In this article, a consultant general practitioner debunks the most common fears and misconceptions about vasectomies.
What is a vasectomy?
Vasectomy is a minor surgical procedure used as a permanent form of male contraception, and the most reliable form of contraception. No-scalpel vasectomy is a straightforward local anaesthetic procedure, which takes approximately 10 to 15 minutes, and involves cauterising the vas deferens, which are the tubes that carry sperm from the testicles to the urethra. The operation is usually performed under local anaesthesia. Recovery is relatively quick, and most men return to normal activities within a few days. Millions of vasectomies have been performed worldwide, typically 500,000 in the US alone annually, but despite its effectiveness and simplicity, many misconceptions surround vasectomy, particularly regarding its impact on sex, hormones, and fertility.
Ejaculation typically has many millions of sperm, so immediately following a vasectomy, there are always some active sperm left in the system, which need to be cleared. Patients are not considered sterile until a single post-vasectomy semen analysis, which is usually a postal kit and shows that no sperm remain in their ejaculate. Semen will be tested after the procedure to check that there are no sperm remaining.
Myth: A vasectomy affects a man's ability to get or maintain an erection
Fact: A vasectomy does not affect erectile function. Erections are controlled by blood flow and nerve signals, which are entirely separate from the vas deferens. The procedure does not interfere with blood vessels or the nerves involved in sexual arousal and erection. Men who undergo a vasectomy typically notice no difference in their ability to have or sustain an erection. Any temporary issues with erections following the procedure are usually due to anxiety or discomfort during the short recovery period, not the vasectomy itself.
Myth: Testosterone levels drop after a vasectomy
Fact: Vasectomy has no effect on testosterone production. Testosterone is produced in the testicles, and this process continues unchanged after a vasectomy. The hormone still enters the bloodstream as normal and supports all typical male characteristics, including libido, muscle mass, mood, and overall vitality. There is no evidence to suggest that vasectomy lowers testosterone levels or leads to hormonal imbalance in men.
Myth: Sperm builds up in the body and causes health problems
Fact: After a vasectomy, the testicles continue to produce sperm, but since the vas deferens are blocked or cut, the sperm cannot reach the semen. The unused sperm are naturally broken down and reabsorbed by the body, which is a normal process that occurs even in men who haven't had the procedure. This has no negative impact on a man’s health or well-being. Sperm count in the ejaculate drops to zero over time, but this does not affect the quality of sexual function.
Myth: There is an increased risk of prostate cancer after vasectomy
Fact: There is no strong evidence to support a link between vasectomies and prostate cancer. Some older studies found a small increase in risk. But more recent studies have not found a causal link.
Myth: Ejaculation feels different or decreases after a vasectomy
Fact: Vasectomy does not noticeably change ejaculation. The vast majority of semen volume (about 95%) comes from the seminal vesicles and prostate gland, not the testicles. As sperm contribute only a small portion to semen, most men notice no change in the volume, appearance, or sensation of ejaculation after a vasectomy. Sexual pleasure and orgasm remain the same. In fact, many men report greater sexual confidence post-vasectomy due to the removal of pregnancy concerns.
Myth: A vasectomy is easily reversible, so it's not really permanent
Fact: Vasectomy should be considered a permanent form of contraception. It is a hormone-free, permanent contraception, and almost ten times more reliable than female sterilisation, and significantly lower risk, being a local anaesthetic procedure, rather than a general anaesthetic for women. If you feel that your family is complete, or never want children, a vasectomy is an excellent choice.
While vasectomy reversal is possible, it is not guaranteed to succeed, and it becomes less effective the longer it’s been since the original procedure. Reversal involves microsurgical techniques to reconnect the vas deferens, but even when technically successful, it does not always restore fertility. Men considering a vasectomy should view it as a permanent decision, and only pursue reversal with the understanding that natural conception may still not be possible. If future fertility might be a concern, sperm banking before the procedure is cost-effective and worth discussing with a specialist.
No-scalpel vasectomy is the procedure of choice for vasectomy. It is a straightforward, local anaesthetic procedure taking a few minutes to perform, with relatively quick recovery, and a permanent form of contraception, with many millions of satisfied men having had a vasectomy worldwide.
