Risks

• Risks with vasectomy are few. No death has ever been attributed to this procedure. On the other hand, tubal ligation, a frequently performed surgical sterilization procedure in women, is associated with no fewer than 20 deaths per year. These unnecessary deaths occur because of the risks of the procedure itself, anesthesia complications, and increased ectopic pregnancy rates.

• Complications with vasectomy are usually related to bleeding or infection. Prolonged pain sometimes occurs as a result of inflammation along the vas due to sperm leakage (sperm granuloma) or congestion of sperm at the epididymis (epididymitis). These conditions usually go away with rest and anti-inflammatory medication.

• Some earlier studies suggested that vasectomy may be associated with an increased risk of heart disease and prostate cancer. According to the National Institutes of Health, research that examined this issue found no evidence that men with vasectomies were more likely than others to develop heart disease or any other immune illness. Other studies, including a recent study of 2,000 men, have shown that the risk of prostate cancer is not increased among vasectomized men.

• Fears about the procedure: Fear can prevent a man from choosing a vasectomy. The following issues are addressed to help a man understand that a vasectomy procedure is simple and safe:
  
  
  • Fear of pain - Men don’t like to think of any procedure near their genitals. Fact: What men need to understand is that an anesthetic is used to numb the area. There is usually no pain or just some pulling after the anesthetic is given. The procedure is usually so well tolerated that upon completion of the procedure, men are frequently surprised that it is over.
    
    
  • Fear of loss of masculinity - Fact: A vasectomy does not affect manliness. A vasectomy does not affect the blood and hormone supply to the penis. The amount and appearance of semen ejaculated will not change noticeably. Of course, during the recovery process, men may be sore, thus making sex less desirable. Later, some men report that sex is actually more enjoyable without the threat of pregnancy. Women may appreciate that their partners have chosen to take the responsibility for sterility (permanent birth control).
    
    
  • Fear of failure of the procedure - Fact: Except for complete abstinence, no method is more effective than vasectomy in preventing pregnancy.

• Alternatives: Before choosing a vasectomy, a couple should seriously consider the many alternative methods of contraception (birth control). Table 1 shows that the effectiveness of each of the methods can vary greatly. For a more complete description, visit vasectomy.com.

  Table 1. Theoretical and Actual Success Rates With Various Methods of Contraception

  Method	Used by	Theoretical Failure Rate*	Actual Failure Rate†	Advantages	Disadvantages
  Vasectomy	Man	0.02-0.1%	0.02-0.2%	Very high effectiveness; no cumbersome methods to use before or during intercourse	Should be considered permanent; some risk of infection
  Tubal ligation (tying off tubes)	Woman	0.2%	0.2-0.4%	Comparable in effectiveness to vasectomy	More expensive and complicated than vasectomy with higher surgical risk
  Birth control pill (combination)	Woman	0.1%	0.16-3%	High success rate; no loss of sensation; other established health benefits	Side effects can be significant
  Condom	Man	1-3%	1-33%	No side effects; adds protection from sexually transmitted diseases	Reduced sensation; risk of pregnancy if not used correctly; application cumbersome
  Diaphragm	Woman	1-6%	1-21%	No loss of sensation	Prescription required; application cumbersome
  Spermicidal jelly, foam, cream, or suppositories	Woman	3%	13-28%	No serious side effects or loss of sensation; prescription not required	Cumbersome; lower effectiveness
  Hormonal implants	Woman	0.2%	0.2%	High effectiveness; 1 implant lasts up to 5 years	Requires surgical insertion and removal; irregular vaginal bleeding
  Intrauterine device (IUD)	Woman	0.6-1.5%	0.5-3%	Onetime application; high success rate; no loss of sensation	Prescription required; some side effects
  Natural family planning (rhythm method)	Both partners	1-3%	14-47%	Nothing to buy or apply	Requires abstention for 5-15 days per month; high risk of pregnancy
  Withdrawal	Man	4%	19%	Nothing to buy or apply	Reduced satisfaction; high risk of pregnancy
  No method	Both partners	85%	85%	Nothing to buy or apply	Play now, pay later

  *Theoretical failure rate signifies rate when method is used correctly over a 1-year period.
  †Actual failure rate signifies rate when method is used routinely over a 1-year period.

  In countries with a high rate of vasectomies, such as Canada and New Zealand, two thirds of couples choose vasectomy over the alternative surgical contraception of female tubal ligation. In the United States, one third of couples choose vasectomy, while two-thirds choose tubal ligation. Efforts are presently under way in the United States to inform couples that vasectomy is much safer and easier than tubal ligation.

  Table 2. Comparison of the Two Most Common Permanent Sterilization Procedures: Vasectomy and Tubal Ligation

  Consideration	Vasectomy	Tubal Ligation
  Useful duration	Permanent/long term	Permanent/long term
  Failure range	0.02-0.2%	0.73-1.85%
  Insurance	Usually covered	Usually covered
  Type	In-office procedure	Hospital or surgery center
  Time required	30 minutes or less	1 hour or more
  Anesthesia	Local	General
  Postoperative care	Return home immediately	May require overnight stay
  Time off work	48 hours or less	4-7 days
  Cost	$350 - $1,000	$1,000 - $3,500
  Pain	Mild pain, soreness, bruising, swelling, inflammation	Significant pain, chronic pelvic pain in some women
  Risks	As associated with reaction to local anesthesia	As associated with major surgery and use of general anesthesia
  Complications	In rare cases, infection or hematoma	As with any surgery, possible bleeding, infection, and even death