I'm Dr. Ranjith Ramasamy, the Director of Reproductive Urology at the University of Miami. I'm here today to answer any questions you have about vasectomies. Ask me anything!

Once or twice a year I see news articles about research into alternative male contraceptives such as oral contraceptives, "birth control gel" or something else. In your opinion, are there any promising alternatives / advancements we could see being widely used in the next 5-10 years?

Oral contraception for men, also known as a male contraceptive pill, is still in the experimental stage and not yet widely available. There have been many efforts to develop male oral contraceptive pills that can suppress sperm production, but they are often met with an undesirable, yet prevailing, problem: testis shrinkage. While there have been reports of a potential hormonal oral pill for men, they still come with many side effects such as weight gain and loss of sex drive. A study published yesterday was proven in animals https://www.nature.com/articles/s41467-023-36119-6 but unsure how effective it will be in humans since it is short-acting

I got my snipitty snip snip just two weeks ago. Does it really take 30 cannon fires and 90 days for all sailors to abandon ship? What makes them so stubborn/resilient?

This is because sperm can remain in the semen and the reproductive system for several months following the procedure, and it can take up to 90 days or more for all the remaining sperm to clear out despite several ejaculations.

https://www.auanet.org/guidelines-and-quality/guidelines/vasectomy-guideline

Do you have any idea the physical toll, that three vasectomies have on a person?

Serious note:

1. In your experience, is there any significant misinformation as it pertains to vasectomies that you would like to clear up?

2. Are there substantial health benefits to vasectomies beyond birth control? Risks?

3. Do you notice a pervasive gender inequality as it pertains to contraceptive decision making and medical research?

In general, a vasectomy is a form of birth control that prevents the release of sperm during ejaculation by cutting or blocking the vas deferens tube. This procedure does not affect a man's ability to have an erection or orgasm. Another misconception is that the procedure will decrease testosterone levels. However, since testosterone is transported through the bloodstream rather than the vas deferens, a vasectomy should not affect testosterone levels.

There are no substantial benefits to vasectomy beyond birth control.

The risks of vasectomy can include:
Bleeding or a blood clot (hematoma) inside the scrotum, blood in the semen, bruising of the scrotum, infection of the surgery site, mild pain or discomfort, swelling, and delayed complications such as chronic pain or sperm granuloma.
Discomfort, bruising, and swelling after surgery that usually goes away within two weeks, hematoma, bleeding under the skin that can lead to painful swelling, and infection that may require medical attention.
Pain, soreness for a few days after the procedure, and other rare complications such as infection, bleeding, and inflammation.
It is important to note that serious complications from vasectomy are rare, and most men do not experience significant side effects. However, any procedure involving surgery carries some level of risk, and it is essential to discuss the potential risks and benefits of vasectomy with a healthcare provider before making a decision.

https://theconversation.com/500k-american-men-get-vasectomies-every-year-a-specialist-explains-the-easy-and-reversible-procedure-186984

How long does the procedure normally take?

10 -15 minutes in the office

How successful are reversals?

the success of a vasectomy reversal can vary based on various factors such as the experience of the surgeon, the technique used, and the specific circumstances of the patient. However, with proper surgical techniques, the success rate can be high. It is best to consult with a qualified medical professional for an individual assessment of your specific case. https://pubmed.ncbi.nlm.nih.gov/21716894/

~15 years ago, there was research that there was a link between vasectomies and aphasia/dementia.

What is the current theory about this link?

https://www.webmd.com/men/news/20070222/study-suggests-vasectomy-dementia-link

One study conducted by researchers at Northwestern University found that men with PPA were more likely to have undergone vasectomy than cognitively normal men of the same age, with 40% of men with PPA having had a vasectomy compared to 16% of others. However, it's important to note that this study only showed a correlation and not causation. Further research is needed to determine whether there is a causal relationship between vasectomy and PPA or other forms of dementia. It's also worth mentioning that the vast majority of men who have undergone a vasectomy do not experience any negative effects on their cognitive abilities.

It's .. irksome that after 15 years, this is still filed under "needs more research." Aphasia and PPA are no joke.

My father had severe aphasia in his final years, and this link was enough for me to deny having a vasectomy years ago.

Unfortunately, negative studies (studies that do not show an association) do not get published due to publication bias. I am confident that it was a statistical association without a biological explanation.

There are (rare) chronic pain complications involved with vasectomies, but when looking into this as a layman it's not clear at all how much of a concern this should be to men considering the surgery. Cleveland and Mayo Clinic present it as kind of a medical mystery and both suggest it's difficult to treat. And yet they both also note that it's *extremely* unlikely to develop.

I'm wondering about your general sense of the issue: Is it something you see being seriously studied? Would it cause you to hesitate in receiving or recommending the procedure or is it more of a "cost of doing business" kind of outcome?

Post-vasectomy pain syndrome (PVPS) is a possible complication of a vasectomy that involves chronic pain in one or both testicles that persists for three or more months after the procedure. PVPS is a rare complication, and the risk of developing PVPS after a vasectomy is low. The pain can range from a rare, dull ache to sharp, constant pain that can interfere with daily life. Possible treatments for PVPS include medication, a vasectomy reversal, or surgery to remove the epididymis or the spermatic cord, although these options may not always be effective

https://pubmed.ncbi.nlm.nih.gov/28725617/

post-vasectomy pain syndrome (PVPS) is a possible complication of a vasectomy that involves chronic pain in one or both testicles that persists for three or more months after the procedure. PVPS is a rare complication, and the risk of developing PVPS after a vasectomy is low. The pain can range from a rare, dull ache to sharp, constant pain that can interfere with daily life. Possible treatments for PVPS include medication, a vasectomy reversal, or surgery to remove the epididymis or the spermatic cord, although these options may not always be effective.

https://pubmed.ncbi.nlm.nih.gov/28725617/

What are the chances of the V not taking and a pregnancy slipping through?

According to the sources, the failure rate for vasectomies is very low, with only one to two in 1,000 men experiencing a failed vasectomy. However, in rare cases, a vasectomy can fail if the doctor misses the vas deferens during the procedure, and the tube can regrow, though this is very uncommon. Another possible cause of failure is having sex too soon after the surgery, without using an alternate form of birth control.

Had a vasectomy over a year ago, and now feeling a firm nodule on one side approximately where the doctor cut the vas defrens. Could that be a sperm granuloma? There is no pain. Should I get it looked at?

A sperm granuloma is a small mass or lump that may develop following a vasectomy. This lump is an inflammation created by extravasated sperm which leaks or is forced out of the cut end of the vas deferens during surgery. These granulomas can vary in size and are usually about the size of a pea. They can be encapsulated in a lump of scar tissue. Sperm granulomas are not life-threatening or cancerous. They do not cause any harm but may cause pain and discomfort in some cases. If no pain or discomfort, not to worry

Given the vas deferens are cut/tied what happens to the sperm that continues to be produced ? Do they leak into the surrounding cavity or get re absorbed somehow?

When a vasectomy is performed, the vas deferens, the tubes that carry sperm from the testicles to the urethra, are cut, tied, or blocked [1]. After this procedure, the testes continue to produce sperm, but the sperm cannot reach the semen or be ejaculated out of the body. According to Johns Hopkins Medicine, the sperm that are produced after a vasectomy die and are absorbed by the body. The ends of the vas deferens that have been cut are sealed off, and the sperm cannot leak into the surrounding cavity. The absorption of the sperm by the body is a natural process that happens over time, and it does not pose any harm to the body. Therefore, there is no need to worry about the presence of excess sperm in the body after a vasectomy.

How long does a vasectomy take, and how soon after can one resume sexual intercourse?

15 minutes on average. 1 week after vasectomy

How is a vasectomy actually done and what is being removed or cut during the procedure?

A vasectomy is a surgical procedure in which the vas deferens, the tubes that carry sperm from the testicles to the urethra, are cut, tied, or sealed to prevent the release of sperm during ejaculation. The procedure is usually performed at a doctor's office or surgery center under local anesthesia. During the surgery, a small section of the vas deferens is cut out and removed. The vas deferens is cut and sealed in order to prevent sperm from mixing with the semen and being released from the body during ejaculation. The procedure usually takes about 10 minutes and can be performed on both testicles during the same visit.

What painkillers do you get during/ before hand?

How likely are they to spontaneously reverse/be unsuccessful?

According to the sources, the failure rate for vasectomies is very low, with only one to two in 1,000 men experiencing a failed vasectomy. However, in rare cases, a vasectomy can fail if the doctor misses the vas deferens during the procedure, and the tube can regrow, though this is very uncommon. Another possible cause of failure is having sex too soon after the surgery, without using an alternate form of birth control.

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I typically dont prescribe pain killers either before or after the procedure beyond just the local anesthesia.

According to the sources, the failure rate for vasectomies is very low, with only one to two in 1,000 men experiencing a failed vasectomy. However, in rare cases, a vasectomy can fail if the doctor misses the vas deferens during the procedure, and the tube can regrow, though this is very uncommon. Another possible cause of failure is having sex too soon after the surgery, without using an alternate form of birth control.

I typically dont use pain killers before or after vasectomy. Just local anesthesia.

Are there some ideas to reduce vasectomy's cost?

1. Check with your insurance provider to determine whether vasectomy is covered and what expenses are included. Most insurance companies cover vasectomy
   
2. Consider low-cost providers: Planned Parenthood may offer vasectomy for low cost. It may be worth checking with low-cost providers in your area to find the best option.
   
3. Negotiate with providers: If the cost of vasectomy is prohibitive, some providers may be open to negotiation. Discuss the cost with the provider and explore whether there are any options to reduce the price.

Of all the specialties you chose this one, why?

Reproductive urology is a sub-specialty of urology that focuses on treating conditions related to the male reproductive system. Patients who suffer from problems like infertility, urinary incontinence, prostate issues, and sexually transmitted infections may benefit from seeing a reproductive urologist. Urologists are also skilled in performing surgical procedures on the male reproductive system, such as vasectomies and vasectomy reversals. Overall, I wanted to help patients who need specialized care in these areas and improve their quality of life

What are your thoughts on no scalpel or clamp vasectomies?

No-scalpel or no-clamp vasectomies appear to be a favorable option for individuals considering vasectomy. These procedures offer several benefits over traditional vasectomy, including less bleeding and infections and faster recovery time, and fewer complications such as infections and hematomas.

No-scalpel vasectomies involve a specialized tool that creates a small hole in the scrotum without the need for a scalpel. The vas deferens is then accessed and sealed, blocking the flow of sperm. The no-clamp vasectomy method involves holding the vas deferens in place using a special clamp, rather than a traditional scalpel, while the procedure is performed.

Should I get a fertility test every few months to verify my vasectomy is 100%, or am I being paranoid?

As for the frequency of fertility testing to verify a successful vasectomy, there is no clear consensus on this matter. It is generally recommended to wait three months after the vasectomy before undergoing a semen analysis to allow all sperm to clear the system. Depending on the results, a repeat test may be needed to ensure that the sperm count has remained at zero. After this initial test, your doctor can advise on when you should undergo subsequent testing to ensure that the vasectomy remains effective. If you have any concerns or questions, it is best to speak with your doctor, who can provide personalized recommendations based on your individual circumstances.

I read that there was an upsurge of interest in getting vasectomies in the United States following the reversal of Roe vs. Wade.

I wondered if you could give some comment on that. Have you noticed more interest or procedures since the reversal?

There does appear to be an upsurge of interest in getting vasectomies in the United States following the reversal of Roe vs. Wade in my practice. News sources report that interest in vasectomies has spiked since the Supreme Court's ruling to overturn Roe v. Wade. The news also suggests that the procedure is becoming increasingly popular as a form of permanent sterilization, and that more men are seeking vasectomies in response to the current political climate.

https://pubmed.ncbi.nlm.nih.gov/36420253/

How important is choosing the right doctor when it comes to the success, technique, and pain? Or is it pretty much all the same at this point?

Choosing the right doctor is important when it comes to the success, technique, and pain for vasectomy. It is recommended to ask family, friends, and healthcare providers for recommendations when searching for the right doctor. In addition, some experts suggest that starting with a good old-fashioned word of mouth can be helpful. When choosing a doctor for vasectomy, patients should consider factors such as the doctor's experience with the procedure, their approach to pain management, and their success rates with the procedure. Patients should also feel comfortable asking their doctor about their experience and training, and how they manage pain during and after the procedure. A well-informed patient who chooses the right doctor is more likely to have a successful and comfortable vasectomy procedure.

Thank you all for the great questions. I'll return soon for any new questions!

Is there any significative hormonal change after a vasectomy? I'm seeing different answers all around and even being a pharm chemist I can get which ones are right. We don't really go deep on biology...

Multiple studies have measured hormone levels, especially testosterone, before and after the procedure and found no significant change in hormone levels. While changes in sexual desire are rare after a vasectomy, they are not related to hormonal changes, as a vasectomy does not affect testosterone, the hormone that fuels sex drive

Given the legislative direction Florida has taken lately, are you concerned about efforts to limit access to contraception, from funding support through mechanisms like Medicaid to other measures? Or do you think the intent is to only target women reproductive access? Does the medical community have a responsibility to speak about these issues to government leaders?

it is unclear whether there are any recent legislative efforts in Florida to limit access to contraception. However, it is worth noting that the state's political climate has been largely dominated by conservative lawmakers, and reproductive health has been a contentious issue in the state's legislature.

If there are any efforts to limit access to contraception in Florida, it would be important for the medical community to speak out and advocate for reproductive rights. While it is unclear whether the intent of any such efforts would be to only target women's reproductive access, it is important to ensure that all individuals have access to the health care services they need. The medical community has a responsibility to advocate for their patients and ensure that lawmakers are aware of the potential consequences of their actions on public health.

If someone has a pre-existing autoimmune disease, does that increase their chances of having an autoimmune response to sperm after vasectomy or is the rate of occurrence similar to someone without underlying autoimmune disease?

There is no direct information on whether pre-existing autoimmune disease increases the chances of having an autoimmune response to sperm after vasectomy.

Any thoughts on the Vasalgel contraceptive? Seems like a game changer but it’s been in development for years.

According to a recent study, Vasalgel is a promising new form of male contraceptive [3]. Vasalgel works by blocking the vas deferens, which is the tube that carries sperm from the testicles to the urethra. The procedure is minimally invasive and reversible, and does not affect hormone levels. However, it should be noted that the product is still in clinical trials and not yet available for widespread use [3].
Compared to other contraceptive methods, Vasalgel has some unique advantages. Since it is a non-hormonal method, it does not cause hormonal side effects, such as mood changes, weight gain, or decreased sex drive. Unlike condoms or other barrier methods, it does not interfere with sexual pleasure or require frequent use.
It is important to note that Vasalgel, like all contraceptive methods, is not 100% effective. The gel is designed to be more than 99% effective in preventing pregnancy, but some failures may occur. It is also important to use contraception consistently and correctly in order to maximize its effectiveness.
In conclusion, Vasalgel has the potential to be a promising new contraceptive option for men, but more research is needed to evaluate its safety and efficacy.

What new findings have occurred related to vasectomies and prostate cancer risk?

New findings suggest that there may be a slight increase in the risk of prostate cancer associated with vasectomy, although the absolute risk remains relatively small. It is essential to discuss the potential risks and benefits of vasectomy with a healthcare provider before making a decision.

https://pubmed.ncbi.nlm.nih.gov/32772072/

Dr, what is your experience with patients who have horseshoe kidneys? Are surgeries to move the urinary tract generally successful or no?

Horseshoe kidney is a rare condition where the two kidneys are fused together at the lower end forming a U-shape. People with horseshoe kidney are more prone to developing various conditions including vesicoureteral reflux (VUR), ureteropelvic junction (UPJ) obstruction, and hydronephrosis, which makes the kidneys swell. Children with horseshoe kidneys may have symptoms such as belly pain, nausea, urinary tract infections, and kidney stones.

As for surgery to move the urinary tract, there is no information in the provided search results about such surgery for horseshoe kidney. Treatment for horseshoe kidney depends on the symptoms and complications. In some cases, surgery may be needed to correct complications such as obstruction or reflux. Surgery for horseshoe kidney may be challenging and involves a high risk of complications. Therefore, the decision to undergo surgery should be based on careful consideration of the risks and benefits. It is important to consult a medical professional with expertise (that I do not possess) for individualized advice regarding the management of horseshoe kidney.

References: [1] https://my.clevelandclinic.org/health/diseases/21745-horseshoe-kidney-renal-fusion [2] https://www.massgeneral.org/children/horseshoe-kidney [3] https://www.ncbi.nlm.nih.gov/books/NBK431105/

How do I get insurance to ay for a vasectomy?

Its a good idea to check with / call your specific insurance provider and state to see if you are eligible for coverage. If your insurance does not cover the procedure, you may be able to work out a payment plan or sliding cost scale with your doctor. Overall, while the upfront cost of a vasectomy may be more than other forms of birth control, the long-term benefits and cost savings can make it a worthwhile investment.