The first article in a week-long series on vasectomies features a Q&A with Dr. Stephen Siegel on pain, myths, procedure, and permanence
Now that the new year is no longer new, we here at the Dads & Families section are celebrating an end of new beginnings with Vasectomy Week. First up on the table is Dr. Stephen Siegel, who is a diplomate of the American Board of Urology (board certified), an honors graduate of Duke University and Vanderbilt University School of Medicine. Dr. Siegel completed his general surgery training and urology residency at Yale – New Haven Hospital. Not only has he performed over 2,000 vasectomies, he had his done eleven years ago, after his third daughter was born. A father of three girls, Dr. Siegel practices at Urology Specialists, in Middlebury, CT.
GMP: The most common fear about vasectomy is the pain; what can men generally expect?
Dr. Siegel: Biggest problem that I see is that it is usually healthy young guys having vasectomies—they are not used to going to the doctor for anything, much less choosing to go for an elective procedure, with them wide awake and especially not “down there.” So their fear and anxiety is the biggest obstacle to overcome. Pain is not usually a major issue. There is a pulling sensation but not true pain like we usually think of pain.
GMP: Can you give a step by step of how it goes?
Dr. Siegel: I meet with the patients to go through the specifics of the procedure, to try to calm their anxieties and to talk about the main risks of the procedure—bleeding afterwards, infection, recanalization, and the old paper that [falsely] linked prostate cancer to vasectomies. I suggest that they wear tight underwear to the procedure for comfort afterwards. The day of the procedure they do not need to fast and I do not pre-treat them with any medication. I often invite their wives back to observe the procedure either for moral support or to harass them enough to reduce some of the anxiety. They should go straight home after the procedure—ice (a lot of guys use bags of frozen peas) on and off for the rest of the day and night, take it easy for the first 34 hours, no heavy lifting for 5-7 days (greater than 20lbs). It is OK to return to protected sex after 3-4 days. No unprotected sex until we get a semen sample that shows no sperm—the first one is checked usually 6-10 weeks after the vasectomy.
GMP: What are the most common myths about vasectomies?
Dr. Siegel: I often have patients ask if I do a “laser” vasectomy because that is “what my friend had.” Laser vasectomy does not exist. The least invasive procedure is the “No Needle, No Scalpel” Vasectomy. “No Needle” means rather then injecting the skin and vas to numb it up, we have a spray gun (looks like a fountain pen) that sprays lidocaine fast enough that it penetrates through the skin numbing the skin and the vas underneath.
The “No Scalpel” part is a great marketing phrase that states that we don’t use a scalpel to cut the skin. That is true, but we still need to get through the skin to get to the vas—so we use a really sharp pointy tool to puncture the skin—same result as a scalpel, but “No scalpel” is utilized.
Dr. Siegel: It is a rare entity where men have testicular discomfort after a vasectomy that can be long lasting. Sometimes this is caused by infection, or sperm granulomas. There are even reported instances where men have undergone vas reversals and this has caused the pain to improve. I have never had a patient need to consider a reversal. Most of the time NSAID’s like Motrin are all that is needed.
Dr. Siegel: Reversals can be done. Usually the rate limiting step is that insurance won’t cover them. So what takes me 5-10 minutes to do in my office now takes two hours under a microscope in the operating room. So costs are quite high. The success rate of the reversal is about an 85-90% patency rate—meaning that there will be some sperm in the ejaculate, but the pregnancy rate is only about 50%. This rate can go much lower if the vasectomy was done more then 10-15 years ago. Something about the testicle’s ability to produce healthy sperm is diminished when it has been obstructed for a considerable amount of time. We see patients on occasion for this and probably only do 1-2 of these procedures per year.
Dr. Siegel: That a vasectomy is the safest form of permanent birth control. It can be done in 5-10 minutes in an office setting without the requirement of anesthesia—making it leaps and bounds better then a woman going for a tubal ligation. It is the best way to make sure that if there is a big sports weekend—they will be allowed to lie around and watch TV. We do see an upswing in vasectomy requests around March Madness. What could be better then a Thursday morning vasectomy and then getting permission to spend the next four days on the couch watching wall-to-wall basketball?