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Vasectomy

We regret any inconvenience this may cause, but due to a change in providers we will not offer vasectomy services in January, February, or March of 2014.   If you would like to be on the waitlist for April 2014, please click here.

Vasectomy | Mission Statement

Planned Parenthood of Central North Carolina is committed to providing our male patients the most effective, painless, easily available, and time efficient No Scalpel, Open Ended Vasectomy (NSV) procedure. To help accomplish our mission, we have streamlined the vasectomy process by:

   1.  Allowing patients the option to chose either a preoperative consultation or a single visit for their vasectomy procedure.
   2.  Allowing patients several options for pain control during their procedure.
   3.  Providing a substantial discount to patients who have no, or limited health care coverage for vasectomy procedures. We do accept most major health insurance plans.

Vasectomy

Vasectomy is a popular procedure, which causes permanent sterilization (procedure which permanently prevents pregnancy). Each year approximately 500,000 men choose vasectomy as a permanent birth control method. Vasectomy can be performed quickly and with minimal pain in an office setting. The procedure is extremely effective at preventing pregnancy.

Key concepts regarding vasectomy:
• Permanent method of preventing pregnancy
• Safe and simple procedure
• 3 month delay before ejaculate can be considered free of sperm 
• Does not affect male sexual performance

See these sections below:

How does Vasectomy work?
Two types of vasectomy
Important vasectomy considerations
Risks of vasectomy
How much does the No-Scalpel vasectomy cost at Planned Parenthood of Central North Carolina?
How can I schedule an appointment for a vasectomy?
Who should schedule an appointment to have a vasectomy without a pre-procedure appointment?
Who should schedule a pre-procedure appointment?
Preparing for your appointment
What if I have had a previous vasectomy, vasectomy reversal, history of undescended testicle, or testicular varicocele/varicocele repair?
How is vasectomy done at Planned Parenthood of Central North Carolina?
What if you are extremely anxious about having a vasectomy?
What should you do the night before the procedure?
Can I eat or drink before the procedure?
Can I take medication before the procedure?
What should you expect after the vasectomy?
What are signs of complications after a vasectomy?
What should I do after the vasectomy?
Important points about vasectomy failures
Post vasectomy semen analysis
Training Vasectomy Participation
What will I experience during a training vasectomy?
Training vasectomy appointment availability
Patient Comments

How does Vasectomy work?

Sperm are made in the testes. The sperm then travel from the testes to a long coiled tube called the epididymis- the sperm are stored here during their process of maturation. The sperm then travel up a tube called the vas deferens (there is one on each side of the scrotum). The vas deferentia then join together behind the bladder and form the seminal vesicle. This is where sperm are stored between ejaculations. During ejaculation, the sperm travel from the seminal vesicle to the urethra and then to outside the body.


Image adapted from No-Scalpel Vasectomy
An Iillustrated Guide for Surgeons.
3rd Edition. 2003.Engender Health.


Vasectomy is a procedure which causes both permanent and effective blockage of both vas deferentia in the scrotum. Sperm flow is interrupted between the testes and seminal vesicles. Male hormone levels (i.e. testosterone) are unchanged after a vasectomy.  The hormones are produced in the testes and are absorbed into the blood stream.  The hormones do not require the vas deferens to enter the blood circulation.

After a vasectomy the sperm, which are created in the testes, are gradually absorbed. Seminal fluid (ejaculate) is still created, stored and released from the seminal vesicles during ejaculation but after a vasectomy this seminal fluid does not contain sperm.

Image adapted from No-Scalpel Vasectomy
An Iillustrated Guide for Surgeons.
3rd Edition. 2003.Engender Health.


It is important to understand that immediately after a vasectomy there is a large number of sperm stored in the seminal vesicles. After a vasectomy, it takes approximately 20 ejaculations to clear the stored sperm from the seminal vesicles.

 

Two types of vasectomy

There are two approaches to vasectomy:
• Conventional incisional vasectomy
• No-Scalpel vasectomy (NSV).

Conventional incisional vasectomy requires the use of a scalpel and involves one or two ½ inch incisions on the scrotum to enable access and closure of each vas deferens. Sutures are required to close the scrotal skin.

No-Scalpel vasectomy is a more recent improvement in the vasectomy procedure. The procedure was created in China in the 1970’s and was introduced to physicians of the United States in the 1980’s. In NSV a single ¼ inch opening is made in the center of the scrotum and each vas deferens is closed off through this single opening. Since the midline opening is small, no sutures are required for closure.


NSV has several advantages over conventional vasectomy:
• Less after vasectomy discomfort
• Fewer complications      
• Lower risk of infection
• Lower risk of bleeding

At Planned Parenthood of Central North Carolina we perform the NSV procedure. In addition to the no scalpel approach, we use the techniques of cautery (thermal coagulation) to the proximal portion of the vas deferentia and leave the distal porton of the vas deferntia open.  This is considered an open ended vasectomy technique which has been shown to cause the least amount of discomfort after a vasectomy.  We also use fascial interposition (placing healthy tissue between the two cut ends) to insure the vas deferentia do not reconnect. The use of thermal coagulation and facial closure to assist with the closure and separation of the vas deferentia has been shown to increase effectiveness of permanent closure resulting in lower failure rates.

Important vasectomy considerations

Vasectomy is considered a permanent and effective form of male sterilization. It should only be seriously considered by men who either do not want any additional children or who never want to have any children.

Some men who have vasectomies will regret their decision. Men are more likely to regret their vasectomy if they have had a vasectomy in their 20’s, have not fathered previous children, are being pressured to have a procedure, or having relationship problems. Although, current feelings about having the procedure are very real, one must acknowledge it is hard to predict one’s feelings in the future.

Alternative forms of contraception are limited for men. Condoms are currently the only alternative form of contraception for use by men. Currently there is research into alternative forms of hormonal male contraception but we are several years away from having any acceptable alternative male contraception.

There are several highly effective forms of reversible contraception for women. These include the intra-uterine contraceptive device (5 and 10 year usage), the contraceptive rod (3 year usage), monthly hormonal injections (every three months) and vaginal ring hormonal delivery system (every month), weekly hormonal contraceptive patch, and daily oral birth control pill.

Table adapted from Steiner et al: Understanding risk: A Randomized Controlled Trial of Communicating Contraceptive Effectiveness.

Vasectomy should be considered irreversible. Technically, vasectomies are reversible; however, no man should consider a vasectomy if they are even considering the possibility of vasectomy reversal. Vasectomy reversal procedures are costly and cannot be guaranteed to work 100% of the time. The longer one waits after a vasectomy the less successful a vasectomy reversal procedure is likely to be.

Risks of vasectomy

• Inflammation/Infection — Mild inflammation to serious infection or abscess may occur in the skin, vas deferentia, or testicles. Treatment may include observation, antibiotics, or very rarely, surgical treatment.
• Hematoma — Blood clots or bruises usually clear up with no intervention. In some cases medical or surgical treatment is needed.
• Adhesion — Very rarely, skin attaches to the vas or a connection is formed between the vas and skin — a fistula. This may require surgery.
• Hydrocele — Fluid build-up in the scrotum may clear on its own, or it may need to be removed surgically.
• Spermatic Granuloma — Swelling caused by leakage of sperm from the vas deferens. Usually resolves on its own, or it may require drainage.
• Pain — There may be temporary discomfort or pain in the testicles. Very rarely, pain may be chronic and severe.
• Recanalization — The cut ends of a vas deferens may grow back together. Rarely, the tubes grow back together again and pregnancy may occur.
• Sexual Problems — Decreased sexual desire or inability to have an erection is reported in about four out of 1,000 cases. The most likely causes are emotional — there is no physical cause for sexual dysfunction associated with vasectomy.

How can I schedule an appointment for a vasectomy?
                                
• A pre-procedure consultation appointment to discuss if the vasectomy procedure is right for you and then a second appointment for the procedure.

Call our customer service center or request an appointment on-line.

Customer Service Center hours are:

Monday- Saturday  8AM – 6PM
Call (919) 942-7762 or our toll free at (866) 942-7762.

Please be advised if you are having the procedure paid for by Medicaid or Title X then you must have vasectomy sterilization form filled out and signed at least 30 days before your vasectomy can be done. You can contact your health care provider, local health department, or our office to arrange to have this form filled out. We must have a copy of this consent form signed and dated 30 days before the vasectomy procedure can done.

How much does the No-Scalpel vasectomy cost at Planned Parenthood of Central North Carolina?

The cost of the procedure depends upon your method of payment and which of the two appointment options you decide upon.

Health Insurance
If you are using your health insurance to pay for the vasectomy your health insurance will be billed. You are responsible for any co-payments. Check with your insurance company to determine if vasectomy coverage is provided and the amount of co-payment you will be responsible for.
If we are out of network for your insurance carrier, then you can have the procedure with us and submit forms to your carrier for reimbursement.  Please make sure this is acceptable with your insurance carrier before you have your vasectomy procedure.

Cash or Credit Card
If you are paying by cash, debit or credit card prior to the procedure, we offer a
same-day payment discount and the cost to you for the Vasectomy procedure will be $550. 

If you choose to have an optional preoperative consultation visit, the cost of that visit is $190.

Additional Cost Considerations
We do not charge for the after vasectomy semen analysis if you bring it back to our health center. We also do not charge for the optional vasectomy follow-up appointment (one week after the procedure.)
If you desire intravenous conscious sedation the cost for the sedation will be extra and you will need to have a pre-operative consulation before your vasectomy appointment (read the section below regarding intravenous sedation.)  If you have the post-vasectomy semen analysis at an outside lab, the patient is responsible for the cost.

**Please note that due to limited availability of appointments, you will be charged $100 no-show fee if you miss your appointment without giving us at least 24 hour notice.

 

A pre-procedure appointment will identify:
• desire intravenous concious sedation
• questions which remain unanswered after reading this information
• any significant medical illnesses (i.e. heart disease, previous heart attack, chronic and seriously debilitating lung conditions, poorly controlled diabetes, etc)
• taking anticoagulant medications (blood thinners, i.e. heparin, coumadin, aspirin)
• history of previous vasectomy and vasectomy reversal (see next question)
• history of undescended testical (see next question)
• history varicocele or varicocele repair (see next question)
• history of testicular hydrocele or hydrocele repair
• undiagnosed scrotal or testicular mass

Preparing for your appointment

 To prepare for your appointment we ask you to:

* Avoid any aspirin containing medications for 7 days prior to your vasectomy.
* Bring a firmly fitting athletic supporter (jock strap) with you to your procedure.
* Shave the front of the scrotum with a razor or clippers 1 or 2 nights before the procedure (if you are able)
 
* Bring comfortable clothes.
* Bring headphones with music (if you prefer).
* Bring a driver if you are choosing oral or intravenous medication

Please be aware an exam will be performed prior to your vasectomy procedure and if there are any anatomical abnormalities which could make your vasectomy more challenging then your vasectomy may not be done the same day.

If you desire intravenous sedation (read the section below regarding intravenous sedation) then you must notify the appointment person and schedule a pre-operative consultation appointment before your vasectomy procedure.

If you are currently suffering from an active infection (fevers or feeling poorly), have diarrhea, or have a scrotal skin or testicular infection you should schedule your appointment for vasectomy after these symptoms or conditions have resolved.

Below are our consent forms and post-procedural client information sheets. You should read these prior to your visit and we will have you sign them after all your questions have been answered.

Consent Form 1 English/Spanish
Consent Form 2 English / Spanish

Post-procedural client information sheet English/Spanish 

Semen Sample Collection Instructions

What if I have had a previous vasectomy, vasectomy reversal, history of undescended testicle, or testicular varicocele/varicocele repair?

The no-scalpel vasectomy may not be an appropriate surgical approach for your vasectomy. Call us for referral information.

How is vasectomy done at Planned Parenthood of Central North Carolina?

We perform NSV with coagulation of the proximal vas deferens and fascial interposition at our office. We utilize an open ended technique in which the distal end (the lower end of the vas deferen) is not closed.  This technique has been shown to cause the least amount of discomfort after vasectomy. The procedure takes approximately 15-30 minutes.

We give an antibiotic by mouth and also offer an optional (no extra cost) anti-anxiety medication lorazepam (Ativan) by mouth.  You must have a driver with you in order to receive lorazepam (Ativan.)

If a patient chooses intravenous sedation we will start an IV and give intravenous medications which will produce a light but conscious sedation prior to starting the vasectomy. If you desire intravenous sedation, please notify us when you make your appointment.

Local anesthetic is injected into the skin in the center of the scrotum using a small needle. The anesthetized scrotal skin is about the size of a nickel and the medication last for approximately 6 hours.

Image adapted from No-Scalpel Vasectomy
An Iillustrated Guide for Surgeons.
3rd Edition. 2003.Engender Health.

The doctor then uses their fingers to bring one of the vas deferens to the center of the scrotum underneath the anesthetized area. Using a small needle, the doctor injects anesthetic around the vas deferens. The same manipulation and administration of anesthesia is then done with the opposite vas deferens.

Image adapted from No-Scalpel Vasectomy
An Iillustrated Guide for Surgeons.
3rd Edition. 2003.Engender Health.

The doctor tests to make sure there is no sensation in the area of previously anesthetized scrotal skin. The doctor makes a small, ¼ inch opening in the center of the scrotum using a small hemostat. One vas deferens is then brought through the center opening using a combination of finger movement a vas deferens ring forceps, which is specially designed to hold the vas in the center opening.
 

Image adapted from No-Scalpel Vasectomy
An Iillustrated Guide for Surgeons.
3rd Edition. 2003.Engender Health.

The doctor again tests to make sure there is no sensation in the vas deferens and it is then cut with a cautery device. The inside of the upper end of the vas deferens is then cauterized with the cautery device.  The cautery causes a more effective closure of the vas deferentia than just cutting alone.

Using a very fine suture a single, internal stitch is used to bring healthy fascial tissue in between the two cut ends. This suture will dissolve and does not need to be removed. The purpose of the suture is to keep the two cut ends of the vas from coming back into close proximity and possibly healing back together. The doctor then repeats the procedure for the second vas deferens.
      

Image adapted from No-Scalpel Vasectomy
An Iillustrated Guide for Surgeons.
3rd Edition. 2003.Engender Health
.

We then place gauze around the NSV entry site and place a secure athletic supporter (jock strap) around the waist and testicles. We will provide the athletic supporter for you to wear if you did not bring one.

You are then able to walk out of the office without any significant side effects. You should arrange to have someone drive you home.

What if you are extremely anxious about having a vasectomy?

We offer, at no extra charge, an optional anti-anxiety medication ativan which is taken by mouth.

The majority of vasectomy patients do extremely well with ativan. We have found this medication to be very effective at decreasing anxiety and making the procedure easier for most patients. If you should feel ativan may not be enough, then we also offer intravenous sedation medication. An IV is necessary for this medication and this service is provided at an extra charge.

To achieve a light but conscious sedation we use fentanyl and midazolam. This medication significantly reduces pain and anxiety.

If you have either ativan or intravenous sedation medication, then you must bring a driver with you the day of your procedure.

What should you do the night before the procedure?

We ask that you shave the front of your scrotum and around the base of the penis 1-2 nights before your procedure. If you do not feel comfortable shaving or do not remove enough hair from the vasectomy area then we can assist you with shaving the day of the vasectomy.

You should also wash the penis and testicles with soap and water both the night before and the day of the procedure.

Can I eat or drink before the procedure?

You can eat and drink both before and after your vasectomy procedure.  There are no food/drink limitations. 

Can I take medication before the procedure?

You should not take aspirin containing medications for seven days prior to the procedure.

What should you expect after the vasectomy?

• Minimal pain and discomfort
• No strenuous exertion for 24 hours
• No sex for one week after the procedure
• Small amount of swelling and achy discomfort can occur
• Small amount of blood could be seen in first urination and ejaculate
• Small amount of discoloration in the testicular skin could occur after the procedure
• 1 out of 10 men could develop swelling and discomfort on one side which should gradually resolve
• Use an alternative form of contraception for 3 months after the vasectomy
• Semen analysis should be done 3 months after the vasectomy

What are signs of complications after a vasectomy?

• Any hard swelling which occurs immediately after the vasectomy could be sign of bleeding or blood clot formation. This could be the size of a nickel or could be larger than a lemon. This would typically occur within 48 hours after your procedure.
• Any fever, redness, and foul smelling discharge could be a sign of infection. Should this occur this would most likely occur within the first 2-7 days after a vasectomy.

What should I do after the vasectomy?

• Minimize activity for 12 hours after the procedure
• You may take acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) for discomfort.  Avoid aspirin containing medication for 48 hours after the vasectomy
• You may shower the next day
• Wear a jock strap for 24 hours and after that wear it as needed for the next 7 days
• No strenuous exertion for 48 hours after your vasectomy
• You may drive or do light activity the day after your vasectomy
• You may return to work the next day after your vasectomy if you have a desk job
• If you have a job which requires strenuous exertion then you will need to refrain from work for 48 hours
• No sex for 7 days after the vasectomy procedure

Important points about vasectomy failures

Vasectomy failures are grouped into two categories: early and late.

Early failures occur within the first several months after a vasectomy. The reason for early vasectomy failures are failure to use alternative means of contraception in the first several weeks, occlusion of a structure other than the vas deferens, reattachment of the cut vas deferens ends, and recanalization. Recanalization occurs when the vas deferens ends are reconnected by sperm being pushed up through the healing tissue and forming many small channels which connect with the cut vas deferens up stream from the occlusion site.

The risk of early failure is about 1-2 per 1000 vasectomy procedures.

Late failures occur after the semen analysis and are thought to be primarily due to recanalization. The risk of this is about 1-4 per 5000 vasectomies.

The most common reason for pregnancy after vasectomy is failure to use an alternative form of contraception for the first several weeks after the procedure. The seminal vesicles store sperm and are located ‘upstream’ from the sites where the vas deferentia are closed. It takes approximately 20 ejaculations to empty the seminal vesicles. If contraception is not used during this time then pregnancy can occur. This is the most common reason for pregnancy after a vasectomy.

Post vasectomy semen analysis

To determine if the vasectomy was successful, we ask that you complete a semen analysis after your procedure. We ask that you wait for 3 months and have a minimum of 20 ejaculations before your semen is evaluated.  During this period, you should use an alternative form of contraception.  We will provide patients with information regarding semen analysis.

Approximately 95% of men will have no sperm in their semen 3 months after a vasectomy. If sperm is visible in your collection then we will ask you to continue with an alternative form of contraception and provide another semen sample after the passage of an additional month. The majority of men will have a negative semen sample after the passage of the fourth month.

1-2 per 1000 men will still have sperm present in the semen 4 months after their vasectomy. Approximately, 1-2 per 1000 men could have sperm reappear in their semen in the future.

Patient Comments

"The procedure was quick, easy, and professionally immaculate.  The benefits greatly outweigh any temporary discomfort.  With such a fast and inexpensive procedure, there is no reason to delay taking permanent control of your reproductive choices."  C.V. Durham, NC

"Best decision I ever made. Ouick heal time. Very professional. Highly recommend."  G.C.  Charlotte, NC

"I would just like to say thanks to the doctor. I had my procedure back in August and it was practically pain free, nothing that would even warrant an aspirin.  Your professionalism and that of your staff made for a quick and pleasant procedure that I would gladly recommend to anyone.  Thanks again!" G.B. Durham, NC

"The doctor was great!  The procedure was very quick and painless.  He made me feel very comfortable with the process and was very informative with a step by step explination as to what was going on." S.P. Durham, NC

"I had a very pleasant experience and very helpful staff." M.E. Somerset, KY

"I was very satisfied.  Much less painful than expected.  Compared to the horror stories my friends had with their high dollar doctors (severe bruising and 2 incision points) this was a breeze.  I have already recommended you to my other friends ready for this." D.O. Raleigh, NC

"The procedure was very quick and easy.  Staff at Planned Parenthood are very professional and answered any questions I had about the procedure or what to expect after the procedure.  I highly recommend the no scalpel vasectomy." M.P. Rougemont, NC

"The procedure was quick and pain free.  After a week all the discomfort was gone and I was back to normal activity.  The doctor kept the experience light with humor." E.P., Durham, NC

"The worst part about the procedure was my anxiety.  It was slightly uncomfortable like a pinched nerve.  I didn't even use an ice pack and was on my feet immediately." J.B. Raleigh, NC

"The procedure was quick and painless.  Recovery was smooth and no complications at all.  The doctor and staff are very friendly and understanding.  Highly recommend!" Anon

"I'd do this for fun on weekends if it were cheaper.  No pain during, or after the procedure.  1000% Satisfied" Anon

"My vasectomy procedure was very informative and relaxing.  The doctor went step by step during the procedure explaining exactly what he was doing.  I would highly recommend anyone wanting this procedure to see this doctor.  I'm very appreciative.  Thanks." E.G. Efland, NC

"The Doctors and staff were very informative and professional.  The procedure was simple and as comfortable as it could be. I would recommend Planned Parenthood of Central NC for anyone contemplating a vasectomy." MT, Bahama, NC

"Que la verdad se los recomiendo ya que es algo muy facil y sencillo y me hace sentir muy bien. No tengan temor." M.A

 


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