No pain but all gains in getting a vasectomy

Dear Dr G,

I am a happily married man with a healthy sexual appetite.

When we first got married, we both agreed that we should defer having a family till at least three years into our marriage.

Sadly, within two months of getting together, my wife got pregnant, and we became parents before our first anniversary.

Fast forward 10 years later, and my wife is soon expecting our fourth child.

Don’t get me wrong, we are both grateful for our healthy children and growing family. However, there is a limit to what we can offer and afford.

The problem lies with the both of us not agreeing on the form of contraception.

My wife cannot tolerate oral contraceptive pills and experiences severe pain with an Intrauterine Contraceptive Device (IUCD).

On the other hand, I am really put off by the cumbersome condoms that always seem to slip or break.

We are both certain we do not want to expand our family anymore. I am really contemplating vasectomy and would like to put Dr. G on the spot about the snip.

Is vasectomy really better than the condoms, the pills or female sterilisation?

What exactly is done during a vasectomy? How many ways are there to perform the procedure?

Truthfully, I am an absolute coward when it comes to pain, especially when it involves the most sensitive part of a man’s body.

How is anaesthesia applied before vasectomy?

How much pain can I expect after the vasectomy and how do I ease the pain?

Lastly, I have heard of post-vasectomy pain syndrome. What exactly is that and how long will that last? Will it be all pain and no gain?

Pain-fearing Peter

Vasectomy is an elective surgical procedure for male sterilisation, as a means of “permanent” form of contraception. During the procedure, the vasa (vas deferens) or tube which delivers the sperm to ejaculate, is ligated to prevent passage of sperms to fertilise eggs during intercourse.

Vasectomy has no adverse impact on the volume and texture of ejaculation. The procedure is also not associated with altered sexual functions including erectile rigidity, interval of intercourse and intensity of sexual climax. Vasectomies are usually performed in a physician’s office and medical clinics.

The procedure is minimally invasive, straightforward with minor incisions and minimal complication of less than 2%. Most patients can resume their typical sexual behaviour within a week and do so with little or no discomfort. Despite the short recovery time and minimal complications, many men are still fearful of getting a vasectomy.

Several approaches of vasectomy procedure have been described, all of which involves blocking at least one part of the vas deferens on either side, accompanied by the administration of local anaesthesia. To help reduce anxiety and increase patient comfort, patients may opt to have a “no-needle anaesthesia”.

The “no-scalpel” or open-ended techniques may also help to accelerate recovery times with minimal post-operative pain. For patients who are needle phobic or are fearful of the injections in their private parts, the option of general anaesthesia can be offered. Following the vasectomy, it is normal to expect mild pain, swelling or discomfort.

The level of pain is typically worse on the day of operation and the day after surgery. More than 95% of patients undergoing a vasectomy can safely manage their pain without opioids, by using over-the-counter medications such as paracetamol or ibuprofen.

The best strategies for controlling pain after vasectomy include resting and limiting activity after surgery. Applying an ice pack on the scrotum area can also ease the discomfort. Cover the ice pack with a towel so it is not directly against the skin and alternate by placing the ice pack on the area for 20 minutes, then remove for 20 minutes. Do this until bedtime on the day of your vasectomy.

Wear snug or tightfitting underwear to help support and minimise swelling to relieve the dragging discomfort. Although vasectomy has a low risk of problems, some men develop post-vasectomy pain syndrome (PVPS). PVPS involves chronic pain in one or both testicles that is still present three months after the procedure. Pain can range from a rare, dull ache to sharp, constant pain that can interfere with daily life.

For some men, the pain is severe enough to seek treatment. The causes of PVPS are largely unknown, however this can be attributed to infection, nerve compression or back pressure of trapped sperms from the ligated vas.

Most PVPS can be treated with mild painkillers. However if left untreated, severe pain may cause significant emotional and psychological distress.

The acceptance of vasectomy varies considerably between cultures and ethnicity. Globally, women tend to take the lead role in family planning, as reflected by 223 million women who rely on tubal ligation, while only 28 million men had vasectomy.

Vasectomy has an excellent efficacy, as the failure rate is less than 1 in 2000. Vasectomy is also more cost effective, less invasive, has significantly less complication than tubal ligation.