What is male sterilization (vasectomy)?
A vasectomy is a minor surgical procedure that permanently ends fertility in men.
How does it work? (mechanism of action)
Vasectomy interrupts the vas deferens, preventing the sperm from entering the semen, so that semen is ejaculated without sperm.
Who can use male sterilization?
- Any men (couples) who are certain they do not want or cannot have more children and desire permanent protection from pregnancy.
- There is no reason to deny sterilization to any man. Men with certain conditions should have the sterilization procedure delayed until the condition is resolved.
(For more information, see WHO eligibility criteria.)
Advantages
- Highly effective, but not 100%
- Permanent
- Has no systemic side effects
- Does not interfere with intercourse
- Easy to use
- Less surgical risk/expense than female sterilization
Disadvantages
- Chance of regret
- Risks and side effects of minor surgery
- Delayed effectiveness
- No protection from STIs/HIV
Note: In the early 1990s, some researchers were concerned that vasectomy might increase the risk for prostate cancer, but the evidence was considered inconclusive. More recent research has shown no increased risk of prostate cancer after vasectomy.
Possible side effects:
- Some pain and discomfort during and right after the procedure
- Complications associated with the procedure itself are rare
Follow-up:
- Observation for an hour after the procedure
- Any time soon after the procedure if signs of complications are present
Counseling
Time to effectiveness should be discussed:
- Vasectomy is NOT immediately effective because it takes a while for the vas deferens to become completely clear of sperm. Where semen analysis is available, men should ask for a test to make sure the operation was successful. Usually the doctor will recommend the test about 12 weeks after surgery. Where semen analysis is not available, men should wait 12 weeks before relying on their vasectomy.
- Abstinence or a back-up method, such as a condom, should be used in the meantime, or a man's partner should continue using the method she relied on before the vasectomy.
Given the permanent nature of this procedure, thorough counseling is very important. Clients most likely to regret sterilization can be identified through counseling. The possibility of failure should also be discussed. Although vasectomy is highly effective, some studies--especially those in low-resource settings--have found pregnancy rates as high as 1% to 2% in the first year after the procedure.
Client characteristics associated with regret:
- Under age 30
- Single or recently married
- No male children
- Client pressured into decision
- Partner opposed to decision
- Limited access to other methods
