening. The hole will be sutured at the end of the procedure. In no-scalpel vasectomy, the initial hole in the scrotum is so microscopic that it closes on its own with no stitches needed. Either way, after that, you’ll be on your way. 

It takes about a weekexternal link, opens in a new tab to fully recover from a vasectomy, but many people return to work just two to three days later. You will want to have ice and compression wear readily available for the days after the procedure. You should also avoid any exercise or other strenuous activity at this time. Meanwhile, abstaining from full ejaculations during solo or partnered play is also required to allow your body to heal. The pre- and nocturnal ejaculations common amongst young people are unlikely to cause harm. 

A vasectomy won’t impact the way ejaculation⁠ (ejaculation: In a sexual context, a discharge of genital fluid, usually (but not always) as a result of sexual stimulation and/or orgasm.) looks, feels, or how much of it there is, in case you were wondering. Sperm only makes up five percentexternal link, opens in a new tab of ejaculatory fluid prior to a vasectomy, and they are not and have never been visible to the naked eye.  After a vasectomy, there will not be semen⁠ (semen: Fluid which comes from the urethra of the penis during ejaculation, and which usually contains sperm.) in the ejaculatory fluid, but it won’t be different in color, texture, or appearance in any other way. It also won’t impact your testosterone⁠ (testosterone: A steroid hormone produced in the testes and in the ovaries. Is responsible for sperm production, and influences sexual desire, arousal and bone health. Is also blamed for for a lot of things it isn’t actually responsible for.) levels, your desire⁠ (desire: A feeling of wanting something. In the context of sex or sexuality, desire can be a feeling of a physical and psychological want for any kind of sex or way of being sexual.) for sex⁠ (sex: Different things people choose to do to actively express or enact sexuality and sexual feelings; often this involves genitals, but not always. ) , or how your penis⁠ (penis: One of the two external reproductive organs of people often assigned male at birth.) feels or functions. “Some patients even say they are more interested in sex after the procedure because they are no longer concerned about unwanted pregnancy⁠ (pregnancy: The state of carrying a developing embryo or fetus within the uterus. Medically, someone is considered to be pregnant when an egg has been fertilized by sperm, cells divide, and the fertilized egg is implanted within the lining of the uterus.) ,” according to De-Lin. 

This is important: A vasectomy is not instantly effective as a form of birth control. There is a backlog of still-active sperm called the ampulla that needs to be emptied before you can become sterile. The vasectomy will make sure no more sperm gets added, but the pre-loaded loads have to exit first. Most urologists recommend getting a semen analysis three months after the procedure as proof of efficacy⁠ (efficacy: How well something works under ideal or controlled conditions, like efficacy proven through scientific study.) , and waiting to use the vasectomy as the sole form of birth control until after that. A semen analysis can be performed by the same provider who performed the vasectomy, or you can explore mail-in options. 

Other methods you can use as birth control during the waiting period:

That you can use/wear as the person who got the procedure: 

• External Condoms
• Withdrawal

That a person with a uterus⁠ (uterus: An internal, muscular reproductive organ in the pelvis. During pregnancy, this is where a fetus will develop. The lining of a person’s uterus is also the thing that sheds every menstrual cycle in what we call a period.) you’re having vaginal intercourse⁠ (vaginal intercourse: When a penis or sex toy is inserted into and held by the vagina while partners move their bodies as feels good to them for the purpose of either sexual stimulation and/or reproduction.) could use as non-hormonal, short-acting birth control: 

• Internal Condoms
• Cervical Barriers (Diaphragms, Lea’s Shield and Cervical Caps)
• the Sponge
• Spermicide
• Emergency Contraception (Plan B⁠ (Plan B: A brand of emergency contraception pill.) ⁠ or the Morning-After-Pill)

That person with a uterus you’re having vaginal intercourse could use as a hormonal and/or long-acting birth control: 

• Combined Oral Contraceptives (The Pill)
• Progesterone-Only Oral Contraceptives (Mini Pills)
• the Vaginal Ring (Nuvaring)
• the Contraceptive Implant (Implanon)
• the Contraceptive Patch
• Depo-Provera (The Shot)
• Intrauterine Devices (IUD⁠ (IUD: Intra-uterine device. A long-term birth control method inserted into the uterus by a healthcare provider. Also called an IUS (Intrauterine system) or IUC (Intrauterine contraceptive).) ⁠)
• Fertility Awareness (FAM⁠ (FAM: Keeping records of periods, body temperature and cervical mucus to try and predict fertility.) ⁠)

Why would someone get a vasectomy? 

A vasectomy is a highly effective method for preventing unwanted pregnancy now and forever. After an individual has gotten the all-clear from their post-op semen analysis, it is a method that will allow a person to never think about unwanted pregnancy again. “A vasectomy should be considered permanent for anyone contemplating it,” says Dr. Werthman. 

There is a procedure—known as vasectomy reversals or vasovasostomy—where a surgeon can attempt to rejoin the previously-severed vas deferens. However, this procedure is much more complicated than a vasectomy, and results are not guaranteed. Vasectomy reversals are effective just 25 to 55 percentexternal link, opens in a new tab of the time when performed more than a decade after the initial procedure. With that, most providers counsel patients who are considering a vasectomy with the intent of getting it reversed down the road, not to get it at all, since reversals are expensive and still may not work. In the event you are someone who wants a vasectomy but also wants the option of being a biological parent in the future, banking or freezing sperm would be a way you could have both.

To get a vasectomy, you’ll need to schedule a consultation with a urologist or other healthcare provider⁠ (healthcare provider: A qualified person to provide sound physical and/or mental healthcare, such as a doctor, nurse, clinician, counselor, medical assistant, midwife or other healthcare professional.) who offers the service (who may also be your regular doctor). If the provider agrees you are a good candidate, you’ll be able to schedule the vasectomy. 

A vasectomy can cost anywhere from $0 to $3,000, including the initial visit, medications, and the follow-up appointment. 

What will/might I need to discuss with a partner⁠ (partner: In a sexual context, a person with whom someone is having some kind of sex. The term “partner” can be used for all kinds of relationships, not just serious ones. “Partner” can also mean the person someone is with in a romantic or familial partnership.) ?

• If you or they are interested (or not) in having kids with you in the future—and why, since a vasectomy should be considered permanent
• What, if any, circumstances would open you to the possibility of children in the future
• What barriers will be used to prevent unwanted pregnancy in the interim period⁠ (period: The fluid – or flow – which contains blood, from the shedding of the uterine lining usually at the end of each menstrual cycle. Sometimes periods may be less fluid and more globby; this is the state that is often mistaken for blood clotting.)
• Whether this procedure changes relationship⁠ (relationship: An ongoing interaction or association with another person, place or thing.) agreements regarding safer sex⁠ (safer sex: Practices which aim to reduce the risk of sexually transmitted infections, such as use of latex/nonlatex barriers, regular testing for infections and limiting the number of sexual partners.)  practices
• Current STI⁠ (STI: Sexually transmitted infections: illness, infection and/or disease which is often or can be transmitted through sexual or other intimate contact, like HIV, Chlamydia or Herpes. Some people call STIs STDs.) status and testing protocol for the future 

When Good Birth Control Does Bad Things: Vasectomies are unlikely to fail and thus effectively prevent unwanted pregnancy; however, they are unlikely to be granted to minors. Many countries have a minimum age an individual must be to legally consent⁠ (consent: To freely and actively agree to do a specific thing with someone else with all the information about what that thing is, and the right to change your mind.) to a vasectomy, and it is clinics that provide the service may have their own policies that set an even higher minimum age. Additionally, many doctors refuse to perform a vasectomy on people who do not have children, due to the belief that they do not understand the permanence nature of the procedure and will regret it. 

Why would a vasectomy be a good option for me? If you know you don’t want kids or to donate sperm in the future, and one or more of the following are true: 

• You do not reliably use other forms of birth control
• Your uterus-having partner does not want additional hormones⁠ (hormones: Chemicals – via our endocrine system – that send messages across our bodies and brains. They both naturally exist and can also be made in a lab.) or foreign objects (internal condom⁠ (condom: A thin sheath or tube of latex or another material, worn over the penis during sex to prevent or reduce the risk of pregnancy and/or sexually transmitted infections.) , ring, implant, etc) in their body
• The conversation about pregnancy risk induces dysphoria in you or your partner 

This is part of Scarleteen’s Birth Control Bingo. Need to start over or anew?

Don’t forget: Sexually active young adults⁠ (adults: People whose age in years exceeds the legal age of majority, people considered to be adults by law, or people who a culture or individual considers to have reached an adult stage of life.) are the group at the highest risk at protecting against sexually transmitted infection⁠ (infection: When harmful microbes, or germs, or harmful levels of microbes/germs, enter the body and multiply, causing illness. The common cold, flu viruses, sexually transmitted infections, chickenpox, impetigo, rabies and diphtheria are some kinds of infections.) and vasectomies do not protect against them. After the waiting period, you may not have to worry about impregnating your partner, “but you’ll still need to do proper precautions to avoid infection and transmission,” says Dr. Werthman.

Internal and external condoms are the birth control method that protect against STIs. You can read all about safer sex ⁠here:  Safe, Sound & Sexy: A Safer Sex How-To. But what most doctors advise —and what we also encourage at Scarleteen—is using condoms with anyone whose current STI status you do not know and getting tested before and after every new partner. You might also talk to your provider about PrEP if you’re at risk of contracting HIV⁠ (HIV: A virus that attacks cells of the immune system, weakening the body’s ability to fight infections and diseases.) .