Vasectomy: Male Sterilization, Information, and Specialists

Men who

• have previously undergone groin surgery,
• have problems with their lumbar spine, or
• experience occasional pulling sensations in the testicles,

should mention this during the consultation with a specialist. This also applies if they have chronic pain from other causes.

The urologist puts the patient under light twilight sedation or administers a local anesthetic. The vas deferens is then surgically severed and—depending on the technique—either tied off or cauterized using heat. As a result, the ejaculate no longer contains sperm.

A vasectomy can usually be performed very effectively using local anesthesia. Only in rare cases is general anesthesia or a brief period of general anesthesia necessary. These cases include, for example,

• a very short scrotum, where both vas deferens cannot be palpated and isolated by hand, 
• following varicocele resection or other scrotal surgeries, or
• in patients with anxiety.

The various vasectomy techniques include, among others:

• The classic conventional vasectomy (ligation technique),
• the minimally invasive non-scalpel vasectomy,
• the fulguration technique (involving the insertion of a diathermy needle into the vas deferens), and
• the open-ended vasectomy.

The sole purpose of a vasectomy is to prevent pregnancy. Unintended paternity can be virtually ruled out after the procedure, and other methods of contraception are no longer necessary.

A vasectomy does not affect any other bodily functions. The procedure therefore has no negative impact on

• sexual potency,
• orgasm,
• sexual desire (libido), or
• erection, or
• ejaculation

. Nor does the sensation during orgasm change. Ejaculation itself does not change significantly either. The only difference is that, after a vasectomy, the seminal fluid no longer contains sperm.

For many couples, their sex life improves after the procedure because the worry about an unintended pregnancy is eliminated.

The functions of the testicles also remain unchanged. Thus, the male sex hormone testosterone continues to be produced as before even after a vasectomy.

The body naturally breaks down the sperm cells produced in the testicles. This rules out what is commonly referred to as “sperm congestion.” Sperm congestion is often mentioned in popular belief when ejaculation does not occur for an extended period.

In Germany, men generally have to cover the costs of a vasectomy themselves; statutory health insurance plans only cover them in rare, exceptional medical cases. Depending on the clinic and procedure, a vasectomy usually costs between €400 and €750, with an average of about €500. The price generally includes the procedure and basic services such as local anesthesia and follow-up visits; additional services such as general anesthesia or histological examinations may be billed separately.

Sperm may remain in the semen for up to 12 weeks after a successful vasectomy. Therefore, several laboratory tests must be performed before infertility can be confirmed. A semen analysis is used for this purpose. This is a laboratory analysis of the ejaculate.

The first follow-up semen sample is submitted for testing approximately 4 to 6 weeks after the vasectomy (or after about 20 ejaculations). The second follow-up should take place after another 4 weeks.

Infertility is considered confirmed if no sperm are found in the semen in both ejaculate tests.

Overall, complications following a vasectomy occur only in rare cases. Whether this is the case, however, depends heavily on the experience of the treating physician. It is therefore recommended to have a vasectomy performed by an experienced vasectomy specialist or a trained urologist.

In one to two percent of men, various symptoms may occur after the surgery, such as

• a feeling of pressure in the testicles,
• bruising,
• a wound infection, or
• inflammation of the epididymis
• pain in the testicular area

may occur. However, these symptoms can be treated appropriately, so they usually subside after a short time.

Months after the procedure, so-called sperm granulomas may also form. Sperm granulomas are nodular tissue inclusions of sperm cells. They are usually caused by pressure in the testicles resulting from continued sperm production.

Although these usually go undetected, in rare cases they can contribute to the vas deferens growing back together.

Other long-term effects of a vasectomy may include psychological issues related to infertility as well as chronic pain in the scrotum. This pain can intensify during sexual activity and thus significantly impair the quality of life for those affected.

It is not yet fully understood how many men are affected by this. It is estimated that the number ranges between one and 14 percent. The cause of the pain has also not yet been definitively determined. It is believed that pressure equalization in the testicles cannot be adequately regulated.

It is also possible that nerves were damaged during the procedure. Under certain circumstances, this may require further surgery, such as

• targeted recanalization or
• removal of the spermatic cord nerves or the epididymis.

To date, there is no evidence that a vasectomy increases the risk of testicular or prostate cancer.

In most cases, this procedure can be reversed using microsurgical techniques. Reversal, or vasovasostomy—a microscopically precise procedure to restore patency of the vas deferens—achieves high success rates: Within the first three years after the vasectomy, patency rates are particularly promising, reaching up to 97%, but do not fall below about 70% even after ten years.

Despite these high patency rates, the probability of a natural pregnancy is usually between 50% and 70%, depending on factors such as the time elapsed since the vasectomy and the partner’s fertility. More complex procedures, such as tubulovasostomy, result in significantly lower pregnancy rates (~48%). At the same time, modern microsurgical and robot-assisted techniques further improve the chances of patency and pregnancy—in some cases, even achieving over 90% patency following robotic-assisted procedures.