Vasectomy in men: procedure and costs

In addition to the classic contraceptive methods such as condoms and the pill , couples also resort to sterilization to prevent pregnancy. In women, during sterilization, the fallopian tubes are severed in a surgical procedure. In men, a vasectomy, i.e. a severing of the vas deferens, provides a permanent form of contraception. We have summarized more about female sterilization in the following article:

How is the vasectomy performed?

A vasectomy is usually performed on an outpatient basis in a urology practice, either by the urologist himself or, in rare cases, by a surgeon. During the procedure, the scrotum is given a local anesthetic and two small incisions are made on the back to expose the vas deferens. Then a piece about one to three centimeters long in the middle of the vas deferens is pinched off and removed. Depending on the surgical method, the interfaces are welded, sclerosed or sewn up with electricity to close the ends. The incisions in the scrotum are then usually sewn up with self-dissolving threads so that they do not have to be pulled out after the healing phase.

A vasectomy usually lasts between 20 and 60 minutes. The healing time is about 2-3 weeks, during which no sexual intercourse should be practiced. Even if the vasectomy is only a minor operation, it should be well thought out by the partners. A detailed consultation with the doctor treating you is absolutely necessary in advance. There are also various counseling centers that provide information about the consequences of the procedure and can explain the effects on family planning to both partners.

Is a vasectomy risky?

In general, it can be said that a vasectomy in men entails far fewer risks than tubal sterilization. Despite this, some problems may arise after the procedure.

• During the operation, the blood vessels in the testicles can be injured, for example, which can result in painful hematomas. Infections of the surgical wounds can also occur in some cases. However, these symptoms are only temporary.
• Even persistent problems such as recurring inflammation of the epididymis are not exceptional cases, since the sperm can no longer be discharged and thus cause the epididymis to swell temporarily.
• About 5 to 33% of the operated men experience chronic pain in the testicles. This can be caused, for example, by nodular accumulations of sperm below the severed areas or by adhesions between the spermatic cord and the skin. The resulting scar tissue can then cause nerve irritation, which can lead to pain during exertion or sexual activity. In this case one speaks of the so-called “post-vasectomy pain syndrome”.

However, contrary to what many men fear, a vasectomy has no effect on sexual desire or the ability to have an erection. The ejaculate also remains largely unchanged in terms of quantity and texture, it just no longer contains any sperm.

How reliable is vasectomy?

It is important to note that the desired protection is not provided immediately after the procedure. Even after several months, the semen may still contain fertile sperm that were formed before the spermatic ducts were severed. For this reason, the attending doctor checks the success of the operation using several spermiograms before additional contraceptive methods can be dispensed with. Only if no sperm, neither dead nor alive, are detected in two samples, is protection really guaranteed.

Vasectomy is considered a very effective contraceptive method. The Pearl Index, which indicates the safety of a contraceptive method, is 0.25 for vasectomy. This means that only one in 400 men who have the operation is still fertile despite the procedure. For comparison: the Pearl Index of the pill is 0.1-0.9.

In rare cases, unwanted refertilization can occur after a vasectomy, for example due to the severed vas deferens growing together. As a result, the vas deferens become passable again for sperm and the man is fertile again.

Is a vasectomy permanent?

In principle, it is possible to reverse a vasectomy. In a microsurgical operation, the severed vas deferens are reunited. In most cases, this can restore sperm permeability. However, the longer it has been since the intervention, the less likely it is that fertility can be restored. This is because after the vasectomy, the body continues to produce sperm but can no longer drain it. These sperm are gradually resorbed by the tissue and thus enter the blood. The immune system then forms so-called auto-antibodies against its own sperm, which affects their fertility.

For this reason, too, many doctors do not like to perform sterilization on very young men under the age of 30, since at this age it is still quite common for long-term family planning to change again.

How much does a vasectomy cost?

The cost of the procedure varies from doctor to doctor, but is usually around 300 to 400 euros. Since 2004, the costs for sterilization are no longer covered by health insurance companies. Only if there is an absolute medical indication, for example in the case of serious hereditary diseases, will both private and statutory health insurance companies cover the costs of the procedure. If the vasectomy is used solely for family planning, the interested parties must bear the costs themselves. However, the statutory health insurance companies will at least cover the costs for the preliminary and follow-up examination as well as for any medication or sick leave that may be required.

At an average of 3,500 euros, subsequent refertilization is significantly more expensive than the procedure itself. This is not the only reason why the decision to have a vasectomy should be carefully considered.