Interest in vasectomy is on the rise—here’s what to know

A vasectomy is a surgery used for birth control. It prevents pregnancy by keeping sperm from reaching semen and leaving the body. Since the Supreme Court overturned Roe v. Wade in June 2022, the number of people in the United States seeking information on vasectomies has surged. As states have moved to restrict or outlaw abortion, more people have been looking to gain greater control of their reproductive health and well-being.

When speaking about the procedure, Jay Sandlow, MD, professor of urology at the Medical College of Wisconsin and member of the American Urological Association’s Vasectomy Guidelines panel, points out that many of his patients say the inability to have the option of terminating a pregnancy, particularly if there is a lethal abnormality of the fetus, has definitely played a role in vasectomy inquiries.

Studies showed a similar surge in vasectomy interest online following the Roe v. Wade decision. Searches for the procedure jumped, as did questions about how it could affect sexual function.

“Having a vasectomy has no impact on erections, ejaculation, sex drive, sexual pleasure, testosterone production or virility,” Dr. Sandlow explains, noting that most of his patients don’t notice any difference in sex after a vasectomy. For some people, he points out, the procedure could even improve their sex life since they no longer need to worry about unwanted pregnancy.

What happens during a vasectomy?

A vasectomy is a common, minor surgery. Overall, about 50 million people in the U.S. have already had a vasectomy, and about 500,000 people undergo the procedure each year. It’s usually performed by a urologist, a doctor who specializes in the male urinary tract and reproductive system.

About 98 percent of vasectomies are done using local anesthetic with the patient wide awake in an outpatient clinic, says Ranjith Ramasamy, MD, former director of reproductive urology and associate professor at the University of Miami. During a procedure, a urologist makes a small incision in the scrotum (the loose sac of skin that holds the testicles) to access the vas deferens. Also called sperm ducts, the vas deferens are two tubes that carry sperm from each testicle to the urethra (the tube that runs from the bladder to the penis). There, they combine with semen and can be ejaculated during orgasm.

The urologist divides each vas deferens and closes off the loose ends so that sperm can no longer reach the semen. After a vasectomy, the testes will continue to make sperm each day. Old sperm cells are continuously replaced by new sperm cells. But these sperm cells will not mix with semen. Instead, they will get reabsorbed by the body while the semen remains sperm-free.

What’s recovery like?

A vasectomy takes about 20 minutes. It’s common to have some minor bruising and swelling afterward. It can be treated with ice packs and over-the-counter pain medication like acetaminophen, commonly sold under the brand name Tylenol. Discomfort usually goes away within two weeks.

Complications are rare but can include bleeding and infection at the site of the surgery. Some people develop a painful lump about the size of a pea after the procedure, which can happen if sperm leak from the vas deferens. It’s not dangerous, and almost always gets absorbed by the body. It is also possible to experience testicular pressure about 2 to 12 weeks after a vasectomy. This can happen if sperm gets backed up and congested inside the testes. This also usually goes away on its own over time.

In most cases, people return home the same day they’ve had the procedure and resume normal daily activities within a week. It’s usually safe to start having sex again after seven days, but it’s important to continue to take precautions against pregnancy.

“During the first three months after a vasectomy, there may be residual sperm in the tubules ahead of where the procedure was performed, so it’s imperative to use alternative contraception during this period,” Dr. Ramasamy says. “You can think of a vasectomy as performing a roadblock and any cars ahead of the blockade can still reach their destination, but no new cars can pass through.”

Two to three months after a vasectomy, follow-up tests are needed to confirm that a person’s semen is sperm-free. If it shows sperm, the test is usually repeated about a month later.

Also, a vasectomy does not protect people or their partners from sexually transmitted infections (STIs) such as HIV. Proper use of a condom is the best form of protection against STIs.

Is it effective?

After tests show that semen has become sperm-free, vasectomy is the most effective form of birth control aside from abstaining from sex, according to the Urology Care Foundation.

In fact, it’s over 99 percent effective in preventing pregnancies. While there’s still a chance of pregnancy, the risk is about 1 in 2000. By comparison, condoms fail about one out of every 100 times they’re used.

How do you get one—is it covered?

Those thinking of having a vasectomy should talk with their primary care physician (PCP) or urologist to be sure it’s the right decision for them. Their doctor will check for medical issues that could complicate the surgery, such as past surgery or injury to their genitals. The option to freeze sperm may also be discussed. Frozen sperm could be used for in vitro fertilization (IVF) and other assisted reproduction in the future.

Vasectomies are often covered partially or fully by insurance, with costs ranging from $0 to $1000, according to Planned Parenthood. Anyone considering vasectomy should check with their insurance provider since individual coverage may vary.

Are they reversible?

Vasectomies are considered permanent. But if life changes, they can be reversed. Compared to a vasectomy, reversal is a more complicated operation that can take four to six hours to complete. It’s done in an operating room while the patient is asleep under anesthesia.

A vasectomy reversal is considered microsurgery, because a specially trained surgeon uses a microscope to magnify the vas deferens 5 to 40 times their size. The surgeon makes small cuts on either side of the scrotum, trims the scarred ends of the vas deferens, and re-joins them using stitches as thin as an eyelash.

Following a reversal, most people resume their usual daily routine within one to four days, but they need to abstain from sex for about three weeks. Results may not be immediate. It can take up to 12 months to become fertile again. Success rates (defined as restoring sperm to semen) can be as high as 95 percent for reversing a vasectomy that was done within the past 10 years. Success rates are lower if it’s been longer since the procedure. Whether or not vasectomy reversal can lead to pregnancy is highly dependent on a partner’s age and the health of the sperm, Ramasamy adds.

Keep in mind, most health plans do not cover reversals, and costs can range between $5000 and $15,000 plus other fees.

Why would someone want a vasectomy?

For some people, having a vasectomy is about avoiding an unplanned pregnancy. It may be an option for people who do not want to have children or increase the size of their family. But people could choose to have a vasectomy for many reasons. Removing worries about unplanned pregnancy can strengthen a relationship, promote intimacy, and allow partners to focus on each other.

The decision to have a vasectomy can also be about shifting the burden of birth control. Compared to vasectomy, a tubal ligation (surgery to close the fallopian tubes), which is also considered a permanent form of birth control, may have a slightly higher failure rate (about 1 to 3 percent, depending on how it’s done). It may also have a longer recovery time (from two to six weeks), and cost up to $6000 or more, depending on how the procedure is done and insurance coverage.

Even though vasectomy is less costly and has a shorter recovery period, many more tubal ligations are performed each year in the United States. Sandlow suggests this may be changing. “While there are still twice as many [tubal litigations] done in the U.S. than vasectomies, the gap is closing,” he says. “Men have become much more active in their contribution to contraception.”