Vasectomy risks and complications

Are you getting a vasectomy?
Plan ahead and get some cold packs on Amazon and a 3 pack of jock straps for a comfortable post-surgery recovery!

No medical procedure is without risk. Life itself is not without risk. We subconsciously risk assess all the time. For example, every time we take a trip in the car, every time we cross a road, and every time we lift a can of beans from the shelf we do a risk assessment. When undergoing a medical procedure – especially an elective one, we go through a conscious process of risk assessment. It’s important to consider what risks there are to vasectomy. At the same time, it’s also important to consider the risks of other birth control methods, your personal circumstances and come to a balanced risk decision.

Please note that all references on this page have links to the original so that you can verify the text and context yourself.

Post-procedure

Most men report feeling sore, or uncomfortable for a few days. Most men also report bruising (sometimes spectacular!), and swelling. The bruising and swelling doesn’t always happen immediately – it often happens after a few days but in most cases has mostly disappeared after two weeks. You should discuss with your doctor what is, and isn’t normal, and how to get treatment if necessary. Remember that most vasectomies are done on a Thursday or Friday, so you need to know how to get treatment or advice over the weekend if necessary.

Allergic reaction to anaesthesia

A few men will develop itching & hives due to an allergic reaction to anaesthesia.1

Post operative pain

All men experience some form of pain in the scrotum, it usually disappears within 2 days, but the scrotum will still be sore for a few more.1

“Over the counter” pain killers are the usual recommendation. Consult with your doctor or pharmacist. Aspirin based remedies should be avoided.

Bruising & swelling

This is normal. The bruising and swelling doesn’t always happen immediately – it often happens after a few days but in most cases has mostly disappeared after two weeks.

Use ice (frozen peas /corn) to help with the swelling – especially in the first 24 hours. Wearing a jockstrap as support for the first few days is highly recommended. Wear it as long as it helps you feel more comfortable.

Bleeding

Frequently blood may seep under the skin, so that penis and scrotum appear bruised. If there is no dangerous swelling this painless problem usually disappears without treatment within a week or two.1

Hematoma

Typically occurs in 2%1 of cases, but this rate is affected by how often surgeon performs vasectomy:

4.6% 1-10 vasectomies per year
2.4% 11-50 vasectomies per year
1.6% >50 vasectomies per year2

A hematoma is bleeding inside the scrotum, and can cause a painful swelling. Medical advice should be sought.

Infection

3.5%2 – 4%1 of cases.

Risk is reduced for no-scalpel.1 Experience of surgeon, or number of vasectomies performed per year seems to have little effect on the statistics.

Antibiotics are usually used to treat infections.

Blood in the ejaculate

This is pretty rare, but it does happen. It may typically happen anytime during the first couple of weeks, and appears as brownish sludge.

Normally it will clear after a few ejaculations. If not, then contact your doctor.

Allergy to chromic sutures

This is quite rare, but worth mentioning. The material used to sew up the incision after many surgical procedures (including vasectomy) is known as “Surgical Gut”, and is derived from the small intestine of healthy sheep. It’s fine-grained, has great tensile strength and elasticity. By tanning it in varying amounts of salt of chromic acid, the delay time for tissue absorption is set. Some people are allergic to Chromic acid.

Reactions to this material are difficult to diagnose post-operatively. They may be interpreted as non-specific complications of surgery. One site visitor reports that he was still experiencing very aggravating stinging/burning/itching pain at the incision sites 10 days after his vasectomy, and his doctor diagnosed this as an allergy to the sutures. Time as ever is the great healer.

Longer term complications

Sperm granuloma

Usually defined as a leakage of sperm from vasectomy site or rupture in epididymus. Sperm has highly antigenic properties, and the leakage can provoke an inflammatory reaction. The body forms pockets – firm balls of tissue about .05″ in diameter to trap sperm.

Granulomas typically occur in the 2nd or 3rd week2 in 60% of men with vasectomy, but are troublesome in only 3%-5% of cases.1 Most granuloma’s are asymptomatic (the patient doesn’t know they are there), and resolve themselves over time. However, if they are not healed by time, then injecting it with steroids or actually cutting out the inflamed granuloma has been found to be effective. Surgery should always be viewed as a last resort. Most granulomas resolve with conservative treatment, < 1% require surgery.6

Congestive epididymitis

Inflammation of the epididymus – may occur in the first year and usually clears up within a week when treated.1 General incidence 0.4% – 6.1%, 1 Standard vasectomy 6%, 2 Open ended vasectomy 2%.2 In standard vasectomy, incidence varies between 2.8% and 5.6% depending on the method of sealing the vas deferens.2

Antisperm antibodies (ASA’s)

Antisperm antibodies are present in all men and women, but not necessarily at detectable levels. Between 52%-68% of men1,2 will develop an increase in detectable ASA’s. Genital tract infections, orchitis or std’s will increase the risk.1

Not all men develop detectable levels of ASA – men with higher pre-vas sperm count are likely to have sustained or early high levels of antibodies. Non-vasectomised men who are infertile have the highest level of antibodies.2 The antisperm response appears to be a problem only if a man wishes to have his vasectomy reversed.1

Negative psychological effects

Some men go through a brief period of self consciousness. 50% of men keep their operation a secret, they may believe that the operation is tainted by the stigma of emasculation and thinking it would degrade them in the eyes of their friends. This period passes quickly. A small percentage of men experience depression and angry emotions. Some experience a period of mourning over the loss of their ability to reproduce. These feelings usually resolve given time. A very small percentage of couples experience adjustment difficulties. The emotional distress manifests in sexual dysfunction, impotence, or premature ejaculation. The vasectomy is the catalyst but not the cause. Studies show men who experience impotence post vasectomy are more likely to have female partners who are unable to accept the operation.1

Post vasectomy pain syndrome (PVP) or chronic noninfectious epididymal pain

Otherwise known as post vasectomy pain syndrome (PVP), or sometimes chronic testicular pain (CTP).

A small percentage of men do suffer what is know as “Post Vasectomy Pain syndrome” (PVP). This is a collective title for any long term problem relating to vasectomy – not a disease or syndrome in it’s own right. The percentage will vary widely depending on what web article or study you are reading. Also, the definition of PVP varies between studies/articles. Some studies/articles include the normal slight bruising or swelling that occurs in the statistics, some don’t.

The accepted definition is where problems remain unresolved after a period of three months or more. Responsible research will adhere to this accepted definition.

There is a problem with quoting statistics on PVP – due to the diversity of the condition and quality of research available, it’s NOT possible to put a percentage on the number of men that suffer PVP. One peer reviewed study8 explains the difficulty: “In most studies, assessment of post-vasectomy complications was based on unsystematic, self referred, unblinded medical consultations with no objective criteria and no timing and length of follow-up specified. All the preceding pitfalls contribute to the overall low methodological quality of most currently available comparative studies.”

The causes of pvp tend to be scarring from the surgery, obstruction of part of the epididymus causing swelling in another section and pinched nerves. In some men, an immunological reaction of antisperm antibodies can also give rise to the symptoms. Chronic orchialgia happens in approximately 1% of cases. This is a dull ache in testicles due to congestion of dead sperm. It usually disappears within 6 months.1

Recent recommendations are that doctors warn patients there is a risk of long term pain. However, there is insufficient data to enable anyone to put an accurate figure on what the risks actually are. Comparative studies are rare, but one study that compares vasectomised men with non-vasectomised men quotes 0.9% in the first 12 months for men with vasectomy, and 0.1% for the non vasectomised controls. After the first year the rates quoted are 1.8%, and 1.0% non vasectomised controls (median 7.9 years follow up).2 One review study2 quotes the rate of post vasectomy epididymitis-orchitis as approximately 1 case per 1000 person-years.

Treatment options are dependant on the exact symptoms. As explained earlier, the condition known as PVP is a collection of various symptoms and causes – many of them common urological conditions. Doctors will generally initially adopt conservative treatment measures including antibiotics and pain killers.

If the problem is not resolved by conservative treatments, then there are several surgical options – dependant on the symptoms. Vasectomy reversal has a success rate of up to 84%5. This tends to be the most general approach. Epididymectomy (removal of the epididymus) has a success rate of up to 90%4, but requires more specific diagnosis. Microsurgical denervation has a success rate of up to 96% in meticulously selected cases.3

Prostate cancer and vasectomy

This has made the news on occasions, but what are the facts?

In the early 1980’s a couple of studies found that vasectomised men had higher testosterone levels later in life that non-vasectomised men. If the studies were entirely accurate is a matter of debate. However, it is known that an increased level of testosterone can lead to an increased risk of prostate cancer.

Two studies published in 1993 by the same team, using the same data set indicated that men with vasectomy were more likely to develop prostate cancer later in life. It’s important here to look at the numbers involved in the studies. The study had 10,055 participants, and 37,800 non vasectomised men as controls. The number of men who had prostate cancer AND a vasectomy were 59, and 54 in each study. The numbers involved do not provide sufficient data to make statements from – especially as much of the data was a postal questionnaire sent to female partners. However, the results of the study made the headlines, and the rest is history.

It’s interesting to note that a study published in 1974 by Kaiser Permante Healthcare involving 43,432 men on an 8-15 year after vasectomy follow up study based on medical records found that vasectomised men did not have an increased incidence of prostate cancer. That study never made the news, and consequently didn’t become an urban legend.

More recent studies have learned from the flawed methodology of sending out postal questionnaires to third parties. There have been some very large studies carried out in various countries in recent years concentrating on medical records. They ascertain if the men have had a vasectomy, and prostate cancer. These more recent studies found firstly that men with a vasectomy did not have prostate cancer any more often than non vasectomised men. They also found that men who had vasectomies were more likely to look after their general health, therefore more likely to get themselves checked for prostate cancer, therefore prostate cancer was more likely to be detected.

The World Health Organisation has reviewed all the research, and for some time has been recommending that men who have had a vasectomy should not be screened any more than non vasectomised men are.

The fact is that simple dietary changes will decrease your risk of developing all cancers, whereas having a vasectomy is not going to alter your chances of developing it. We have an article that gives you more information on the topic.

Other discounted health risks

Over the years, many associations between vasectomy and various health conditions have been researched. The following are all conditions where the association between it and vasectomy have been disproved.

Testicular Cancer

“The record linkage study by Moller et all and the case control study by the United Kingdom group represent the largest studies to date, report no elevated risk among men with vasectomy. These studies offer the most convincing evidence that vasectomy is not likely to induce or accelerate testicular tumors. In summary, testicular cancer rates are not increased among men with vasectomy.”2

Heart disease & blood pressure

“There is no association between vasectomy and any coronary disease risk factors and no relationship between vasectomy and degree of occlusion of the coronary vessels. There is also no significant difference in mean systolic or diastolic blood pressure after vasectomy.

The incidence of cardiovascular disease or coronary heart disease does not rise with time after vasectomy in excess of the normal increase with ageing, even when men are followed up long term after the procedure for 10 or 15 years. Morbidity and mortality from cardiovascular disease does not increase after vasectomy and may even be reduced, as healthier men seem to choose vasectomy.”7

Auto-immune, endocrine, neurological, pulmonary, and mental disorders

There is no significant difference in incidence of or hospitalisation for the diseases listed opposite. There is no significant change in activity of blood clotting factors, no clinical evidence of Thrombosis and no significant difference in blood chemistry measurements, white blood cell count or haematocrit.

The largest cohort study to date involving nearly 22,000 men found that men who had undergone vasectomy had similar or lower rates of 98 diseases (including various cancers, auto-immune diseases and heart disease) as controls who had not had vasectomy.

Whilst at least 50% of men permanently had sperm agglutinating or immobilizing auto-antibodies in their serum after vasectomy, numerous studies failed to show any immunological or other adverse effects upon general health. These antisperm antibodies are therefore only important to those men seeking a return of fertility, and even then the correlation is poor.”7

Sources

1 Harvard Medical School (“Well connected”), 2001

2 Safety & effectiveness of vasectomy. Schwingl & Guess, 2000

3 Management of chronic testalgia by microsurgical testicular denervation. Heidenreich A, Olbert P, Engelmann UH, 2002

4 Epididymectomy is an effective treatment for scrotal pain after vasectomy. West AF, Leung HY, Powell PH, 2002

5 Vasectomy reversal for treatment of the post-vasectomy pain syndrome. Myers SA, Mershon CE, Fuchs EF, 1997

6 Vasectomy review: sequelae in the human epididymis and ductus deferens. McDonald SW, 1996

7 RCOG. UK national sterilisation guidelines 2004.

8 Vasectomy surgical techniques: A systematic review. Labrecque M, Dufresne C, Barone MA, St-Hilaire K., 2004.

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