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Vasectomy (male sterilisation)
Vasectomy is permanent and very effective contraception, but sterility is not immediate: another method continues until a semen analysis 8 to 16 weeks later shows azoospermia or only rare non-motile sperm (up to 100,000 per mL).
Why it matters in the exam
The exam asks about counselling before the procedure, the test afterwards and complications. Counselling explains that the procedure is considered permanent, that reversible alternatives exist, that sperm banking can be considered, and that contraception must continue until laboratory confirmation. The no-scalpel technique causes less bleeding, pain and infection. The AUA guideline states there is no need to counsel about a higher risk of prostate cancer, heart disease or dementia, because no such link has been proved.
Complications: haematoma, infection, chronic scrotal pain in 1 to 2 percent, sperm granuloma, and failure — early (recanalisation, less than 1 percent) or late and rare (about 1 in 2000), discovered by an unplanned pregnancy. The post-vasectomy semen analysis is the only way to confirm success; if motile sperm are found after 6 months the procedure is considered a failure and a repeat is considered.
Reversal: microsurgical joining of vas to vas (vasovasostomy) or vas to epididymis (vasoepididymostomy), chosen at surgery according to the appearance of the vasal fluid. Success falls as more time passes since the vasectomy, especially beyond 15 years. An alternative to reversal is sperm retrieval from the testis or epididymis and IVF. Vasectomy does not noticeably affect testosterone, libido or semen volume. Before the procedure the scrotum is examined to confirm that both vasa are palpable, and a man with chronic scrotal pain, a large varicocele or a hydrocele gets specific counselling. The procedure is usually done under local anaesthesia in the clinic, and the patient returns to normal activity within a few days.
Key points
- Permanent contraception.
- Sterility is not immediate.
- Semen analysis after 8 to 16 weeks.
- Chronic pain in 1 to 2 percent.
- Reversal is possible; success falls with time.
Summary table
| Topic | Point | Value |
|---|---|---|
| Sterility | Not immediate | Continue contraception |
| Post-vasectomy semen analysis | Azoospermia or non-motile sperm | 8 to 16 weeks; up to 100,000 per mL |
| Chronic pain | Not a rare complication | 1 to 2 percent |
| Late failure | Rare | About 1 in 2000 |
| Reversal | Vasovasostomy or vasoepididymostomy | Success falls after 15 years |
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Sources
- AUA Guideline: Vasectomy, 2012, amended 2015 — Counselling, technique and post-vasectomy semen analysis
- EAU Guidelines on Sexual and Reproductive Health, 2025 edition — Male contraception
- Campbell-Walsh-Wein Urology, 12th edition (2020) — Vasectomy and Vasectomy Reversal
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.