Low-cost No-Needle No Scalpel Vasectomy in Florida

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.

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 divided about one inch above each testis, where it is just beneath the thin scrotal skin and very easy to reach. 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 24,000 vasectomy patients served by Dr. Stein, six 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. Four 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-inflammatory 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 or neurolysis (division of the sensory nerves coming from the testes). 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 twelve (12) weeks after the procedure to see if all stored sperm have been passed. Ninety-eight percent of men are sperm-free after 12 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.

1.	Spend a quiet evening at home, reclining in bed or on the sofa. Minimize activity.
2.	You may take acetaminophen (Tylenol^® or generic) or ibuprofen (Motrin^®, Nuprin^®, Advil^®, or generic) for any discomfort. Avoid aspirin for 2 days after the vasectomy.
3.	No need for ice packs.
4.	You may remove the scrotal support and take a daily shower starting the morning after the procedure. Replace the scrotal support and wear it whenever you are up and around for the next 2 days, during sports for the next 7 days.
5.	On the day after the procedure, you may walk and drive as much as you like, but no sports, yard work, swimming, or heavy lifting. Men with non-strenuous jobs may work the next day.
6.	Two days after the procedure, you may return to rather strenuous work and regular activities wearing your scrotal support. Wait 3 days for aggressive sports like basketball and tennis, and wear the scrotal support during sports for a week..
7.	You may have sex 2 days after the procedure. It is uncommon but normal to have some blood in the semen for the first few ejaculations.
8.	Since no incision is made, a follow-up visit is not required. You will be given Dr. Stein's home phone and cell phone numbers and if you have undue discomfort or any concerns, you should call him anytime after your vasectomy.
9.	It is normal to have some discoloration of the skin (black and blue) around the puncture site a day or two after the vasectomy. Some men will develop considerable discoloration of the scrotum about 4 days after the vasectomy. Blood from the deep vasectomy site comes to the surface as a purplish-blue mark, gets darker and spreads out like an oil slick, then gradually dissipates.
10.	Some men (about one in 20) will develop swelling and discomfort on one side, sometimes on both sides, starting anytime from 3 days to 3 months following vasectomy. This usually represents an exaggerated form of the normal inflammatory response necessary for sperm resorption and recycling. It is effectively managed with a 5-7 day course of ibuprofen 600 mg 3 times per day.
11.	Twelve weeks after your vasectomy, have your semen tested to be sure that it no longer contains sperm and that it is thereby safe to stop other forms of contraception:
	a.	If your vasectomy is performed at a location other than the home office in Tampa, we will provide you with a mailer so you can send us a semen sample by mail, at least twelve (12) weeks and 20 ejaculations after your vasectomy (number of ejaculations and number of weeks are both important). The container provided contains a bit of antibiotic so that the sample does not become overgrown with bacteria. Call us at 813-972-1365 a few days later for the results.
	b.	If your vasectomy is performed at the home office in Tampa, testing is done in one of three ways:
		i.	If you live or work close to the office, we will provide you with a container and ask you use it to bring a semen sample to the office 12 weeks and 20 ejaculations after your vasectomy. (Number of ejaculations and time are both important, so a semen sample brought in before 12 weeks is less likely to be free of sperm.) If you lose the container that we provide, you may use a small container with a lid, such as a pill bottle, baby food jar, 35 mm film canister, etc. Please do not bring the sample in a condom or baggie as we will be unable to retrieve an adequate specimen and you will be asked to return with another sample in a container with a lid. The sample should be produced on the day of examination, but can be 3 or 4 hours old. You may bring the sample anytime during regular office hours (9:00 - 6:00), and we will tell you within 5 minutes if you are sperm-free. If sperm are seen, you will be asked to continue other means of birth control and to return with a second specimen in 2-3 weeks. After twelve weeks and 20 ejaculations (both), 98% of men will have no sperm in their semen. Two percent will have to repeat the test at least once.
		ii.	If you live and work far from the Tampa office, we will provide you with a mailer so you can send us a semen sample by mail, at least twelve weeks and 20 ejaculations after your vasectomy. The container provided contains a bit of antibiotic so that the sample does not become overgrown with bacteria. Call us for the results at 813-972-1365 five days after you mail the specimen.

Fees

Description	Fee
Vasectomy consult and procedure	$490*
Vasectomy reversal consult	$50
Vasectomy reversal	$4900**

On Monday, February 20 and Tuesday, February 21, 2012 at his Tampa office, Dr. Stein will host a training day for Michelle Shelly, MD, a Doctor of Family Medicine in Goshen, Indiana. Dr. Shelly would like to offer vasectomy services to couples in the Goshen area. Observation is helpful, but there is no substitute for "hands-on" training. Vasectomies performed while Dr. Stein trains another physician usually will take about 30 minutes, whereas Dr. Stein's routine vasectomy procedure takes 10-15 minutes. So we are looking for men with patience and a desire to save $100.00 (20%) off the usual vasectomy fee. Since Drs. Stein and Shelly will work together on each patient, there should be no increased risk of either complications or pain, but there will be more manipulation of the vas tubes as Dr. Stein shows Dr. Shelly how to position and access the vas on each side. Patients will hear Dr. Stein explain the procedure. Some hardy men will even be interested enough to lift up on their elbows and observe, which is always fine with Dr. Stein. Because of the reduced rate and the need for men who are not likely to postpone to a later date at the last minute (Dr. Shelly cannot learn on men who don't show up), we ask for a non-refundable deposit of $100 at the time that February 20 & 21 procedures are scheduled. Thank you.

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. If you are scheduled to have a vasectomy at one of these Private Office locations, use may pre-pay with Visa or MasterCard by calling the Tampa office at least one day in advance with your credit card information.

*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 is a contracted provider with the WellCare plans called HealthEase and StayWell. If you are insured through a Medicaid HMO, you will require a special referral authorization from your primary care physician.

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

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 AM & 6 PM M-F. They can also answer many technical and logistical questions.

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.)

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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Limitations of Vasectomy... Not 100% reversible * Must use other forms of birth-control until sperm-free. Does not prevent transmission of sexually transmitted infections (STI's).	Advantages of Vasectomy... Low one-time expense often covered by insurance companies, and by federal grant money through state programs for low-income men with no insurance (see Florida Providers). More dependable than any other form of contraception including female sterilization. Eliminates risks associated with birth control pills or shots and the IUD. Vasectomy reversals are less costly and more successful than tubal ligation reversals (see Vasectomy Reversal). No need for inconvenient and less dependable methods, so there are... no more worries!!!!

* - Since reversal attempts often do not lead to pregnancy, vasectomy should be considered an irreversible form of contraception. Statistics show that men who undergo vasectomy in their 20's are more likely to seek vasectomy reversal than men who have vasectomies later in life. In fact, men in their 20's and with fewer than 2 children should read Dr. Stein's Special Message for young men. Before choosing vasectomy, couples, especially couples in their 20's with fewer than 3 children, should consider all other forms of reversible contraception including birth control pills, shots, and patches; the IUD (intrauterine device); and barrier methods such as the condom and diaphragm. Couples using barrier methods should also be aware that, for those occasions when they are just "careless", EC (emergency contraception, or the "morning after pill") is readily available at most women's health services sites such as private primary care and gynecology offices and Planned Parenthood clinics. EC is effective at preventing pregnancy for up to 72 hours (perhaps longer) after the "careless" encounter (visit www.not-2-late.com for a list of EC providers in your area). Men should not proceed with vasectomy if they feel they are being pressured to do so, if their private lives are temporarily unstable due to marital discord, or if they have not considered all reversible alternatives. For many stable men, circumstances change, and all men, especially younger men, should consider sperm storage as insurance against regret over vasectomy in the event of a major life change.
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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 they need it, the procedure code is 55250; the diagnosis code is V25.2.) Be sure that you make it clear that this is an OFFICE procedure and NOT an OUTPATIENT procedure (to insurance companies, "outpatient" means done in an outpatient operating room facility). [If vasectomy is not covered under your plan and if your income is low, 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?
Get the name of the person with whom you speak. We bill insurance companies $600, as opposed to $490 for direct pay patients. If you are told that you have coverage under your plan, and the company denies our claim, we will bill you directly, the same amount that we bill insurance companies. It's important that you have the name of the company representative, so that he or she can be held accountable. Only your insurance company (not even someone in our office) can verify if Dr. Stein is a provider under your specific plan because provider lists change frequently as insurance companies merge and split. (As of February 2011, Dr. Stein is a contracted provider under many plans offered by, among others, the following companies: Blue Cross PPOs, Cigna PPO and HMO, AvMed, United HealthCare, Aetna, Coventry, and Beech Street.)

Vasectomy is...