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Vasectomy  - General Information Vasectomy - In Dr. Stein's Practice Vasectomy is ... Dr. Stein's Technique Before vasectomy ... Instructions for Before & After Vasectomy Methods used to perform vasectomy Fees After vasectomy ... Financial Aid Risks of having a vasectomy ... Scheduling Your Vasectomy Limitations and advantages of vasectomy Counseling Video

FAQ's: No Scalpel? No Needle? No Laser? Tiny hemoclips? Pain after vasectomy? Can it fail? Open-ended? Is it reversible? What's a VasClip®? Age restrictions? Vasectomy is... Developed as a means of contraception very early in this century, and popular (500,000 procedures per year) since the 1950's, vasectomy is a dependable method of birth control for men who think they will never want any or any more children.  It is a simple 15 minute procedure performed in a doctor's office or clinic with a local anesthetic.  The objective is to prevent sperm from entering the semen, 95% of which is support fluid made by glands called the prostate and seminal vesicles, located in the pelvis behind and beneath the bladder (anatomy diagrams). Be her hero!

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.

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After Vasectomy... The portions of the vas tubes within the pelvis still contain live sperm until they are all released. About 95% of men are sperm-free after 20 ejaculations and 8 weeks.  In 5% of men, the semen may still contain some sperm (usually few in number and not active) for months, so it is important to have a semen sample checked and to use other forms of birth control until it is confirmed by microscopic examination that the semen is sperm-free.

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:

No change in the semen No change in sex drive No change in climax sensation No change in the testes or scrotum No change in erections   For more details about changes after vasectomy in our patients, please see the results of our 2006 survey.
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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. Periodic tenderness usually responds to an anti-inflamatory medication like ibuprofen, but over the past decade, 5-10 men been so troubled by chronic tenderness that they chose to undergo removal of the lump, an office procedure performed under local anesthesia similar to the original vasectomy.

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 (PVPS or Post-Vasectomy Pain Syndrome) 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 about one in 2000 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.

Dr. Stein's Technique:

No-scalpel ... and no-needle!

Dr. Stein uses the no-scalpel technique, exposing each vas in turn through a tiny opening in the front scrotal wall under local anesthesia. Since the opening is so small, it is easy to apply anesthesia without the use of needles. A spray applicator (MadaJet^®) delivers a stream of anesthetic so fine that it penetrates the skin and diffuses to a depth of about 3/16 of an inch, enough to surround and anesthetize each vas tube in turn as it is lifted into position beneath the skin. Most, about 99%, of patients require no more anesthetic than this for completion of the procedure itself without pain. Some, about 1%, of patients do require injection of a little more anesthetic, but since the skin and vas are already partially numb, injection of more anesthetic with a fine needle rarely causes more than the slightest sensation. The tiny opening in the dime-sized area of numb skin is made with a pointy hemostat: one tip makes a pinpoint opening, then the two tips are used to spread and enlarge the opening to about 1/4 of an inch. Since blood vessels in the skin are spread apart rather than cut, bleeding is less than when a scalpel is used, no stitches are required, and the opening is usually sealed closed (often barely visible) by the next day.

Once each vas tube is lifted through the small skin opening, it is divided under direct vision with fine surgical scissors. Nothing is removed; the ends of the divided vas are placed out of alignment and kept from rejoining by applying a tiny clip to the sheath surrounding the vas so that one end stays inside the sheath, the other outside. While extremely effective (failure rate less than 1 in 2000), the technique provides for easier reversal (less scarring than when sutures are used) in men who choose reversal later in life. Procedure time is about 15 minutes. Most men say it hurts less than having a blood sample drawn. Many have called it painless. (In an e-mail, one patient recounted his experience step-by-step here.) A scrotal support (jockstrap) is applied and should be worn overnight and reapplied, after a next-morning shower, when up and around for the next 2 days. Ice-packs are not necessary. Men are advised to recline on the evening of the vasectomy, light activity the next day, sex and full activity 2 days after the vasectomy. After vasectomy about half of men will take non-prescription pain pills (Tylenol or ibuprofen), often just to prevent expected discomfort; the other half don't take any pain pills. About 1 in 1000 men will have enough discomfort to request a prescription pain medication. Semen samples can be brought or mailed (we provide the mailers) to the office two months after the procedure to see if all stored sperm have been passed. Ninety-five percent of men are sperm-free after 8 weeks and 20 ejaculations, some sooner, and a few men will not be sperm-free for 5 or 6 months. Evaluation of semen samples is included in the price. A copy of our vasectomy instructions and consent are available below and here as a PDF file, so you can open and print a copy with Acrobat Reader^®, available here as a free download if you don't already have a copy of Acrobat Reader^® on your computer.

INSTRUCTIONS BEFORE VASECTOMY

1. Understand the "Instructions Following Vasectomy" below so that you know what to expect.

2. Please shave the underside of the penis and the front wall of the scrotum, preferably before the day of the procedure. A bit of alcohol is used to clean the skin before use of the MadaJet® and it can sting slightly right after a fresh shave if the skin is chafed.

3. Use no powder or deodorant in the genital area on the day of your procedure.

4. No need to bring an athletic supporter. One will be provided.

5. Be prepared to sign the operative consent sheet (part of the PDF file in the paragraph above) upon your arrival in the office.

6. If possible, arrange to have someone drive you home.  If you must drive yourself, a flat tire or fender bender could lead to complications. Plan to do nothing but recline at home (sofa or bed) on the afternoon and evening of the vasectomy.

7. Do not take any aspirin-containing medication for five days before the procedure.

8. If your insurance company or HMO requires authorization, be sure to bring it or call our office (813-972-1365) a day or two before your vasectomy to see whether we have received it. If your procedure is covered through a county health department under Title 10 (see below) and scheduled at a facility outside the health department, call us to be sure we have received the paperwork.

9. To save time on your procedure day, please watch the Online Counseling Video and complete our Online Registration Form.

10. Eat before your procedure, a normal breakfast or lunch. Nervous men who do not eat beforehand are more likely to become lightheaded during or after their vasectomies.

11. Prior to the procedure, payment of $490 is required of those paying cash, $100 deposit when making the appointment and $390 immediately before the procedure. At the time of service, no co-payment is required of those in health plans with which we have a contract. After we hear from your insurance carrier, we will refund your deposit less your co-payment/deductible, or we will send a bill if your deductible is higher than the $100 deposit.

INSTRUCTIONS FOLLOWING VASECTOMY

Fees

VISA & MasterCard are accepted at the Tampa office and at all Planned Parenthood locations, but are not accepted at the Private Offices indicated by green stars on the Florida map on the home page.
*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.
**According to the Federal Tax Code, the expenses of attaining medical treatment to correct a functional impairment (sterility in the case of vasectomy reversal) are tax-deductible once the total medical expenses for the tax year (including what is spent for health insurance) exceeds 7.5% of adjusted gross income. This includes the reversal fee, airfare, mileage expenses at $0.50 per mile, and lodging expenses up to $50 per night.

At all locations, a deposit of $100 is required to schedule a vasectomy, unless your procedure is being covered under Title 10 (see below) through your county health department. The deposit is fully refundable until 7 calendar days prior to the appointed vasectomy date, non-refundable thereafter for either cancellation or postponement. Later cancellations leave us with open appointments that might gladly have been taken by men who had to choose later dates because of full schedules on earlier dates, but those same men cannot take open dates with less than one week notice.

Financial Aid...

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.

Scheduling

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 to thoroughly discuss the issues here.)  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 & 6 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 Karin 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, Manatee, Hardee, 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 Alachua, Marion, Polk, Hillsborough, Sarasota, Lee, Collier, Indian River, St. Lucie, Martin, and Broward 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. (Please do not hit SUBMIT more than once. Contact our office if there is any doubt that the registration went through.)

Send vasectomy questions via our Visitors Page, or call 813-972-1365 or toll-free 866-VAS-TIME (that's 866-827-8463). 
Dr. Stein answers queries to the Visitors Page from home and can usually respond within 24 hours.
Thank you.
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