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What are the complications and known risks of vasectomy?
No medical procedure is without risk. Life itself is not without risk. We subconsciously risk assess all the time. For example, every time we take a trip in the car, every time we cross a road, and every time we lift a can of beans from the shelf we do a risk assessment. When undergoing a medical procedure - especially an elective one, we go through a conscious process of risk assessment.
It's important to consider what risks there are to vasectomy. At the same time, it's also important to consider the risks of other birth control methods, your personal circumstances and come to a balanced risk decision.
Post-procedure
Most men report feeling sore, or uncomfortable for a few days. Most men also report bruising (sometimes spectacular!), and swelling. The bruising and swelling doesn't always happen immediately - it often happens after a few days but in most cases has mostly disappeared after two weeks. You should discuss with your doctor what is, and isn't normal, and how to get treatment if necessary. Remember that most vasectomies are done on a Thursday or Friday, so you need to know how to get treatment or advice over the weekend if necessary.
Condition |
Incidence / information |
Treatment options |
Allergic reaction to anaesthesia. |
A few men will develop itching & hives due to an allergic reaction to anaesthesia1 |
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Post operative pain |
All men experience some form of pain in the scrotum, it usually disappears within 2 days, but the scrotum will still be sore for a few more.1 |
"Over the counter" pain killers are the usual recommendation. Consult with your doctor or pharmacist. Aspirin based remedies should be avoided. |
Bruising & swelling |
This is normal. The bruising and swelling doesn't always happen immediately - it often happens after a few days but in most cases has mostly disappeared after two weeks. |
Use ice (frozen peas /corn) to help with the swelling - especially in the first 24 hours. Wearing a jockstrap as support for the first few days is highly recommended. Wear it as long as it helps you feel more comfortable. |
Bleeding |
Frequently blood may seep under the skin, so that penis and scrotum appear bruised. If there is no dangerous swelling this painless problem usually disappears without treatment within a week or two.1 |
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Hematoma
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Typically occurs in 2%1 of cases, but this rate is affected by how often surgeon performs vasectomy:-
4.6% 1-10 vasectomies per year
2.4% 11-50 vasectomies per year
1.6% >50 vasectomies per year2 |
A hematoma is bleeding inside the scrotum, and can cause a painful swelling. Medical advice should be sought. |
Infection |
3.5%2 - 4%1 of cases.
Risk is reduced for no-scalpel.1 Experience of surgeon, or number of vasectomies performed per year seems to have little effect on the statistics. |
Antibiotics are usually used to treat infections. |
longer term complications / other information
Sperm granuloma
Usually defined as a leakage of sperm from vasectomy site or rupture in epididymus. Sperm has highly antigenic properties, and the leakage can provoke an inflammatory reaction. The body forms pockets - firm balls of tissue about .05" in diameter to trap sperm.
Granuloma's typically occur in the 2nd or 3rd week2 in 60% of men with vasectomy, but are troublesome in only 3%-5% of cases.1 Most granuloma's are asymptomatic (the patient doesn't know they are there), and resolve themselves over time. However, if they are not healed by time, then injecting it with steroids or actually cutting out the inflamed granuloma has been found to be effective. Surgery should always be viewed as a last resort. Most granulomas resolve with conservative treatment, < 1% require surgery.6
Congestive epididymitis
Inflammation of the epididymus - may occur in the first year and usually clears up within a week when treated.1 General incidence 0.4% - 6.1%, 1 Standard vasectomy 6%, 2 Open ended vasectomy 2%.2 In standard vasectomy, incidence varies between 2.8% and 5.6% depending on the method of sealing the vas deferens.2
Antisperm antibodies (ASA's)
Antisperm antibodies are present in all men and women, but not necessarily at detectable levels. Between 52%-68% of men1,2 will develop an increase in detectable ASA's. Genital tract infections, orchitis or std's will increase the risk.1
Not all men develop detectable levels of ASA - men with higher pre-vas sperm count are likely to have sustained or early high levels of antibodies. Non-vasectomised men who are infertile have the highest level of antibodies.2 The antisperm response appears to be a problem only if a man wishes to have his vasectomy reversed.1
Negative psychological effects
Some men go through a brief period of self consciousness. 50% of men keep their operation a secret, they may believe that the operation is tainted by the stigma of emasculation and thinking it would degrade them in the eyes of their friends. This period passes quickly. A small percentage of men experience depression and angry emotions. Some experience a period of mourning over the loss of their ability to reproduce. These feelings usually resolve given time. A very small percentage of couples experience adjustment difficulties. The emotional distress manifests in sexual dysfunction, impotence, or premature ejaculation. The vasectomy is the catalyst but not the cause. Studies show men who experience impotence post vasectomy are more likely to have female partners who are unable to accept the operation.1
Chronic noninfectious epididymal pain
Otherwise known as post vasectomy pain syndrome (PVP), or sometimes chronic testicular pain (CTP).
A small percentage of men do suffer what is know as "Post Vasectomy Pain syndrome" (PVP). This is a collective title for any long term problem relating to vasectomy - not a disease or syndrome in it's own right. The percentage will vary widely depending on what web article or study you are reading. Also, the definition of PVP varies between studies/articles. Some studies/articles include the normal slight bruising or swelling that occurs in the statistics, some don't. The accepted definition is where problems remain un-resolved after a period of three months or more. Responsible research will adhere to this accepted definition.
The causes of pvp tend to be scarring from the surgery, obstruction of part of the epididymus causing swelling in another section and pinched nerves. In some men, an immunological reaction of antisperm antibodies can also give rise to the symptoms. Chronic orchialgia happens in approximately 1% of cases. This is a dull ache in testicles due to congestion of dead sperm. It usually disappears within 6 months.1
Recent recommendations are that doctors warn patients there is a risk of long term pain. However, there is insufficient data to enable anyone to put an accurate figure on what the risks actually are. Comparative studies are rare, but one study that compares vasectomised men with non-vasectomised men quotes 0.9% in the first 12 months for men with vasectomy, and 0.1% for the non vasectomised controls. After the first year the rates quoted are 1.8%, and 1.0% non vasectomised controls (median 7.9 years follow up).2 One review study2 quotes the rate of post vasectomy epididymitis-orchitis as approximately 1 case per 1000 person-years.
Treatment options are dependant on the exact symptoms. As explained earlier, the condition known as PVP is a collection of various symptoms and causes - many of them common urological conditions. Doctors will generally initially adopt conservative treatment measures including antibiotics and pain killers.
If the problem is not resolved by conservative treatments, then there are several surgical options - dependant on the symptoms. Vasectomy reversal has a success rate of up to 84%5. This tends to be the most general approach. Epididymectomy (removal of the epididymus) has a success rate of up to 90%4, but requires more specific diagnosis. Microsurgical denervation has a success rate of up to 96% in meticulously selected cases.3
Prostate cancer and vasectomy
This has made the news on occasions, but what are the facts?
In the early 1980's a couple of studies found that vasectomised men had higher testosterone levels later in life that non-vasectomised men. If the studies were entirely accurate is a matter of debate. However, it is known that an increased level of testosterone can lead to an increased risk of prostate cancer.
Two studies published in 1993 by the same team, using the same data set indicated that men with vasectomy were more likely to develop prostate cancer later in life. It's important here to look at the numbers involved in the studies. The study had 10,055 participants, and 37,800 non vasectomised men as controls. The number of men who had prostate cancer AND a vasectomy were 59, and 54 in each study. The numbers involved do not provide sufficient data to make statements from - especially as much of the data was a postal questionnaire sent to female partners. However, the results of the study made the headlines, and the rest is history.
It's interesting to note that a study published in 1974 by Kaiser Permante Healthcare involving 43,432 men on an 8-15 year after vasectomy follow up study based on medical records found that vasectomised men did not have an increased incidence of prostate cancer. That study never made the news, and consequently didn't become an urban legend.
More recent studies have learned from the flawed methodology of sending out postal questionnaires to third parties. There have been some very large studies carried out in various countries in recent years concentrating on medical records. They ascertain if the men have had a vasectomy, and prostate cancer. These more recent studies found firstly that men with a vasectomy did not have prostate cancer any more often than non vasectomised men. They also found that men who had vasectomies were more likely to look after their general health, therefore more likely to get themselves checked for prostate cancer, therefore prostate cancer was more likely to be detected.
The World Health Organisation has reviewed all the research, and for some time has been recommending that men who have had a vasectomy should not be screened any more than non vasectomised men are.
The fact is that simple dietary changes will decrease your risk of developing all cancers, whereas having a vasectomy is not going to alter your chances of developing it.
Sources
1. Harvard Medical School ("Well connected"), 2001
2. Safety & effectiveness of vasectomy. Schwingl & Guess, 2000
3. Management of chronic testalgia by microsurgical testicular denervation. Heidenreich A, Olbert P, Engelmann UH, 2002
4. Epididymectomy is an effective treatment for scrotal pain after vasectomy. West AF, Leung HY, Powell PH, 2002
5. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. Myers SA, Mershon CE, Fuchs EF, 1997
6. Vasectomy review: sequelae in the human epididymis and ductus deferens. McDonald SW, 1996
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