Before Vasectomy...Sperm are made in the testes. From each testis, sperm move through a long curled-up tube behind the testis (the epididymis) wherein they become mature. From there, they swim up a foot-long tube (the vas) which guides them up to the channel (urethra) through which men urinate and ejaculate. Just before entering the urethra, the left and right vas tubes are enlarged, and it is here, behind the bladder, where many sperm are stored between ejaculations. The easiest place to access the vas tubes is just above the testes where the vas tubes are just beneath the thin scrotal skin, easy to feel and very mobile. Methods... (Dr. Stein's preferences are below) Anesthesia: An anesthetic solution can be injected with a tiny needle to numb the scrotal skin and the vas tubes, or a pressure spray applicator can be used to numb the skin and vas tubes without using any needles. Access: During conventional vasectomy, one or two 1/2-inch scrotal incisions are made to gain access to the vas tubes. These incisions are later closed with sutures, which remain in place for about 5 days until they dissolve or are removed. During no-scalpel vasectomy (NSV), special instruments are used to perform the procedure through a single tiny access-opening on the front side of the scrotum. The 1/4-inch slit usually seals within hours, so no stitches are needed. Blocking the vas tubes: Whichever technique of accessing the vas tubes is used, each vas (left & right) is either pinched closed or divided about one inch above each testis, where it is just beneath the thin scrotal skin and very easy to reach. A relatively new device called a VasClip® (click for details) can be used to pinch the vas closed without actually dividing it. Alternatively, the vas tubes can be divided, and what is done with the ends of the divided vas tubes depends on the preference of the person performing the vasectomy. Some operators remove a piece of vas; others don't. Some tie off one or both vas ends using permanent or absorbable sutures or the small clips used to stop bleeding blood vessels during other types of surgical procedures; others cauterize the ends so that they will seal by scarring. Still others simply place the divided ends out of alignment, by closing the vas sheath between the 2 ends with a suture or tiny clip so the ends won't grow back together. Sperm are still made by the testes but can no longer pass up through the vas tubes (anatomy diagrams). So the body adjusts: white blood cells ingest and digest the retained sperm, recycling the proteins back into the system for use in other body functions. Men usually notice:
Risks...Bleeding can occur during or after vasectomy by either method, but it is less common with NSV. If this occurs within the scrotum, drainage of a scrotal hematoma (blood clot) in a hospital operating room could be necessary. Smaller hematomas do not require surgical drainage, but tender swelling can last for 2 to 4 weeks. Both large and small hematomas are very rare. If the scrotal skin bleeds at the vasectomy access site, the scrotum can become discolored (black and blue) for about a week; this is more common than swelling, but painless. Infection is also a rare complication. Among the first 16,000 vasectomy patients served by Dr. Stein, four infections have occurred (infection rate 1 in 4000): two patients had prolonged discomfort and progressive swelling on one side, not responsive to oral antibiotics, eventually maturing to a painful walnut-sized abscess requiring office drainage through a half-inch incision and a two-week period of local wound care. Two other milder infections (swelling unresponsive to anti-inflammatory medications) responded to oral antibiotics. Sperm granuloma is a pea-sized (sometimes tender) lump on the vas tube at the vasectomy site, almost never requiring treatment. Some consider sperm granulomas beneficial, as they may increase the likelihood of success with vasectomy reversal. Congestion, tender buildup of sperm and white blood cells upstream from or at the vasectomy site, can occur anytime after vasectomy, but usually goes away with use of an anti-inflammatory drug such as aspirin or ibuprofen. About one in 2000 patients will experience chronic post-vasectomy discomfort severe enough that he will seek vasectomy reversal. A larger percentage may have milder forms of chronic pain that can affect quality of life but not severely enough to seek vasectomy reversal. Recanalization is the development of a channel for sperm flow between the two cut ends of the vas. If this happens during the healing process (early), the semen never becomes sperm-free until the vasectomy is repeated. If recanalization happens late (months or years after a man's semen has been examined and declared sperm-free), an unplanned pregnancy could result; but the odds of this occurring is far less after vasectomy than the odds of pregnancy with any other form of birth control including birth control pills and tubal ligation (female sterilization). Failure rates of vasectomy vary with the technique used to obstruct sperm flow through the vas tubes. In our practice, the early failure rate is one in 3000 and the late failure rate is one in 4,000 (details here). There are no proven long-term health risks (neither cancer nor cardiovascular disease) associated with vasectomy, but since questions have been raised, they are addressed in our page of Frequently Asked Questions.
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| Description | Fee |
|---|---|
| Vasectomy consult and procedure | $390* |
| Vasectomy reversal consult | $50 |
| Vasectomy reversal | $3900 |
VISA & MasterCard accepted.
*This is a discounted rate for patients who pay with
cash, check, or charge card. When we apply for payment to insurance companies, a higher
standard rate structure is used. Because of this discrepancy
in fees, we are required by Florida statute to inform you of the following:
THE PATIENT AND ANY
OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL
PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR
TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO
THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE,
EXAMINATION, OR TREATMENT.
| Private Health Insurance | ||
| Health insurance often covers vasectomy. Health insurance COMPANIES sell a variety of health insurance PLANS. Within the same company, some plans may cover and others may not. If you have private health insurance (as opposed to Medicare or Medicaid), call your insurance company (the phone number should be on the back of your card) or check with your primary care physician. Here are the important questions: | ||
| 1. | Is vasectomy covered under my plan? [If not, you may seek assistance under Title 10 (see below) or plan to cover the cost yourself.] If vasectomy is covered ... | |
| 2. | ... Do I have a deductible and how much of that have I already met this year? (Your deductible may be higher than our "cash" fee, in which case we can give you a receipt for payment that can be applied toward your deductible.) If I don't have a deductible or if I have already met it ... | |
| 3. | ... Does my plan require that I use only "network" doctors contracted with the plan? If so ... | |
| 4. | ... Is Dr. Stein one of the contracted providers under my plan? If not ... | |
| 5. | ... Is there any "out-of-network coverage" for procedures by doctors who are not in the plan's network? | |
Medicaid
We have learned that, when it comes to procuring vasectomy
services, Medicaid can be more of a hindrance than a benefit. Some county
health departments will deny Title 10 funding for patients who are on straight
Medicaid or enrolled in Medicaid HMO's. Medicaid has a reputation of paying so
slowly that few doctors wish to participate. Certain county health departments
participate, but they may require referral authorizations from the Medicaid
primary care physicians, and getting a referral authorization may be
discouragingly slow. Dr. Stein is a Medicaid provider of vasectomy
services in our Tampa office and in the Planned Parenthood and primary care
offices (not the county health department clinics) listed in our schedule
page. Under the Medicaid
plan, there must be a 30-day interval between the date that a man signs a
consent form for vasectomy and the date of the procedure.
Consent forms are signed during consultation visits. Medicaid patients may have
their consultation and procedure visits in different locations if desired.
Medicaid tries to shift all Medicaid patients to Medicaid HMO's,
sometimes without the Medicaid recipient even being aware of the shift. Dr. Stein does
not currently have a contract with any Medicaid HMO's. If you
are insured through a Medicaid HMO, you will require a special referral
authorization from your primary care physician, who may (1) require that you
obtain services from a physician contracted with that HMO, or (2) authorize
payment for services by an "out-of-network" physician, such as Dr.
Stein.
Title X (Ten)
If your income is low and you have no health insurance
that covers vasectomy, Federal Title X (Ten) grant money is available in Florida and nationwide to help fund
vasectomy services. Most if these federal Title X funds are allocated through
county health departments. Please see our Guide
to Florida Health Department Vasectomy Programs. If you live in a county whose health
department has no vasectomy program or no federal funds available for vasectomy,
you may apply for financial aid through the health
department of a neighboring county.
Tampa Office:
At our Tampa office (click for location and directions), we have 30 time slots available for vasectomy most weeks, so we can usually see any candidate within one week of his call.
Because there is so much information here in vasweb.com, especially with the online counseling video, we do not require preliminary consultation visits and most men opt for only one visit. If you would like to visit the office and meet Dr. Stein personally before deciding to proceed, we would be delighted to see you twice. (In fact, Dr. Stein prefers to consult with childless men in their 20's either in person or by telephone at least one week before their vasectomies.) If the consultation and vasectomy are on separate days, either can be done on any weekday. At the Tampa office, Tuesday, Thursday, and Friday afternoons are the designated vasectomy times, but we will try to accommodate your schedule if these times are inconvenient for you. Consultations take 10-15 minutes and vasectomies take 15-20 minutes.
All scheduling is done by Vivian and Karen at 813-903-1902 (or toll-free 866-827-8463) between 9 & 4 Eastern Time M-F. They can also answer many technical and logistical questions.
Outfield Locations:
As you may have seen in the Florida map on our Index Page, Dr. Stein performs vasectomies at a number of locations in peninsular Florida. A complete schedule with links to maps and information about these locations is in our schedule page. Scheduling of consultations at county health departments is done by the health department staffs. Scheduling at all other locations is done through Dr. Stein's office by Vivian and Ana at the numbers above. (Note: Some county health departments served by Dr. Stein like him to do the procedures at a health department facility, in which case they do the procedure scheduling. Examples include Hernando, Pasco, Pinellas, and Charlotte Counties. Others prefer to have Dr. Stein perform the vasectomies at his non-county locations, in which case his office does the procedure scheduling. Examples include Marion, Polk, Sarasota, Lee, Collier, and Indian River Counties.)
Registration:
When you arrive at either the Tampa office or at one of the outfield locations (except county health departments), you will be asked to provide demographic and health history information as you are at any doctor's office. You may now register online before your visit. The benefits are numerous and listed in our On-line Registration Page.
Send vasectomy questions via our Visitors Page, or call toll-free 866-VAS-TIME
(that's 866-827-8463).
Dr. Stein answers e-mail from home and can usually respond within 24 hours.
Thank you.
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