What is a vasectomy?
A vasectomy is a simple operation designed to make a man sterile, or unable to father a child. It is used as a means of contraception in many parts of the world. A total of about 50 million men have had a vasectomy -- a number that corresponds to roughly 5% of all married couples of reproductive age. In comparison, about 15% of couples rely on female sterilization for birth control.

Approximately half a million vasectomies are performed in the United States each year. About one out of six men over age 35 has been vasectomized, the prevalence increasing along with education and income. Among married couples in this country, only female sterilization and oral contraception are relied upon more often for family planning.

Vasectomy involves blocking the tubes through which sperm pass into the semen. Sperm are produced in a man's testis and stored in an adjacent structure known as the epididymis. During sexual climax, the sperm move from the epididymis through a tube called the vas deferens and mix with other components of semen to form the ejaculate. All vasectomy techniques involve cutting or otherwise blocking both the left and right vas deferens, so the man's ejaculate will no longer contain sperm, and he will not be able to make a woman pregnant.

What are the different vasectomy techniques?
In the conventional approach, a physician makes one or two small incisions, or cuts, in the skin of the scrotum, which has been numbed with a local anesthetic. The vas is cut, and a small piece may be removed. Next, the doctor ties the cut ends and sews up the scrotal incision. The entire procedure is then repeated on the other side.

An improved method, devised by a Chinese surgeon, has been widely used in China since 1974. This so-called nonsurgical, or no-scalpel, vasectomy was introduced into the United States in 1988, and many doctors are now using the technique here.

In a no-scalpel vasectomy, the doctor feels for the vas under the skin of the scrotum and holds it in place with a small clamp. Then a special instrument is used to make a tiny puncture in the skin and stretch the opening so the vas can be cut and tied. This approach produces very little bleeding, and no stitches are needed to close the punctures, which heal quickly by themselves. The newer method also produces less pain and fewer complications than conventional vasectomy.

Regardless of how it is performed, vasectomy offers many advantages as a method of birth control. Like female sterilization, it is a highly effective one-time procedure that provides permanent contraception. A vasectomy is medically much simpler than female sterilization, has a lower incidence of complications, and is much less expensive.

What are the side effects of a vasectomy?
A major study of vasectomy side effects occurring within eight to 10 years after the procedure was published in the British Medical Journal in 1992. This study -- the Health Status of American Men, or HSAM -- was sponsored by the National Institute of Child Health and Human Development (NICHD). Investigators questioned 10,590 vasectomized men, and an equal number of nonvasectomized men, to see if they had developed any of 99 different disorders. After a total of 182,000 person-years of follow-up, only one condition, epididymitis/orchitis (defined as painful, swollen, and tender epididymis or testis) -- was found to be more common after vasectomy. This local inflammation most often occurs during the first year after surgery. When treated with heat, it usually clears up within a week.

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