Overview
   How does Vasectomy Work?
   How is Vasectomy Performed?
   Steps to be Followed Before the Procedure
   Postoperative Instructions.
   Life after Vasectomy. 2
   Is there any Complications?.
   Myths and Facts

Overview
Family planning is gaining popularity these days with most of the couples limiting the number of children to a maximum of two. Various methods of contraception (male and female) are being practiced to ensure the prevention of pregnancy. The common methods of male contraception, which include coitus interruptus, condoms and vasectomy, have been noted to be in practice since 19th century.

Vasectomy also referred as male sterilization has been opted by about 1% of the males in India during the year 2005–2006 according to the National Family Health Survey. Vasectomy is popular among better-educated males who are affluent and married.^1,2

The sperms are produced in the testis and are transported through a tubular structure known as vas deferens to the penis. Vasectomy involves the division or occlusion of vas deferens thereby preventing the sperms from reaching the penis. The number of sperms in the ejaculate is reduced progressively after the procedure is performed and the possibility of impregnating women becomes the least after 4 weeks.³

How is Vasectomy Performed?
Vasectomy is performed as a minor surgical procedure under local anesthesia either by placing an incision in the scrotal area or by the no-scalpel vasectomy (NSV) technique, wherein a sharp instrument is used to puncture the scrotal skin to aid in the procedure. The main objective of these techniques is to ensure that the sperms produced in the testis do not reach the penis to be present in the semen while ejaculating. Vas deferens may be divided and tied or may be occluded with the use of metal or rubber clips or a procedure known as cauterization.^3–5

Steps to be Followed Before the Procedure
The individual undergoing the procedure should have a proper bath and clean the genital area thoroughly. He should not consume any food for about 2 h before the vasectomy procedure. Medications such as aspirin should not be consumed about 1 or 2 weeks prior to the procedure. An opinion of the doctor should be taken about any other medications being consumed.⁶

Postoperative Instructions
After the vasectomy procedure, the individual is kept in the postoperative care for about 2 h. intermittent application of ice pack to the scrotal area is advised for the next 8 h with bed rest and appropriate scrotal support for the next 48 h after the procedure. Sexual activity and strenuous work should be avoided for 1 week after the procedure.⁶

Life after Vasectomy
The quality of life remains unchanged after vasectomy, and the sexual life is said to be enhanced due to the almost completely decreased chances of pregnancy and elimination of the need of condoms for this purpose. However, other methods of contraception should be followed until the reduction of sperms in the semen has been confirmed by the doctor. The sperms continue to be produced in the testicles even after the procedure and are reabsorbed into the body after being broken down by the body’s cleansing system (cells known as macrophages). The volume of the semen being ejaculated remains unchanged after the vasectomy procedure.^6,7

Is there any Complications?
Bleeding and swelling are the complications associated with vasectomy procedure. However, it is rarely observed when performed by well-experienced surgeons. Other rare complications include chronic pain and a condition known as epididymitis. With the advent of medical technology, these complications are rarely observed. The vasectomy procedure can be reversed in about 50% of the cases.³

Myths and Facts
Some common myths and facts on sterilization and vasectomy are given in Table 1.

Table 1: Myths and facts on sterilization and vasectomy

Myths	Facts
Only women can undergo permanent sterilization procedures	Permanent sterilization can be performed both in case of men and women and the success rate is almost similar in either sex.
Vasectomy procedure is painful and requires one to take rest for several weeks	Vasectomy is performed under local anesthesia and with the advent of newer techniques, the procedure is completely painless. The no-scalpel method involves puncturing the scrotal skin with a sharp instrument and nullifies the requirement of placement of sutures. Following the procedure, one is required to take rest for about 48 h. Strenuous activity may be resumed after 1 week.
The libido is lost after the procedure	Vasectomy procedure does not affect the sexual drive in a man. It just prevents the sperm from entering the ejaculatory fluid (semen). The amount and quality of semen also remains unaffected. In fact, several men have reported increased pleasure, as there is no need for them to wear about condoms.
The complications are severe and lifelong	Bleeding and swelling are some of the common complications associated with vasectomy. Some men tend to suffer from chronic pain after the procedure. However, these are rarely observed, when vasectomy is performed by an experienced surgeon and proper postoperative care is taken.
Vasectomy is associated with increased chances of cancer of the prostate or testis	Studies have ruled out the association of prostate and testis cancers with vasectomy. The common belief that the sperms that continue to be produced can result in cancer. However, the sperms are cleared by the phagocytes that break down the sperms. As age progresses, the amount of sperm production also begins to decrease in these men.